Tag Archives: American Elect

Facts about Tom Price, HHS nominee

Health economists and every concerned citizen should disseminate the facts in this NEJM article about Donald Trump’s nominee of Tom Price to be the next secretary of HHS.
Coauthor Richard Frank is also a BU Ph.D. alum!

Randy Ellis

 

Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS

Sherry A. Glied, Ph.D., and Richard G. Frank, Ph.D.

New England Journal of Medicine

December 21, 2016DOI: 10.1056/NEJMp1615714

http://www.nejm.org/doi/full/10.1056/NEJMp1615714#t=article

 

Since there is no abstract, here are the first two paragraphs.

Representative Tom Price of Georgia, an orthopedic surgeon, will be President-elect Donald Trump’s nominee for secretary of health and human services (HHS). In the 63-year history of the HHS Department and its predecessor, the Department of Health, Education, and Welfare, only two previous secretaries have been physicians. Otis Bowen, President Ronald Reagan’s second HHS secretary, engineered the first major expansion of Medicare, championed comparative effectiveness research and, with Surgeon General C. Everett Koop, led the fight against HIV–AIDS.1 Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines,2 and introduced President Bush’s health insurance plan, which incorporated income-related tax credits3 and a system of risk adjustment. In their work at HHS, both men, serving in Republican administrations, drew on a long tradition of physicians as advocates for the most vulnerable, defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Tom Price represents a different tradition. Ostensibly, he emphasizes the importance of making our health care system “more responsive and affordable to meet the needs of America’s patients and those who care for them.”4 But as compared with his predecessors’ actions, Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.

Since the NEJM full article  requires a subscription, here is a summary what they document:

Price has sponsored legislation that

  • supports making armor-piercing bullets more accessible
  • opposes regulations on cigars
  • Repeals and replaces the ACA (see details below)

Voted  

  • Against the Affordable Care Act (ACA)
  • Against regulating tobacco as a drug
  • Against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act
  • Against funding for combating AIDS, malaria, and tuberculosis
  • Against expansion of the State Children’s Health Insurance Program
  • In favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments
  • Against reauthorization of the Violence Against Women Act
  • Against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people
  • Against enforcement of laws against anti-LGBT hate crimes.
  • Against expanding the NIH budget
  • Against the recently enacted 21st Century Cures Act

Price stated views:

  • Favors converting Medicare to a premium-support system
  • Favors changing the structure of Medicaid to a block grant program
  • Favors amending the Constitution to outlaw same-sex marriage
  • Opposes stem-cell research
  • Inconsistent in supporting investments in biomedical science.

His proposal for repealing and replacing the ACA is H.R. 2300, the Empowering Patients First Act,5 which would

  • Eliminate the ACA’s Medicaid expansion and
  • Replace ACA subsidies with flat tax credits based on age, not income
  • Be regressive, with larger subsidies for high than low incomes.
  • Credits would pay only about one third of the premium of a low-cost plan
  • Credits proposed are smaller than those proposed by President Bush in 1992, and will not be sufficient to get most people to buy health insurance
  • Eliminate the guaranteed-issue and community-rating requirements in the ACA, with ineffective substitutes.
  • Withdraw almost all the ACA’s federal consumer-protection regulations, including limits on insurer profits and requirements that plans cover essential health benefits.
  • Allow the sale of health insurance across state lines, effectively eliminating all state regulation of health insurance plans
  • Fund his plan by capping the tax exclusion for employer-sponsored health insurance at $8,000 per individual or $20,000 per family, caps that are lower than the unpopular Cadillac tax in the ACA, which Price himself has voted to repeal, and hence is unlikely to ever be approved
  • Directly advance physicians’ economic interests by permitting them to bill Medicare patients for amounts above those covered by the Medicare fee schedule and allowing them to join together and negotiate with insurance carriers without violating antitrust statutes.
  • Oppose strategies for value-based purchasing and guideline development,
  • Oppose the use of bundled payments for lower-extremity joint replacements and
  • Propose that physician specialty societies hold veto power over the release of comparative effectiveness findings.

Consider what you can do to make sure that these facts are widely known. Perhaps ask your legislators which of these views they support.

Sobering Scott Adams interview about Trump on Real Time

This email will interest people who are closely following the US presidential election.

I invite you to watch the following four minute video on Trump and Hillary when you have time. It changed my thinking.

On the Friday June 2  Real Time with Bill Mayer, Scott Adams (who is the genius creator of the Dilbert comic strip) gave a very sober assessment of why Trump has been so successful. Adams is a trained hypnotist and has written several books on the art of persuasion.  Adams has a blog and LAST SUMMER he predicted Trump would win by a landslide. This, plus his careful comments were very real to me. According to Adams, Trump is not a fool, but rather he is a high IQ master persuader.

The Real Time clip was taken down on YouTube, where they want you to subscribe to Real Time, but it is still linked here.

http://lastnighton.com/2016/05/31/dilbert-creator-tells-bill-maher-why-trump-will-win-election/

Here is a link to his the Scott Adams blog.

http://blog.dilbert.com/tagged/RealTime

Here is  a link to his October 2015 blog where he predicted Trump will win in a landslide.

http://blog.dilbert.com/post/131749156346/the-case-for-a-trump-landslide-part-1

Here are the first three sentences from this blog from last October

“The latest poll out of Iowa shows Carson ahead of Trump. And you know what that means?

It means Iowa is about to become irrelevant. Here I am assuming evangelicals will band together to give Carson the win in Iowa before Trump goes on to run the table everywhere else.”

I also liked this review from the Washington Post in March 2016. It summarizes the six principles Trump is using to win.

https://www.washingtonpost.com/news/comic-riffs/wp/2016/03/21/donald-trump-will-win-in-a-landslide-the-mind-behind-dilbert-explains-why/

Here are his principles in list form.

  1. Trump knows people are basically irrational.
  2. Knowing that people are irrational, Trump aims to appeal on an emotional level.
  3. By running on emotion, facts don’t matter.
  4. If facts don’t matter, you can’t really be “wrong.”
  5. With fewer facts in play, it’s easier to bend reality.
  6. To bend reality, Trump is a master of identity politics — and identity is the strongest persuader.

Here are the final lines from that Washington Post article.

Writes Adams: “Identity is always the strongest level of persuasion. The only way to beat it is with dirty tricks or a stronger identity play. … [And] Trump is well on his way to owning the identities of American, Alpha Males, and Women Who Like Alpha Males. Clinton is well on her way to owning the identities of angry women, beta males, immigrants, and disenfranchised minorities.

“If this were poker, which hand looks stronger to you for a national election?”

http://lastnighton.com/2016/05/31/dilbert-creator-tells-bill-maher-why-trump-will-win-election/

Watch the Real Time interview. And think about how you can get your favorite politician – local, state or national – to be better at persuasion and the use of modern media.

Randy

Obamacare reality: It is working

At a time in the US when all of the Republicans presidential candidates are declaring Obamacare a failure which needs to be undone, it is worth noting the REALITY that it is succeeding in its primary purpose of covering more American with health insurance. It does not mandate insurance coverage, but the subsidies and tax penalties for not having insurance are motivating more people to get insurance. 20 million more people now have health insurance than did before. (Click on graphs for a clearer image.)

 20 Million Gained Health Insurance From Obamacare, President Says
The Huffington Post

Uninsured rate Gallop-HealthwaysEven though cost containment was not its primary goal, Obamacare is also reducing, not increasing, costs of health care.
Since many people don’t trust the government, here are some private sector slides.
PriceWaterhouseCoopers, an actuary firm not known for being political, forecasts that health expenditure
cost growth in 2016 will continue to slow down.

http://www.pwc.com/us/en/health-industries/behind-the-numbers/assets/pwc-hri-medical-cost-trend-chart-pack-2016.pdf

Here are my two favorite slides from their chart pack. Note the changes since 2010.

pwc trends gdpand nhe

My view is that the above figure is misleading, since the decline in rates of growth did not start in 1961, but still the slow growth since 2010 is clearly evident.

 

spending growth rate PWC 2016

Obamacare is working. We just don’t have enough leaders and media telling us this.

 

Note: I sent this blog to my BUHealth email list.

Let me know if you would like to be added as a BUHealthFriends subscriber by emailing ellisrp at bu.edu

All Taxes and Budgets Should be Expressed as Dollars per Person

Time to change the discussion #1

This is the first of five posts on my blog on how discussion of taxes and budgets in the US needs to change to improve decision-making.

Recent political debate and the media throws around costs of millions, billions and trillions of dollars even though there is no easy way for an ordinary citizen to evaluate the meaning of these terms. All of these are very big numbers. Consider the following numbers, sorted from largest to smallest. Which ones should we be worrying about?

Sample of recent numbers in the news (or that should be there)

$16.4 trillion US National Debt [1]

$3.7 trillion Total cost of wars in Iraq, Afghanistan and Pakistan [Reuters,2]

$1.2 trillion Size of tax increases and budget cuts in the fiscal cliff [3]

$1.1 trillion Federal deficit for 2012 [4]

$849 billion What is at stake in the Bush-era tax cuts for the wealthy, those earning more than $250,000, over ten years. [ABC news,5]

$ 807 billion The US government’s estimate of the direct cost of the war in Iraq thru FY2012. [6]

$ 571 billion The US government’s estimate of the direct cost of the war in Afghanistan and Pakistan thru FY2012 [6]

$ 100 billion Cost of the Iraq war that was used in discussions just before attacking Iraq [7]

$ 1.4 billion Financial spending for all presidential candidates, 2011-2012. [8]

$ 446 million The FY2013 annual budget for the Corporation for Public Broadcasting. [9]

$192 million The cost of the 2010 Newton North High School serving half of the Newton MA population [10]

$  83 million Campaigning expenses, all candidates including outside spending, on Elizabeth Warren vs. Scott Brown Massachusetts Senate race, 2012. [11]

$ 11 million Proposed tax override for Newton MA in 2013 to pay for schools [12]

$ 54,000 Cost of running the March special election to vote on the Newton override. [13]

The relevant populations

US population: 315 million people

MA population:  6.6 million

Newton population:  86,000 (half served by Newton North High School, the other by Newton South High School.)

Costs revisited with Ellis commentary

 

$ 52,000                US National Debt per Person –    High, but can be reduced if we try hard.

$12,000                 Total cost of wars in Iraq, Afghanistan and Pakistan per Person Not worthwhile to me, and 23% of our total US debt!

$ 3,800                  Per person size of the 2013 fiscal cliff, in taxes and reduced spending.

$ 3,500                  Extra cost per person per year to eliminate the federal deficit for 2012. Although similar to the preceding, note that this is for one year, while the above is over ten years… Even jumping over this cliff does not eliminate our deficit.

$ 2,700                  Ten-year cost per person of the Bush-era tax cut on those earning more than $250,000. A lot is at stake here, not small change.

$ 270 Average per year cost per person of Bush-era tax cut on >$250k Doesn’t look like such a big number, and this is how much it reduces our per person annual deficit.

$13,500 Average per year cost per wealthy person (top 2%) of Bush-era tax cuts. Recall that the average income of this group is way higher than $250k

$ 2,600                  The official direct cost per person of the war in IraqWhy isn’t there more discussion of this?

$ 1,800                  Cost per person of the Afghanistan war. Maybe Afghan was worthwhile, but I doubt it.

$   317                    Initial cost per person of the Iraq war used in selling it to the public. How could we have been so wrong?

$       4                    Cost per person of the US presidential campaign. Maybe higher than I wish, but it is not going to break our budgets. Plus it is all voluntary, unlike the taxes.

$       1                    Cost per person of federal funding of public TV and radio. A small portion of their total budget. Why are we talking about this at all?

$4,500                   Cost per Newton resident of the Newton North High School. High, but I bet we more than made it back in increased property values. Even ignoring that more than half was funded by the state, if there are 4 people per household, then this is only 2.6% of median property value in Newton.

$    13                     Cost per Massachussetts resident of the 2012 Senate race. Seems reasonable expense for making big decisions. Plus it only happens every six years for each senate race, so only $2 per year per person.

$  128                     Cost per Newton resident per year of proposed tax override to help pay for schools. Definitely affordable.

$       .62                 Per person cost of running Newton’s March special election. Should not have even made the papers. Informed decision-making costs money.

Lessons

Big cost numbers are easier to understand when expressed as a cost per person.

Some big numbers don’t look very scary. Others look worse.

The numbers that get a lot of play in the media are not necessarily the right numbers.

Thought to Ponder: Why is it that almost no one in Newton is worried about having incurred a debt for one school in the amount of $4500 per resident, while citizens, and our Congress in particular, seems paralyzed to contemplate reducing our federal debt by a similar amount?

Citations

[1]  http://www.brillig.com/debt_clock/

[2] Reuter. 2012. Cost of war at least $3.7 trillion and counting.  http://www.reuters.com/article/2011/06/29/us-usa-war-idUSTRE75S25320110629 based on estimates from “Cost of War at http://costofwar.com/ which is sponsored by the National Priorities Project.

[5] http://abcnews.go.com/Politics/fiscal-cliff-bush-tax-cuts-expire/story?id=17907791#.UMnzFXfgztE

[4] http://www.gpo.gov/fdsys/search/pagedetails.action?packageId=BUDGET-2012-BUD

[5] http://abcnews.go.com/Politics/fiscal-cliff-bush-tax-cuts-expire/story?id=17907791#.UMoiRnfgztE

[6] Congressional Research Service, 2011. The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9/11. http://www.fas.org/sgp/crs/natsec/RL33110.pdf updated continually at “Cost of War at http://costofwar.com/.

[7] Tom Russert Interview with Vice-President Dick Cheney, “NBC News’ Meet the Press,” Transcript for March 16, 2003.https://www.mtholyoke.edu/acad/intrel/bush/cheneymeetthepress.htm

[8] Center for Responsive Politics, 2012.Most Expensive Races 2012 Overview

http://www.opensecrets.org/overview/index.php and

[9] Corporation for Public Broadcasting. 2012 Fiscal Year 2013 Operating Budget. http://www.cpb.org/aboutcpb/financials/budget/

[10] Newton Tab. 2012. Newton North High School final cost $6M less than expected. http://www.wickedlocal.com/newton/news/x1334618956/Newton-North-High-School-final-cost-6M-less-than-expected#ixzz2EwkW8uLrhttp://www.wickedlocal.com/newton/news/x1334618956/Newton-North-High-School-final-cost-6M-less-than-expected#axzz2EwkHptlI

[11] Center for Responsive Politics, 2012.Most Expensive Races 2012 Overview http://www.opensecrets.org/overview/topraces.php?cycle=2012&display=allcandsout

[12] http://www.newtonma.gov/gov/executive/override.asp

[13] Newton Tab, December 12, 2012. Table showing breakdown of the various costs of the special election in March, 2013 on the override.

Americans Elect is on Ballot in 25 states

Looking ahead 20 years, it is inconceivable to me that the US will sustain its current archaic primary system for selecting presidents. The new party Americans Elect is one possible new approach. It is getting little publicity relative to the Republican Primary, even though AE is now on the ballot in 25 states. Along with many others, I prefer Obama to the current roster of candidates at Americans Elect, (which includes BU’s own Larry Kotlikoff) but I look to AE to play an important role at debates and in our national discourse, even for the coming election. Here is a recent press release from their web site, at http://www.americanselect.org. Worth a visit.

Press Release: AE Hits Halfway Mark for Ballot Access!

WASHINGTON, D.C., APRIL 19, 2012 – Americans Elect has secured ballot access in 25 states. Over 2.5 million people have signed petitions across the country. Demand for a third choice in November is real and Americans Elect is offering that choice. Citizens from across the political spectrum are signing up to change this election and let the people, not the parties, nominate and elect the leadership in the country.

<more>

http://www.americanselect.org/news/4-2012/press-release-ae-hits-halfway-mark-ballot-access