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

Preventing Surprise Medical Bills

The idea I have is not to be surprised. I am a careful patient who asks a lot of questions and also advocate for myself. I have refused treatment when they use drugs which may threaten my health further (Heparin). I am also not well liked by the bloodsuckers who come in to draw blood and stab me through the vein for two weeks and destroyed my left arm in the process. Ask them questions and do not be so willing to accept treatment (if cognizant) until they answer your questions and then get their name. Take names and dates. It is ok to be a forceful advocate for yourself. When all is said and done, the bill will come to you alone.

If you are on Medicare, do not stay for observation unless you have a Plan G or Plan F. If you are on Plan N Supplemental to Medicare or lower, the plan will NOT pay 100% for Observation. You have to be admitted. You can go anywhere with Medicare for treatment.

Medicare Advantage? You had better be in network or have some type of alternative program within your plan.

There are good points to this article which is why I “C and P-ed” it here per their request.

As taken from Preventing Debt from Surprise Medical Bills, Bankrate, Madison Blancaflor. July 19, 2019

The cost of healthcare has become a hot topic in American politics in recent years, and with good reason. A recent survey found that 22 percent of Americans are losing sleep over healthcare or insurance costs, up from 13 percent just one year ago.

One aspect in particular has even gained attention from both Congress and the President within the past two months: surprise medical bills.

Congress has proposed bi-partisan legislation that sets up consumer protections against surprise billing in certain situations. President Trump also issued an executive order in June that calls for hospitals to be more transparent upfront about prices for common tests and procedures, a measure that should go into effect later this year. (While the House took out the 10 year exclusivities for Biologic drugs in the NAFTA Bill, similar  ended up in the Budget bill giving exclusivity for 12 years on new biologics. As I have pointed out repeatedly, risk adjusted R & D costs are recouped in a median period of 3- 5 years. It is another give-away to  pharma which adds to costs.)

Past the leap, causes and prevention of Surprise Billing.

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Old Vet on The Passion of Immigration

(Dan here…this is a post from 2007 by Old Vet, a regular at Angry Bear during this time period.  Pre Trump.  Peter Dorman reminded me of Old Vet, and Mike Kimel dared me to put this Old Vet post up.  Here it is.)

Old Vet on The Passion of Immigration

This post is by OldVet…

—–
When you make a man into a monkey
That monkey’s gonna monkey around”

(Delbert McClinton song)

Call me a Monkey’s Uncle. Out of pure frustration with the name calling debate on immigration, I can’t help wanting to tweak some tails.

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Can The US Assassination Of Qasem Solemiani Be Justified?

Can The US Assassination Of Qasem Solemiani Be Justified?

We know from various Congressional folks that briefers of Congress have failed to produce any evidence of “imminent” plans to kill Americans Soleimani was involved with that would have made this a legal killing rather than an illegal assassination.  The public statements by administration figures have cited such things as the 1979 hostage crisis, the already dead contractor, and, oh, the need to “reestablish deterrence” after Trump did not follow through on previous threats he made.  None  of this looks remotely like “imminent plans,” not to mention that the Iraqi PM Abdul-Mahdi has reported that Soleimani was on the way to see him with a reply to a Saudi peace proposal.  What a threatening imminent plan!

As it is, despite the apparent lack of “imminent plans” to kill Americans, much of the supporting rhetoric for this assassination coming out of Trump supporters (with bragging about it having reportedly been put up on Trump’s reelection funding website) involves charges that Soleimani was “the world’s Number One terrorist” and was personally responsible for killing 603 Americans in Iraq.  Even as many commentators have noted the lack of any “imminent plans,” pretty much all American ones have prefaced these questions with assertions that Soleimani was unquestionable “evil” and “bad” and a generally no good guy who deserved to be offed, if not right at this time and in this way.  He was the central mastermind and boss of a massive international terror network that obeyed his orders and key to Iran’s reputed position as “the Number One state supporter of terrorism,” with Soleimani the key to all of that.

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State Capacity and Liberalism

 State Capacity and Liberalism

Tyler Cowen has a post up on State Capacity Libertarianism.  I’m not so interested in the “libertarian” part of his argument, which is mostly aimed at persuading libertarians to accept some role for government beyond enforcing contracts and protecting property rights.  But liberals (as in progressives) have good reason to think hard about state capacity.  A few thoughts on liberalism and state capacity:

Recognition of limited state capacity should affect how liberals set policy priorities and rank policy tools:

Many promising active labor market policies and economic development policies require a degree of state capacity that we currently lack.

A federal jobs guarantee would require a big increase in state capacity.  I’m not a fan in general, but any effort to implement a jobs guarantee would have to start slowly and concentrate on building capacity.

Carbon taxes require less state capacity than regulation, which requires less state capacity than direct government ownership of power plants.

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Killing Abu Mahdi Al-Muhandis

Killing Abu Mahdi Al-Muhandis

Most of the attention in this recent attack by a US drone at the Baghdad Airport has been on it killing Iranian Quds Force commander, Qasim (Qassem) Solmaini (Suleimani), supposedly plotting an “imminent” attack on Americans as he flew a commercial airliner to Iraq at the invitation of its government and passed through passport control.  But much less attention has been paid to the killing in that attack of Abu Mahdi al-Muhandis, commander  of the Popular Mobilization Forces in Iraq and reportedly an officer in the Iraqi military, as well as being, according to Juan Cole, a Yazidi Kurd, although the PMF is identified as being a Shia militia allied with Iran.

The problem here is that supposedly US leaders approved this strike because there were no Iraqi officials in this group; it was supposedly “clean.”  But there was al-Muhandis, with his PMF also allied to a political faction, the Fath, who hold 48 seats in the Iraqi parliament.  The often anti-Iranian Shia leader, Moqtada al-Sadr, has now joined with Fath and other groups to demand a vote in the parliament to order a withdrawal of American troops from Iraq.  It might be good for them to go, although Trump has just sent in 3,500 more Marines to protect the US embassy that came under attack and protests after an earlier US attack on pro-Iranian militias.

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PPACA Healthcare Information

Of the 16.7 million uninsured people who could be shopping on the Marketplace whether or not they are eligible for a subsidy; a Kaiser Family Foundation analysis estimates 4.7 million of the uninsured Americans are eligible for free ($0 premiums) Bronze plans in the ACA marketplace. The 4.7 million is also a bit less than half of the uninsured who are eligible for marketplace subsidies, according to a 2017 Kaiser estimate.

Bronze plans have an average deductible of $6,506, and many people eligible for a $0 bronze premium would also be eligible for significant cost-sharing assistance by instead purchasing a silver plan. Single individuals with incomes below 250% of the poverty level can purchase benchmark silver plans with cost-sharing reductions (CSR) for $20 to $215 per month after subsidies in 2020, on average, depending on an enrollees’ income. Silver CSR plans have average annual deductibles ranging from $209 to $3,268 in 2020, also depending on income, and have reduced copays and coinsurance. It is therefore important for potential enrollees, particularly those with significant health needs, to not only consider the premium, but also the significant cost-sharing assistance that is only available if they enroll in a silver plan.

Trump and Republicans  stifling ACA advertising has made it impossible for people to gain the knowledge. They support the healthcare industry which can be legitimately blamed for the rising cost of healthcare premiums and deductibles.

How Many of the Uninsured Can Purchase a Marketplace Plan for Free in 2020?, KFF; Rachel Fehr, Cynthia Cox, and Matthew Rae; December 10, 2019

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Michigan Senate and House Majority Republicans Will Usurp the Public’s Right to Vote on an Abortion Ban

As I pointed out in a public meeting, Republicans have had control of the Michigan Senate since 1992, the House two-thirds of the time, and the governorship two of 3 times up till Gretchen Whitmer came to office. Yet under the control of Republicans, the state’s infrastructure is crumbling, its economy has decreased when compared to other nearby competitive states, and employment Participation Rate still has not returned to what it was pre-2008 when the Republicans left a nation’s economy in shambles and a large deficit.

The one thing Republicans are good at is attacking the rights of everyday citizens,  a woman’s right to birth control and information, the rights of minorities to societal equality, and the rights of those living homeless and in poverty. In Michigan, the majority Republican legislature mostly sponsored by creative districting will pass a veto – proof bill based upon petitions from those who wish to deny women the right to decide rather than put the decision on a ballot initiative in Michigan.

From Bloomberg Law:

“Anti-abortion group Right to Life Michigan said it handed in more than enough valid signatures Dec. 23 to put its proposed ban of dilation-and-evacuation abortion procedures before the Legislature in 2020. The procedure, which dismembers the fetus, is the most common second-trimester abortion operation.

The vote would be held under a divisive process that allows the Michigan House and Senate to adopt citizen referendums headed to the ballot on a majority vote not subject to veto. Right to Life of Michigan has used the referendum-to-adoption process four times in the past when a governor opposing abortion restrictions proved a barrier in Lansing, and the group says it already has assurances from GOP leaders in the House and Senate that the ban will be adopted.

‘The 379,418 people who signed their names on this life-saving dismemberment ban should be confident that our prolife majorities in the Michigan Legislature will pass the bill again, just like they did back in May,’ Right to Life of Michigan President Barbara Listing said in a Dec. 23 statement.’”

Michigan Edges Toward Ban on Common Abortion Procedure, Bloomberg Law, December 23, 2019

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NAFTA Revision, H.R. 1865, and Biologics (Pharma) Switcheroo

Sigh . . .

If the general public has not caught it, there are some of us who watch the political mechanizations by commercial healthcare to improve their lot in Congress. I know the public has not caught this switcheroo in Congress causing them to look good (and boast of it) in removing new drug exclusivity from NAFTA. What we have missed is it was granted in H.R. 1865 instead and for a longer period of time to boot. Read on to see how this was accomplished.

Addressed to Congresswoman Elissa Slotkin:

The Good:

Yes with the revision of NAFTA, Democrats “removed a provision giving the makers of ultra-expensive biologic drugs 10 years of protection from less expensive knockoffs. This is up from 5 years.

Democrats opposed what they called a giveaway to the industry locking in inflated prices by stifling competition. Top examples of the injected drugs made from living cells include medications to fight cancer and immune disorders such as rheumatoid arthritis. This legislation impacted drugs such as Rituxan, Humira, and Enbrel. Humira and Rituxan being two of the more expensive drugs on the market which have incurred pricing increases exceeding twice Medical CPI. From January 2012 to December 2017, Humira experienced price increases of 124%. Rituxan which I use from time to time is right behind Humira in cost.

The Bad:

Recently finished up an article on the prices/costs of healthcare and the resulting increases in Healthcare Insurance and deductibles whether it be Employer, ACA, or Medicare/Medicaid. House Bill H.R. 1865 was passed in the Senate and one of the few to make it through the Senate. It was the 2020  budget bill coming out of the House, altered by the Senate and altered by the House and finally passed by the Senate.

Besides repealing the Cadillac tax and the Medical Device tax which were never implemented and the Healthcare Insurance tax which was implemented; the bill also included (page 1503) a phrase to include “chemically synthesized polypeptides,” medicines such as Novo Nordisk’s Victoza. While it is only for new drugs and not drugs newly deemed to be Biologics such as Humulin and Humira, it is similar to what was removed from the NAFTA bill, is 12 years long for exclusivity, and it is still a huge and similar give away to Pharmaceutical companies the same as what was in the NAFTA revisionary bill.

And The Ugly:

The reasoning for the designation is to give companies a chance to bring new and cheaper bio-similar drugs to market. Ok fine bringing a drug to market, risk adjusted costs can be recouped in 5 years for the most expensive drug such as Humira and Rituxan as detailed by the recent World Healthcare Organization Technical Report on Cancer Drugs. With anywhere from 50% increases to a doubling of prices over a two year period (JAMA Network Open), Pharma does not need legislative incentives through extended exclusivity to be creative and profitable.

References:

Generic Drug Groups See Giveaway to Brand Names in Spending Bill, Bloomberg Law, Alex Ruoff and Jaquie Lee, December 19, 2019

THE HOUSE AMENDMENT TO THE SENATE AMENDMENT TO H.R. 1865, Appropriations Act, 2020, Page 1503, December 16, 2019

TECHNICAL REPORT Pricing of cancer medicines and its impacts, World Health Organization

run75441 (Bill H)

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Forward Creeping Excessmass Wins The War On Christmas

Forward Creeping Excessmass Wins The War On Christmas

“Excessmass” is a term neologized in a column in the late 1990s in the Wall Street Journal (sorry, unable to find precise date) by my JMU colleague, Bill Wood.  A devout Brethren, he was and remains disgusted by the crass commercialism associated with the Christmas holiday in the US. In this column he proposed dividing the holiday into two: a strictly religious one, “the Nativity” without gift giving, and a gift giving one he argued should be called “Excessmass,” a term that did not particularly catch on, but I am reviving as I see its forward creep as in fact damaging it not outright destroying the traditional religious Christmas, certainly far more vigorously than any bout of people saying “Happy Holidays!” to each other.

What triggered this post is that over the weekend in the Washington Post comics section (the most important part of the paper), nearly a  quarter  of the comics had a theme of “taking down the Christmas tree” or “taking down the Christmas decorations,” and indeed in my neighborhood I saw several houses where there was a tree out on the street on either the 26th or 27th.  Plus, for some years now a local radio station has started playing the schlocky commercial Xmas music (“Frosty the Snowman,” etc.) starting a day or  two after Halloween, but then on Dec. 26 is back to its usual pop music stuff. Hey, Christmas is over!  Time to move on to Valentine’s Day!  And also this year I saw the stores breaking what had been a Halloween barrier (the Thanksgiving one long ago broken) and putting up all their Xmas stuff in October.  Hey, with all that going on for so long, of course it is time to put all those decorations away the minute Christmas is over!

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Thiessen Balances His Policy Defense Of Trump

Thiessen Balances His Policy Defense Of Trump

Several days ago I posted on Marc A. Thiessen’s defense of 10 policies by Trump in WaPo.  I must now credit him with today on New Year’s Eve in the same venue publishing a column “The 10 worst things Trump did in 2019.”  Good for him, some balance after all.  I agree these are all bad things, although I disagree with some of his analysis of them, with a few caveats especially on a couple of the foreign policy items.  However, I shall just list them with Thiessen’s conclusion.

10. He ridiculously claimed “Our country is FULL”

9. He used anti-Semitic tropes to attack his enemies.

8. He said the Soviet Union was right to invade Afghanistan and congratulated China on the 70th anniversary of the Communist takeover.

7. He lost a needless government shutdown.

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