AMA Warns Of Risks Of Gutting Health Care Reform

With Republicans appearing to make abolishing Obamacare a top priority (following their failure to gut ethics oversight of Congress), the American Medical Association has weighed in with this letter (emphasis mine) stressing the importance of making coverage more affordable, providing greater choice, and increasing the number insured:

Dear Majority Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing regarding our ongoing commitment to reform of the health care system and potential legislative actions during the first months of the 115th Congress.

The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice, and universal access for patients. These policy positions are guided by the actions of the AMA House of Delegates, composed of representatives of more than 190 state and national specialty medical associations, and they form the basis for AMA consideration of reforms to our health care system.

Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time. We continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans. We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.

In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained.

Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.

We stand ready to work with you to continue the process of improving our health care system and ensuring that all Americans have access to high quality, affordable health care coverage.

Sincerely,
James L. Madara, MD

Medical groups and physicians have been conflicted regarding expected health care policy under Donald Trump. There was some early support for Tom Price to head Health and Human Services in the hope that he will work to reduce the regulatory burden, but many doctors have come out in opposition to him out of concern for reductions in coverage for many Americans.

While health care policy could likely a major impact of the all-Republican government, it received very little attention during the presidential campaign. This is partially due to the media’s preference to cover the horse race and scandal, Donald Trump making more noise on matters such as the Wall, and an extraordinarily poor campaign by Hillary Clinton which concentrated on stressing Trump’s negatives and avoiding issues. Democrats are now starting to speak out on health care. Chuck Schumer is trying to turn Trump’s slogan against him, warning that Republicans will “Make America Sick Again.” Hopefully they can provide a resistance beyond coming up with a slogan.

Democrats were successful in blocking George Bush when he attempted to partially privatize Social Security in his second term, and similarly have a chance of receiving public support in opposing Republican attempts to reduce health care coverage, including cuts in Medicare and Medicaid. Republicans are also getting jittery about health care legislation. They could safely please their constituents by voting to abolish Obamacare when Barack Obama was in office and they knew he would veto their efforts if it made it past a filibuster. Many now realize they will be held accountable for what happens, including if people lose coverage, and insurance costs continue to rise rapidly. The Committee For A Responsible Federal Budget, typically conservative on government  spending,  has outline the costs of repealing Obamacare, giving further reasons for Republicans to be cautious.

Donald Trump remains a huge wild care, having both promised to abolish Obamacare and to provide a plan to cover all Americans. So far he has given no meaningful specifics, talking primarily about health savings accounts and allowing insurance companies to sell insurance over state lines. Neither is a real plan. One point to Trump’s credit is that, while his major appointees have been from a very narrow group (primarily wealthy conservatives), he has spoken to a wider range of people. Zeke Emanuel, the architect of the Affordable Care Act, came out of a meeting with Trump expressing optimism, as reported by NPR. He believes Trump might seek to have a bipartisan bill after Republicans have complained about how Obamacare was passed by only Democrats. He also pointed out that some conservatives are pushing for “repeal and replace” as opposed to the currently discussed tactic of “repeal and delay” and discussed how legislation might be handled after an initial resolution (even if along party lines) to abolish the ACA utilizing budget reconciliation:

And so that you really do need to repeal and replace, and you need to do it in one bill. Otherwise, you’re really going to disrupt the individual insurance market in a very bad way, and you’ll be responsible for millions of people losing their coverage but also health insurance premiums going up. And I think that is not a scenario that a lot of Republicans really want…

So one possibility is that they pass a resolution saying that they will then come back and pass a bill that will repeal parts of the Affordable Care Act and at the same time have a replacement for those parts of the Affordable Care Act…

The resolution can be party lines, but the bill would then have to construct both the repeal part but simultaneously the replacement part. And I think if you do it that way, you could begin to negotiate with Democrats. If you just have a repeal and we’ll be back in three years and tell you how we’re going to fix it, then the Democrats are simply going to walk away. Chuck Schumer has made that clear.

And they should walk away because then it’s all – it’s the old pottery barn principle that Colin Powell made famous, which is, you break it; you have to fix it, and you take responsibility. And the Democrats will not want their fingerprints anywhere near the breaking of Obamacare and the disruption of the insurance industry in the United States…

The question is, what is the shape of that bill? Is it just a repeal bill, or is it a repeal with replacement? And that negotiation about that bill could take several months. My own estimate is if both sides come with good faith, they could probably hammer this out in about six months. It’s not a small item. I mean health care reform is big.

The question is, what are the gives and takes? I do think – again, one of the reasons I’m optimistic is that when you look at conservative and liberal health policy experts, there’s about 70 or 80 percent overlap between the two groups about the shape of the future and what you would need. And I think that’s, again, why I’m optimistic – because there aren’t that many ways of doing health care reform. They’re really limited.

Of course counting on the sanity of Republicans is a very risky bet.

The Battle Is On Between Dangerous Donald & Crooked Hillary

Trump Clinton Celebrity Death Match

While I will not entirely give up hope of an upset in the Democratic race by Bernie Sanders, the media is getting set for the showdown between Dangerous Donald and Crooked Hillary. Those are the current nicknames each has chosen for other, and they are both right about the other. I had planned to call them greater evil and lesser evil, but found that too many readers disagree as to which is which, even if we agree both of them are too evil to be fit to be president, or hold any other elective office.

Dangerous Donald is trying hard to win over the Republicans. He already has the racist and xenophobic base of GOP voters, but reaction to him is mixed among the more ideological GOP leaders (who never figured out that the base doesn’t really care about their economic theories). Trump is backing away from one of his more dangerous and controversial ideas. He now says that banning Muslims from entering the country was “only a suggestion.”

It hardly sounded like only a suggestion when he first stated: “Donald J. Trump is calling for a total and complete shutdown of Muslims entering the United States until our country’s representatives can figure out what is going on.”

By this logic, does Trump think that Hitler’s rants in Mein Kampf were only suggestions?

Will he let Clinton get away with saying her proposals for military intervention in Iraq, Libya, and Syria were only a suggestion?

Will the media continue to play softball with Trump, or will they start asking him the types of followup questions which he does not appear capable of answering?

But here’s another sign that Trump is getting more moderate. He has disavowed his butler after he called for the killing of Barack Obama. A month ago Trump would have probably backed the proposal at his rallies.

Meanwhile it hasn’t been a good week for Crooked Hillary. As I warned months ago, the moment the Republicans settled on a candidate, the winner would look more like a serious candidate and would get a bounce in the polls. As I noted Tuesday, the election has become a virtual tie based upon the polls. Since then, a Reuters/Ipsos survey released on Wednesday also shows Clinton leading by just one percent. While the news media has generally been biased towards Clinton, CNN has posted an article entitled Why Sanders is a better bet against Trump on Thursday.

We might be seeing a lot of additional information demonstrating why Crooked Hillary deserves her name. While Sanders didn’t use such scandals against Clinton, there is no doubt that Trump will. Today there were reports that Clinton Charity Aided Clinton Friends.

While I have been far more concerned about the violations of policies regarding government transparency and the influence peddling by Clinton, the FBI investigation has dominated talk in the media. Clinton has tried to downplay this, saying it is just a security inquiry. This week, FBI Director James Corney has contradicted Clinton’s statement. Security inquiry is not a thing. This is an investigation. Still, I continue to doubt that Clinton will be indicted considering her position, even if lower level people have been prosecuted for less. However, nobody knows for sure what will happen, and it makes no sense for a major political party to even consider nominating Clinton under the circumstances.

Clinton has also faced difficulties policy-wise too this week, with Huffington Post and Common Dreams chastising Clinton for refusing to Rule Out Any and All Benefit Cuts to Social Security. On the other side, I’m sure there are a lot of Republicans who are angry with Dangerous Donald for not promising to cut Social Security.

While Sanders remains Clinton’s major challenger for the Democratic nomination, there might be members of the party establishment who will not accept Sanders but realize that Clinton is a major liability for the party. There seems to be some who are out floating a Biden/Warren trial balloon.