Crumb (n) a small, broken-off particle of bread, cake, etc.
Congress is not debating the House’s or Senate’s latest version of health care legislation, at least not in it’s chambers. Dueling Tweets, news analysis, and blogging frenzy about how many votes the GOP has not lined up appears to be the level of civil discourse. It appears that we shall go to Independence Day congressional recess with more legislative grid-lock.
I hope that my USA citizen readers have voiced your opinions to your Representatives and Senators. Here is mine (any surprise?).
The Senate GOP’s version of the American Health Care Act, released a few days ago, appears to say, “Let them eat crumbs”.
For the vote tally, I request that you vote “No”. Do not rush it through the Senate with limited time for consideration, debate, or amendments.
Why “crumbs”? This is my opinion of how our president views society. He likes to see himself as having worked his way to wealth and status. What he did in his business life prior to his election was offer crumbs for his workers and anyone whom he saw that he could scam (or not pay for work done).
I lived in NYC, the very Queens that he grew up in, 30 years ago. I did not like his business model then. I do not like how he is applying this to governing now. His only interest has been promoting himself, building his empire, and rewarding those whom he aspired to be.
If someone did not like his approach, he would send out his team of lawyers to exhaust his or her resources in court. “Take my crumbs or I’ll sue you for all you have” was his attitude.
As to AHCA, the crumbs of health care are all that the Senate GOP bill offers to most of those who are not fortunate enough to have been born into upper-middle class or wealthy families, lacked educational opportunities, or have to live on wages rather than investments.
I doubt any of the writers of this version of the bill (or the House version) will be much effected personally… unless their constituents realize that crumbs is all they are getting.
When I grew up, we called something that was cheap and bad “crumby”. That is my opinion of the AHCA as it currently stands.
In my philosophy, a good debate is one in which more questions are raised that resolved. I know this is not the order of the day in which all competition is a zero-sum game with a winner raising his or her arms above a bludgeoned and bloodied foe. Competition should strength all sides and give us better strategies and skills than we began with. Competition should give us better assurance that we can trust the solution that held up best. At the end of the game, we should hold out a hand to help the fallen up so that we can walk off the field of play together.
Guess that makes me an idealist, huh?
Here are some questions that I see being shouted around, but not addressed directly.
Are the Affordable Care Act and American Health Care Act health care legislation?
The ACA set out 10 Essential Health Care Benefits which it required insurance carries to cover. The AHCA wants to eliminate this concept as a federal government mandate, leaving this question up to states and/or insurance carriers to determine. The ACA’s basic idea is that a healthy society needs a minimum definition for uniformity across the country. The AHCA wants to acknowledge that people may have different standards, thus states and/or insurance carriers can make different packages which would appeal to them.
The ACA requires that all insurance carries cover the 10 essential benefits, but risks that some carriers will withdraw from certain local markets (e.g. states or counties within states in which the cost of providing those benefits out-weighs the potential income generated from premiums). The AHCA would potentially encourage insurance carriers to create a range of insurance plans, with different benefit options and different premium costs. This assumes that people can read a variety of plans, know what they want to have covered, anticipate what coverage they need, and afford to purchase the level of insurance that is sufficient.
If you went to the grocery store, ACA folk would provide you with pre-packaged box of healthy food, regardless of whether you would not eat most of it. But, watch what different people actually select for their nutrition and you will know how well the AHCA idea will work.
Are healthy people beneficial for a healthy society?
The ACA would say “Yes”, and thus attempts to provide for healthier people. The AHCA would say “Yes, but…” with the expectation that people want to be healthy and need to make this decision for him or herself. Go look at those grocery carts full of chips, soda and other processed foods. A society full of obese, diabetic people is good if you run a dialysis center (which is one of the few situations in which you immediate qualify for Medicare Disability prior to age 65 years old). But, a society full of people too ill and in too much pain to participate will soon be a society in which a few take care the many.
Is health care legislation really about entitlement programs?
The ACA says, “Yes, citizens should be entitled to certain benefits”. Not only is heath care essential to healthy people, and therefore a healthy society, everyone should be entitled to the 10 essential health benefits. Thus, ACA provides insurance premium subsidies for those identified as not being able to afford health care through state managed Medicaid programs and income tax deductions. The ACA redistributes the wealth of the top 5% in our economy through taxes on wage income and investment earnings (more on this later).
The AHCA says, “No, citizens should not be entitled to anything not stated in the Constitution (e.g. Life, Liberty, and the Pursuit of Happiness)”. This caucus in the GOP would like to revisit, if not eliminate what they view as New Deal and Great Society entitlement legislation at the federal level: Social Security, Medicare, and Medicaid.
In general, their philosophy is that the idea of having retirement income and health care are great, but when the federal government provide for these, people become lazy and dependent. An incentive for achievement is the goal of being self-sufficient. Entitlement programs encourage dependency from the 95% to expect that the 5% cover the cost.
This sounds great if you were born into an upper-middle class household, had parents who could tolerate each other, had the cognitive capacity and economic security to get a college education, pursued employers who kept you employed for the duration of your career, and were willing to pack up and move your family when opportunity knocked. Hmmmm, guess most politicians fit into that mold.
Are taxes the root of all evil in the health care programs?
Entitlement programs are lighting rods for controversy because they are based on the redistribution of wealth. Millionaire A is going to pay for Poor Person B’s entitlement. Most of the discussion about ACA versus AHCA on tax relief has been about whether the level of Medicaid assistance should be at 400% (ACA) of poverty level verses 350% (AHCA), and how this will lead to 22 to 23 million people dropping off insurance rolls over the next ten years. The savings to the federal treasury on the Medicaid programs is Chump Change in the big picture of tax revenues and expenses, but symbolic for those who loath redistribution of wealth.
From what I can figure out, the hidden debate is about how ACA funded its programs through taxes on the wealthiest 5% in USA society. If I have it right, ACA put a 1% wages tax on the high earners ($200k for individuals, $250k for two-wage households) and 3.8% investment income (aka capitol gains income) for the same folks.
The 1% wages tax is an “Ouch” to those who live on low 6-figure incomes, and read Forbes magazine to aspire to eat a bigger slice of the wealth pie. But, to the truly wealthy, the 3.8% capitol gains tax is the thorn-in-their-side. These folk do not make their wealth on wages. They make it on stock-options and hedge fund income. Billionaires did not get there by punching a time clock. They got there by getting other people to buy stocks and bonds at higher prices than they purchased them at. (I’ll rant on this more in another post, as this relates to the GOP’s and President Trump underlying concern in most of the legislative agenda that rumbles under Making America Great Again…). Now that is Trump Change.
The problem with the questions which I raise is that any answer will be a 3rd-Rail end to any politician who actually tries to answer them directly. Do politicians actually ride Metro?