The Lack of Young and Healthy is Not the Cause of Health Care’s Death-Spiral

According to the Kaiser Family Foundation’s website, 49% of Americans obtain their health insurance as a fringe benefit at their place of work (the employer-provided group), 36% obtain their health insurance through a social program (mostly Medicare and Medicaid), 7% purchase their own health insurance (the self-payer group) and, 8% have no health insurance. Combined, the employer-provided group and the self-payer group represent the entire private-sector health insurance market in America (56% of the population).

When a member of the employer-provided group becomes catastrophically sick and/or injured, they can no longer work and therefore lose their employer-provided health insurance. They fall into the self-payer group just at the time when their health care costs are extremely high. The COBRA law allows them to stay on their employer’s health insurance plan for 18 months. However, they would have to pay the full cost of the employer’s plan. Since they are out of work, they cannot afford this. Instead, they purchase an Affordable Care Act (ACA) plan that is eligible for ACA subsidies.

Falling from the employee-provided group into the self-payer group just when the individual has developed the need for copious quantities of health care is risk dumping. The employer-provided group is saved the cost of the required health care and the self-payer group has no choice but to suck it up. Employers can choose who they hire (healthy), but the self-payers have no choice in who joins their group (unhealthy).

Of course, dependents of an employee (spouses and children) may become catastrophically sick and/or injured and remain on the employer’s health plan. Furthermore, some working couples obtain health coverage from both of their employers. Therefore, the risk that gets dumped may only be 10 to 20% of the employer-group’s overall risk. However, even 10% of the risk from that large group is almost equal to all the risk that is native in the 7% self-payer group. Thus, large annual premium increases for the self-payers will be an on-going occurrence in the current, flawed design of the law.

Prior to the ACA, self-payers purchased health insurance as individuals based on their own level of healthiness. The ACA forced self-payers to purchase health insurance as members of a group and therefore caused the healthy to pay more so that the unhealthy could pay less. This was the “shared responsibility” theme of the ACA. Since the healthy may someday become unhealthy, this seemed fair. However, the ACA created a system where the self-payers shared the responsibility for unhealthy people from both the self-payer group AND the employer-provided group.

The self-payer group has become the high-risk-pool for all private-sector health insurance. Because of this, the little-guy is paying outrageous premiums, and businesses are being shielded from the true cost of health care in America. This has caused the ACA self-payer death-spiral.

Although it makes a small contribution, the lack of the young and healthy purchasing health insurance is not causing the death spiral. The death spiral is caused by risk-dumping.

If the constitution had a uniform premium clause similar to the uniform tax clause, the ACA premiums would be ruled unconstitutional. The little self-payers’ premiums cover the cost of the risk for their co-inhabitants of the self-payer group PLUS for a good portion of the employer-provided groups’ risk.

We are beyond the point where the ACA’s preexisting-condition-safety-net would ever be eliminated. Therefore, we must fairly distribute the ACA’s "shared responsibility" among everyone in the 56% group of the private-sector health insurance market. After all, it is the entire 56% that is realizing the risk-sharing benefits.

The solution is to create a single, private-sector risk-pool where the premium for each individual’s health insurance is based on the average healthiness of that new risk-pool. Employers will still provide health insurance to their employees but they must purchase that insurance through an insurance company. Businesses would no longer be allowed to self-insure their healthy group of employees. Instead, they would pay an insurance company the premiums for their employees as members of the new risk-pool. Insurance companies will be prohibited from offering a plan to a business unless they offer the same plan to self-payers. This will assure fair play and provide health plan choices to the self-payers.

There will still be self-payers and employer-provided groups but they will be in the same risk-pool. This is a single-market, not a single-payer solution.

To demonstrate this proposal with numbers, consider that, per the New York Times, the 2017 nation-wide average premium increase for self-payers was 25%. According to a PricewaterhouceCoopers report, the 2017 nation-wide premium increase for the employer-provided group was 6.5%. The weighted average that results when combining these two groups is 8.8%. There are a lot more people in the combined group with which to share the risks.  8.8% is still too high of an annual increase when inflation has not seen 3% in a long time. More still needs to be done. But, compared to 25%, this is the biggest, single step forward we can make.

President Trump’s Obstruction of Justice vs. Sexual Harassment

Mr. Comey, really?

You state that you don’t know whether President Trump’s suggestion of ‘could you let the General Flynn “matter” go?’ raised to the level of obstruction of justice. Whereas at the same hearing you stated that because he was the president that you took his “could you” as a directive. But, did not inform anybody other than your subordinates of your “concerns” that you felt compelled to document immediately thereafter?

If you took it as a directive, why is it not obstruction of justice? Do you ever have the courage to make a decision when there are political considerations involved?

In the same hearing, you stated that maybe you were not strong enough with both the President and former Attorney General Lynch. Let me fill you in – YOU WERE NOT ONLY NOT STRONG ENOUGH, YOU ARE A WIMP. Furthermore, your testimony today convinced me that the President made the correct decision in terminating your employment from my company – the United States of American. Yes, I am a happy shareholder to see you gone.

In my corporate days, I taught a sexual harassment course. One of the principals taught was that if you felt as though you were being harassed by someone that you had the responsibility to inform the offender of the behavior that you found offensive. If the offender continued this behavior after you notified them, you have a basis of filing a sexual harassment claim. This principal did not apply to blatantly offensive behavior. The correlation here is that the President’s behavior was not blatantly illegal and he could have used your expertise to make him a better President for we Americans.

You, a lawyer and government wonk for life, did not think that President Trump could have used some guidance to help him establish his compass as a new president with no political or governmental experience? You could not muster enough courage to do that – not for President Trump, but for me and the rest of the citizens of America that are now watching the second political crises you have created in the past year?

As you stated during your testimony, you are gutless. But you do have a flair for bringing the attention to yourself. Even if it is at the expense of our great country. Now, please go away forever.

Secretary Clinton, not President Trump Aided the Russians

Yesterday, I was surprised to hear Secretary Clinton state that she had no fault in her loss of the presidential election. But what shocked me was that she proclaimed her private server to be a “nothing burger.” It was really the Russians that orchestrated the outcome of our elections.

Well, if it were the Russians that orchestrated the outcome of our election, where did they get the ammunition to perform the orchestration? Oh, it was by being able to hack into the Secretary of State’s private email. Secretary Clinton has stated that the drip, drip, drip of her hacked emails contributed to her losing the election.

On one hand, the private email server was just a mistake for which she “has already apologized.” She also claims that she never intentionally misused her private email server for classified information. But on the other hand, the information stolen from her private email server was so significant that the Russians hacked it to use against her in the election.

While the media are hyper-ventilating over the chance that some of President Trump’s campaign team may have been colluding with the Russians, they still do not consider Secretary Clinton’s handling of her emails as important. Our intelligence community has concluded that the Russians did attempt to interfere in our democratic process, that there is no evidence that the Trump campaign team colluded with the Russians, and that Russians hacked into Secretary Clinton’s private email server. Connect the dots from our intelligence community’s findings to ascertain who helped the Russians.

Is the private email server a nothing burger or the source of the Russian’s trove of negative information about Secretary Clinton that allowed the Russians to subvert our democratic process? That case of “extreme carelessness” looks more and more like gross negligence to me. If the email information was not classified, it was still of national security importance or the Russians would not have used it to interfere in our democratic process.