The Hypocritical President

It should be amazing, to me and others, how hypocritical the so-called president and his GOP counterparts are with respect to everything they’ve stated when talking about the Democrats. But, in this new age of extreme dysfunction, it isn’t surprising nor amazing with the way they have accused Democrats of being wrong for invoking things like the filibuster and other tactics that they (the GOP) did in such excess during the Obama administration, which caused the senate Democrats to change the rules in order to allow former President Obama to get anything accomplished. During Obama’s presidency, the GOP (openly) stated that they would filibuster anything presented by Democrats in order to make President Obama’s presidency and agenda fail. In fact, the GOP in the senate held more filibusters during the Obama presidency than had ever before been seen. But, now that senate Democrats have proposed doing so it is suddenly the worst thing to have ever happened.

During so-called president trump’s campaign, he continually harped on Hillary Clinton as being “corrupt.” He and General Mike Flynn continually chanted, “Lock her up” and made accusations that the people receiving immunity (in connection with Hillary) must have done something illegal or they wouldn’t be seeking immunity. Now that Mike Flynn is in the hot seat, trump tweeted that Flynn should, “…seek immunity…” and it appears that Flynn is doing just that now that he was caught up in the Russia scandal and is going before Congress to testify.

I stated, all along, throughout trump’s campaign that, “Whenever trump speaks he is talking into a mirror.” That statement was made because it was so apparent that every time he was making accusations directed at Hillary Clinton those accusations were more applicable to trump himself. Unfortunately, that behavior exhibited by trump throughout his campaign hasn’t stopped now that the election is over and he is in the White House. He continues to make wild assertions about Democrats and the mainstream media that are more applicable to him, his administration and the “fake news” (Russian propaganda news sources and trolls as well as media outlets like Breitbart) that he, himself, has supported and promoted.

Every time Sean Spicer gives a news briefing, he (like his boss, so-called president trump) never takes responsibility for their mistakes. Rather, just like trump, he places blame on anyone and everyone other than their administration – the parties who are actually responsible. President Obama always took full responsibility for any mistakes made by those people or departments under the Executive Branch of government. Even when the mistakes made weren’t made by the president (Obama) – if they were made by anyone or any department that was within the Executive Branch, which he headed, he took full responsibility. That’s what grown-ups do. That’s what mentally stable and people fit for the enormous responsibility of being president of the United States do when mistakes happen within their branch of government. I (nor has anyone else) have yet to see so-called president trump take responsibility for anything other than things he views as success. He, even, takes credit for successes that were the result of the former president’s policies and work that would have happened regardless of who the next president (after Obama) would be.

When will so-called president trump grow-up and start acting like an adult? When will he start behaving like a sane and responsible individual? In this viewer’s opinion (from what has gone on and on and on so far) it would be easier to eliminate terrorism off the face of the earth than for Donald Trump to become a grown-up, responsible, sane individual who is capable of handling the awesome responsibility of being president of the most powerful country in the world. He, in the very short time he has been president, has alienated our closest allies, created a perception of the United States and the awesome power of the presidency as a “laughing stock” around the world – from our allies to our enemies – we are, now, the punch-line to every joke in every language around the world.

At this point in time, GW Bush would be a welcomed change to the irrevocably insane trump presidency. That statement should communicate, very clearly, the level of horror felt by most Americans at present. Most Americans, meaning all Americans with common sense, intelligence, sanity and an open and analytical mind. Those excluded from “most” are a small minority of Americans who are gullible, insane, closed-minded, opposed to facts, unable to tell the difference between legitimate, factual news and fake, propaganda, fictional stories that should never be referred to as “news.” But, unfortunately, because this so-called president and his staff creates and promotes such lies as news and his “base” gobbles it up like Thanksgiving dinner – the era of misinformation is likely to continue. And, if such an era continues, the division in this country is likely to follow suit.

No "Extreme Vetting" for Mike Flynn

Every day that I choose to watch the daily press briefing from the White House given by Sean Spicer I hear something (usually more than one thing) that fills me with outrage. Today was no different. Sean was asked about former National Security Advisor Flynn’s working with Turkey while serving as the president’s NSA and the answer given by Spicer was incredulous. I will paraphrase the answer that Sean gave to the press regarding Flynn as, “it wasn’t up to the transition team to advise Flynn on his disclosures.” Spicer was making the statement that each individual is told to “seek outside counsel regarding their paperwork…”

Let me be very clear when I say that it is more than an outrage that someone at the highest level of our government isn’t subject to the same background checks and verification that an average citizen seeking employment for a private (or government) job goes through for (even) the most menial position. Even people who are seeking housing through government housing programs or to lease an apartment are subject to criminal and credit background checks that prevent them from obtaining said housing. When seeking employment for both private and government sector jobs in this country the background check process looks at both credit and criminal background history that prevents many Americans from obtaining employment of any kind – even the lowest of low paying/no benefit jobs.

How is it that someone serving at the highest level of government for security clearances is just “taken at their word?” That is abhorrent. Especially from an administration that has stated the U.S. government needs “more extreme vetting” for immigrants coming from predominantly Muslim countries. I have known people from Palestine and Jordan who were so bogged down by the vetting process that is in place currently (post 9/11) that they completely abandoned their dream of coming to the U.S. to build a better life. These people had family who had immigrated to America to vouch for them and they were educated in high tech fields (like computer engineering and other engineering specialties) and were unable to get, even, a work visa.

I, myself, have gone through the arduous process of losing jobs due to my background information (that is more than twenty years old) coming back to haunt me. That was before employers started waiting to get background check results before allowing a person to begin their employment – even in a “right to work” state like the one where I live. That is why this information is so damn infuriating to me. Hell, had I known all I needed to do was bypass trying to work for the VA Hospital or any other field besides substance abuse and hone my resume to be an advisor to the president and, bam, I’d have a job…

Even to maintain my employment in substance abuse (a profession where I was hired two weeks into my internship) I had to attend a hearing held by the Department of Human Services/DHS at which point the “judge” who heard the case looked at the opposition and said, “Why are you wasting my time with this? She is clearly rehabilitated and well qualified.” Still, I had to go through that process to get “cleared” to work in a field that I had both extensive personal experience and education. That is far more than, apparently, took place with the Trump transition team when clearing a person to serve as the highest national security counsel to the president of the United States. Astonishing!

Repeal and Replace or Cut, Copy and Paste?

The speaker of the House, Paul Ryan, gave a PowerPoint presentation today to explain the GOP’s replacement for the ACA. Before I go any further, I need to give clarification to my readers. I have over a decade of work experience in the healthcare field for, both insurance companies as well as healthcare and behavioral healthcare providers where I worked with a vast array of insurance companies, on behalf of patients, doing everything from verification of benefits to obtaining prior authorization and concurrent review for continuous authorization to arranging continuation of care for patients discharging from inpatient care.

All of this professional experience in the healthcare field, where I dealt “hands-on” with insurance companies for patients being treated by providers (whether working for an insurance company in Utilization Management or working for providers of service – hospitals, Long Term Acute Care/LTAC facilities or residential substance abuse facilities) gives me a comprehensive understanding of how insurance works – or doesn’t work – for patients.

So, when I heard Speaker Ryan’s presentation of the ACA replacement plan, I wasn’t hearing it as a layman, average constituent or (even) as a journalist who may not possess this knowledge while at a press conference without the help of producers or correspondents. I heard it as someone who knew, exactly, what he was talking about so I want to break down and clarify some of the bullet points he touched upon.

First, the only thing good that he presented was the items that are already in place with the ACA like: coverage for those with pre-existing conditions and parents able to keep children on their insurance until age 26. He mentioned that there would be “help” in the form of credits for certain folks – I don’t believe they are credits to offset premiums, deductibles or Out-Of-Pocket (OOP) maxes. However, the dollar amount wasn’t specified for these credits in today’s presentation. I heard mention of what that proposal was, yesterday morning, with Ari Melber’s breakdown during his program on MSNBC. If those figures are the actual dollar amounts to be issued as such “help” for patients they don’t make sense and are grossly inadequate.

Second, Ryan’s proposal that a HSA (Health Savings Account) will offer transparency for healthcare costs is (not only) untrue it is (just) asinine. Health Savings Accounts have been around for quite a long time. All they are is an account that employees “opt into” in order to put away money for healthcare costs like deductibles, out-of-pocket maxes, prescriptions and co-insurance (patient portion of services such as when your insurance covers 50-90% of services leaving you responsible for 10-50% or “the balance”). The money that goes into the HSA is deducted from the employee’s paycheck prior to tax, FICA and Medicare deductions.

Don’t be misled when you read about HSA’s online or in other information materials when that information states that, “it’s a pre-tax contribution made by your employer…” or “the contribution comes from your employer…” Your employer doesn’t give you money – your, pre-taxed, salary (your money) is put into the account by your employer. Money given to you by your employer for healthcare cost offsets isn’t a Health Savings Account; it is a Health Reimbursement Account (HRA). HRA’s are great. They pay for co-insurance charges, deductibles, OOP maxes, labs, pharmacy co-pays and over-the-counter medications.

But, back to my point about the fact that HSA’s aren’t going to magically bring transparency to medical costs. The only time a patient will get a definitive cost breakdown for medical care is if they are paying cash. The reason that there isn’t a way to “shop around” (as Speaker Ryan put it today) like a consumer at a retail establishment is because of something specific to insurance companies called “contractual agreements/contracted rates.” Insurance companies have an entire department (usually called “provider relations”) that is dedicated to establishing contractual agreements with providers of service. A provider of service can be a hospital, a doctor, a lab, a physical medicine and rehabilitation facility, a skilled nursing facility, a home healthcare and hospice provider, etal.

That is why (if you read your bill from any provider or your Explanation Of Benefits/EOB from your insurance company) you will notice “billed charges, contractual adjustment, amount paid.” The billed charges are the charges the provider bills (in general) which would be applicable to cash pay patients or patients who are seeing an “out-of-network provider” (non-contracted provider or non-participating provider). The “contractual adjustment” is the difference between what you’d pay in cash and what the provider agreed to be paid as part of their “participating provider” or “contracted provider” agreement.

But wait, it gets more complex. If you’ve ever had insurance you’re aware that you have an “ID number,” right? But, many people are unaware that they have a group number as well (unless they’re meticulous about looking over their insurance card or unless a provider asks for it). The group number is specific to your employer’s contract with the insurance company. That group number tells the insurance company a whole lot about everything. Every group goes to an underwriting department within the insurance company to determine how much the insurance premiums will be for that group. The underwriting is done to determine risk and profitability.

Also, each group will have contractual agreements for the different providers of services. So, if you work for company X and your husband works for company Y and both companies offer insurance from only one insurance company (let’s say Aetna) – company X’s premiums for the employee (alone, employee/spouse or family) will be different than company Y’s premiums for the same. Also, even though they have the same preferred provider network, the contractual agreements for each provider of service will (usually) be different as well.

It’s because of the contractual agreements that makes Paul’s statement of “having HSA’s for everyone will bring transparency to healthcare costs…” completely untrue. That means one of two things. He either blatantly lied to the press and American people or he (truly) has no idea about what he’s talking about and if the latter is true – he has no business being the “man with the replacement plan.” However, if he’s been working on healthcare reform for twenty years (as he has stated multiple times) then he has to know that what he said was complete bull shit that he knew would go over the heads of most Americans since most Americans don’t possess this knowledge.

Also, he has blamed the Obama administration and legislative Democrats who created and passed the ACA of creating an “over-complex piece of legislation that was made with special interest groups/lobbyists…” From what I’ve heard, so far, from Paul Ryan’s plan and the fact that he stated, openly, that he met with the CEO of Aetna who told him that, “Obamacare is in a downward spiral…” (I’m paraphrasing a bit) and the fact that the information he gave in his presentation was not truthful begs the question of “Who’s, really, pandering to lobbyists and trying to sell the American people a plan that will greatly benefit the insurance companies at the expense of the American citizens?”

The ACA isn’t perfect, but it is very fixable. If the GOP’s real concern is for the people of this country who need healthcare that they can afford and afford to use then it’s a pretty easy fix. The ACA eliminated the pre-existing condition exclusion, lifetime caps and booting kids off their parents insurance at the expense of the insurance companies – yet the insurance companies are still making billions of dollars a year so it didn’t drive them into bankruptcy as was the argument for allowing them to get away with rules such as those in the past. All that’s really needed to fix the ACA in order to make it work for everyone is to limit the deductible amounts insurance companies can charge for individuals and families as well as the out-of-pocket maxes. Also, it should encourage companies to offer both HSA’s and HRA’s.

I work for a very large company and they offer both. The HRA dollars are earned by engaging in “health promoting” tasks that, once completed, earns you dollars that go onto a debit/credit card that’s issued through an outside company that manages these health promoting assignments and education. It’s all done online and is very easy to do in your spare time. My deductible (as an individual) is $1,000 per year and I’m able to earn up to $500 a year in HRA money. So far I haven’t had to pay for any prescriptions or office visit charges to my primary doctor, the two specialists I see nor for any labs I’ve had done. It’s awesome and if the GOP was truly interested in making healthcare work for the poor, working poor and middle classes they’d take notes from my employer and others like them.