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October 14, 2018 · OPINION

Threatening the safety net for millions of citizens

By Anne Burhans
Broad Run

Medicare and Medicaid were enacted in 1965 and are funded by a payroll tax deduction. Civilian workers and military members have been paying in for their entire working lives and are entitled to benefits when they retire.

The 2019 Republican budget includes a Medicare cut of $537 billion! Anyone who currently uses Medicare or who has planned to use it should be outraged. The bill also calls for privatization with a voucher to purchase private insurance. Is this what you bargained for? What happened to campaign promises not to cut Medicare?

The new budget has large cuts to Social Security, predominantly affecting the disabled, and large cuts to Medicaid, predominantly affecting children, the disabled and low-income people.

The new budget also has major changes to the Affordable Care Act, with cuts in subsidies, resulting in increased premiums and putting those with pre-existing conditions in jeopardy. The Medicaid expansion would be repealed, resulting in 14 million to 17 million people losing their coverage.

There were empty campaign promises to do something about reducing drug prices. Medicare is currently banned from negotiating prices with pharmaceutical companies by the Medicare Modernization Act of 2003. It ought to be easy to eliminate this ban, but repeated attempts by the Democrats have been blocked by Republicans.

If you are interested in reducing drug costs and keeping Social Security, Medicare, Medicaid and ACA benefits for yourself or others who rely on them, vote Democratic on Nov. 6 and elect Tim Kaine and Leslie Cockburn.

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Marysmith · November 9, 2018 at 1:04 am
I totally agree with the above article. As far as we take care of our own health and family members we should also think about how to keep our home safe. As due to weather changes no one can ever tell when the disaster like the Flood/wind damage will happen. Thus, one should always be already ready with an insurance agreement of flood damage Glendale ( https://www.alliancepublicadjusters.com/water-damage-glendale/ ), or one can also take some helpful hints from the public adjusters.
nonewtaxes · October 22, 2018 at 6:55 pm
Silii,

Yes I would love to opt of SSI and all the other ilk of government support programs. Just stop taking those taxes out of my paycheck and give me a lump sum for the amount Ive already pay into the system.

No party will cut the tax and there is no lump sum amount for me or anyone else. You can keep your 2% on SSI payments. I'll take th 10% return on the stock market.
Silii · October 20, 2018 at 7:34 am
Thank you Ms. Burhans for stating the facts. Republicans have lied and lied to Americans about not cutting medicare, medicaid, and social security. There are few Americans who do not eventually need and use at least one of these supports. I know wealthy people who use medicare even though they could well afford their own insurance because they "paid into it over the years" and say "don't mess with my medicare." So, to the nay sayers, yes, even people of means use medicare and don't want it touched. btw, medicare premiums are based on income so higher income folks pay higher premiums, yes, even when you're on medicare you pay a monthly premium. Also, medicare does not cover full expenses. That's why people need to get supplemental insurance AT THEIR OWN EXPENSE if they can afford it. If not, they pick up the co-pays and co-insurance and drug co-pays which can be astronomical.

These are programs that can be fixed but lyin' Trump and the lyin' Republicans refuse to do it. I'm not sure what their problem is, but I guarantee you all of them who are 65 or over subscribe to medicare and already or will tap their social security benefits, along with their spouses. Bunch of hypocrits.

To the nay sayer commenters, I say you don't have to apply for medicare or collect your social security - stand up and refuse to be a part of the system that you think is so awful. Face it. These programs are here to stay but you need not use them even when you're old and broke and sick or injured or have a heart attack or stroke. Y Cancel collecting your social security and don't enroll in medicare. Whatever.

Oh, and to those commenting on how much they pay in taxes - that money is now going towards a highly inflated defense budget and will be going towards paying down the more than 1 trillion budget deficit the Republicans and Trump have just given us via tax cuts for the wealthy and corporations and extreme spending, mostly for defense.

Actually, you might want to move to Saudi Arabia. They treat their folks real well.
Melrose Carter · October 19, 2018 at 5:40 pm
JohnnyD - IMHO I think that the downfall of the Democratic party really began when Bill Clinton was given a pass with his "High crimes and misdemeanors" in the White House. That is only my opinion, but it set the course of where we are now at, and our compass as a country is in need of remagnetizing, and the corruption removed.
Melrose Carter · October 18, 2018 at 7:11 pm
nonewtaxes - "...but not say a word about the actor or ball player who makes more for merely entertaining us." The amount paid to professional actors and athletes is ridiculous, which I believe came about because they were tired of the CEO's getting all the profits while they did all the work IMHO.
nonewtaxes · October 18, 2018 at 7:06 pm
Centene profits are the biggest of them all - less than 2% net margin. Only a person playing the lottery o slot machines does worse.

Liberals, ingorant of Finance 101, love to shout about the absolute $$ that a company earns but never accounts for the investment cost.

You complain about the $25 million dollar salary of a CEO who allocates capital to provide goods and services and jobs but not say a word about the actor or ball player who makes more for merely entertaining us.
nonewtaxes · October 18, 2018 at 6:59 pm
JG: I do believe it was the republicans that recently funded the clawback positions. These clawback positions were demanded by the insurance companies going on ACA exchanges because they knew that was a losing deal.

Let's look at facts re:insurance net margins
2018 2017 2016 2015 AVE
AET 3.1% 3.6% 4.0% 3.5% 3.6%
HUM 4.6% 1.1% 2.4% 2.4% 2.6%
ANTH 4.3% 2.9% 3.2% 3.5% 3.5%
CI 5.4% 4.7% 5.5% 6.0% 5.4%
UNH 5.2% 3.8% 3.7% 4.3% 4.3%
Industry Average 3.9%

2018 2017 2016 2015
S&P 500 8.5%* 7.3% 5.0% 6.1%
Market Average 6.7%

The insurance industry net margins are less than 2/3 that of the broad market. How can that be very profitable?

There is just not enough profit in the insurance industry to lower cost. The industry makes a good scapegoat because they sell an intangible product and most younger people don't need it.

What % of my earned income should I be allowed to keep?
What % of my earned income should the government be entitled too?


farmbum · October 18, 2018 at 3:04 pm
Health care costs continue their rise - unabated. Matter not, Republican, Trumpican or Democrat.

The money flows from the worker bees to the massive HealthCare Inc. proift machine.
Melrose Carter · October 18, 2018 at 9:12 am
Article at http://www.npr.com for further reading.

https://www.npr.org/sections/health-shots/2018/10/18/657862337/private-medicaid-plans-receive-billions-in-tax-dollars-with-little-oversight

More than 54 million Medicaid recipients are now covered by managed-care plans, up from fewer than 20 million people in 2000. (In traditional Medicaid, states pay doctors and hospitals directly for each visit or procedure — an approach that many researchers say can encourage unnecessary or excessive treatment.)

Foster Parents Often Struggle To Find Doctors To Treat The Kids In Their Care
SHOTS - HEALTH NEWS
Foster Parents Often Struggle To Find Doctors To Treat The Kids In Their Care
Already, states funnel nearly $300 billion annually to Medicaid insurers. That's up from $60 billion a decade ago. Today's spending is approaching what Pentagon awards annually to military contractors.

Medicaid is good for business: The stock price of Nuñez's insurer, Centene, has soared 400 percent since the ACA expanded Medicaid eligibility. The company's chief executive took in $25 million last year, the highest pay for any CEO in the health insurance industry.

In California, the largest Medicaid managed-care market with nearly 11 million enrollees, Centene and other insurers made $5.4 billion in profits from 2014 to 2016, according to a Kaiser Health News analysis.

Plans get to keep what they don't spend. That means profits can flow from greater efficiency — or from skimping on care and taking in excess government payments.

"States are just giving insurers the keys to the car and a gas card," says Dave Mosley, a managing director at Navigant Consulting and former finance director at the North Carolina Medicaid program. "Most states haven't pressed insurers for the information needed to determine if there's any return on their investment."
Jim Griffin · October 18, 2018 at 7:58 am
Savings were predicated on insurance subsidies John Boehner and House Republicans sued to stop and would not fund.

Rewards of labor are a right unfairly denied working people.

Health insurance companies are very profitable and becoming more so. They outpace the market by 106 percent. It appears you doubt that. Ask your President, this account is from his office and bears his seal:

https://www.whitehouse.gov/wp-content/uploads/2018/03/The-Profitability-of-Health-Insurance-Companies.pdf

"(H)ealth insurer profitability in the individual market has risen due to substantial premium increases, government premium tax credits that pay for those premium increases, and the large, government-funded, Medicaid expansion. Since ACA implementation on January 1, 2014, health insurance stocks outperformed the S&P 500 by 106 percent. Insurers remaining in the individual and small group markets seem to have recently accounted for ACA regulations and an older, more costly risk pool than they expected by charging higher premiums that have largely been covered by federal government premium subsidies. Stable year-over-year enrollment, despite
large premium increases, suggests a distorted market that involves large transfers from taxpayers to insurers. Large insurers, many of whom left the individual market, are profiting from the Medicaid expansion, which is largely provided through private managed care and paid for by the federal government. All health insurers can expect to become more profitable this coming year due to the recent tax reform."

Reinforces my point: Insurance is an inefficient approach to health care. Direct provision of care is the right model to the extent practical. It works for Congress, it works for vets, it works for Fauquier County, it is the way forward for most.
nonewtaxes · October 17, 2018 at 9:56 pm
Still waiting for my $2500 savings.

Reaping the rewards of one's labor is a basic human right.

Regulating or replacing health insurance companies aint gonna fix a dang thing. They dont make all that much money. The cost drivers are drugs, personell, and legal. Until those factors are considered aint nothing getting done.
Jim Griffin · October 17, 2018 at 8:24 am
Speaker of the House is determined by vote, not party dictate, and there are possible challengers. The votes are in the hands of as-yet un-elected reps. The more new dems elected the less likely her grip holds.

As regards health care, 3rd-party payment systems are flawed. As long as the 3rd party pays, neither provider nor patient engage in cost control; they detest and can evade controls imposed by insurers.

Direct care provision is the lesser of many evils. It is the method of choice when results and bottom-line matter. No wonder its the system used by much of the world, including our vets, legislators and county employees.

Yes, we should always be free to choose a health care provider with our own money or privately-contracted insurance, but the direct provision of care is the most efficient and effective system for governments.
Jim Griffin · October 16, 2018 at 12:10 pm
Agreed with BJ, I am no fan of Nancy Pelosi. It's up to her constituents to decide when she should no longer represent them.

Republicans decided to gut ACA upfront, immediately challenging in court the insurance company payments, without which the rates escalated (of course).

Let's be done with it. Health care is a basic human right. The direct provision of care is how we treat Members of Congress, veterans and others. Fauquier County employees, too -- they now have a clinic that directly provides the care needed. It's the way forward.
BJ · October 15, 2018 at 1:39 pm
JohnnyD - I don't like or support Nancy Pelosi, and think she needs to go! What happened with the ACA at least gave people that couldn't obtain healthcare in the first place some hope, I'm not saying it was perfect. Again, Nancy Pelosi needs to go as do quite a few Republicans.
BJ · October 15, 2018 at 11:24 am
It's as plain as the nose on all our faces, the Republicans and the TRUMP Administration do NOT care about the average American, only the RICH who have plenty of money to seek whatever healthcare and plastic surgery services they desire. (Correction of typos and addition of name).

Blaine Johnson
BJ · October 15, 2018 at 11:22 am
It's a plain as the nose on all our faces, the Republicans and the TRUMP Administration do NOT care about the average American, only the RICH who have plenty of money to seek whatever healthcare and plastic surgery serves they desire.
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