Why is Medicare the way it is?

The purpose of government is to improve and protect the lives of the governed.

Is the Medicare Advantage plan an admission that Medicare itself is unnecessarily incomplete?

Rolls-Royce Phantom Prices, Reviews and New Model Information
Free, but with strings.

A story: You receive a call from the wealthiest man on earth. He owns an infinite amount of money.

He tells you he’s in the mood to do a good deed.

He has picked your name randomly, not based on anything but the luck of the draw, and he is giving you a free, no-strings-attached, Rolls Royce automobile.

Well, actually, there are two small strings. You must choose between two Rolls.

One has no heater. The other has no air conditioning.

And you must wait until you are 65 years old before you pick your car.

This puzzles you, so you ask him, “Why would someone having infinite money decide that when does his good deed, he gifts you a car that is missing either a heater or air conditioner?”

And why must you wait until you’re 65?

What’s his purpose?

While you ponder that question, consider this: The federal government, being uniquely Monetarily Sovereign, has infinite dollars. It never can run short of its own sovereign currency.

The government provides you with Medicare, which comes in two basic “models,” Original Medicare and Medicare Advantage.

And you typically must wait until you are 65 to join (with certain exceptions).

But Medicare and Medicare Advantage have different options depending on many of your personal factors.

WHY? Why doesn’t Original Medicare simply cover all medical conditions for everyone?

The American Association of Retired People (AARP) published “8 Reasons to Change Medicare:

1. My prescription costs have jumped.
That happens usually due to one of two scenarios: You’ve been prescribed a new drug your Plan D policy doesn’t cover, or your current medicines have fallen off your Plan D’s formulary (list of covered medicines), Neuman says.

Each September, Part D prescription plans will send out a list of changes to drug coverage, giving you time to make sure your medicines are still covered.

If not, you can shop around for another plan or ask your doctor to apply for an exception in covering your favored medicine.

WHY? Why must a person pay extra for Part D, and why must that person shop around for a plan that covers all his medicines?

2. I’ve decided to spend my winters (or summers) in a different state.
Advantage plans typically charge more to go to doctors outside of their networks; in some cases they won’t cover any charges if it’s not an emergency.

So a Midwesterner might have to pay more to see out-of-network doctors while in Florida.

You need to read the details of your plan, or talk with a representative, to know where you stand. If you’ll be living a dual-residence existence for years to come, you might consider a switch to original Medicare, with the usual caveats.

WHY? Why the “in-network, out-of-network” rigamarole?

3. I need surgery and prefer a specific doctor.
Original Medicare allows patients to choose any doctor or hospital that accepts Medicare.

But if you’re in a Medicare Advantage plan and its surgeons don’t meet your needs, you may need a different MA plan or to switch to OM.

The people who really need to focus on whether doctors are in network are those who’ve suffered major problems like cancer and heart attack, says Joseph Antos, health care expert at the American Enterprise Institute.

“A specialist may be key to their treatment,” he says.

WHY? Why does one Medicare plan cover any doctors or hospitals that accept Medicare and the other plan doesn’t?

4. I’m super healthy and rarely need a doctor.
If you’re in original Medicare, all should be well: As a “pay-for-service” arrangement, not seeing the doctor isn’t costing you anything extra beyond your mandatory parts B and D monthly insurance premiums.

If you’re in an MA plan in which you’re paying a monthly premium on top of your standard Part B premium, that may be for a plan that offers lots of extras , such as gym memberships.

Consider switching to a lower-cost MA plan that doesn’t offer services you don’t plan to use in the coming year.

WHY? Why are there any premiums, and why does one plan not cover the “extras?

5. I’ve been diagnosed with a chronic condition.
A serious medical change should trigger a full review of your Medicare coverage. Make sure your Plan D policy pays for new prescriptions.

Consider the care you’ll need . If you want disease-specific programs, find an MA plan that offers them.

But if you will need lots of specialists, there’s an argument for OM. Making critical changes early can “really affect your pocketbook and save you money,” says Gretchen Jacobson, a vice president with the Commonwealth Fund.

WHY? Why the difference in plans? Why doesn’t one plan cover everything?

6. My income has dropped sharply.
If you are in original Medicare, your Part B monthly premium is locked in, but your Part D drug plan isn’t.

And there’s a chance you can find a lower-cost policy that covers the medicines you are on.

If you’re in an Advantage plan, consider a switch to a plan in which there is no extra payment on top of the mandatory Part B premium.

And you might qualify for help. Ask your state Medicaid office about Medicare Savings Programs. Find the state offices here or call 800-MEDICARE (800-633-4227).

WHY? Why is there a monthly premium? Why does one plan not even lock in premiums? Why the difference in costs?

7. My former employer is changing its retiree health benefits.
Some companies provide retirees with Medigap supplemental insurance, which covers many health costs not covered by OM.

If you have changes to your retiree benefit coverage, or for some reason that coverage no longer is offered, contact Medicare’s Benefits Coordination & Recovery Center (855-798-2627).

Someone can tell you whether you fall in the window in which Medigap insurers cannot deny you coverage based on preexisting conditions.

WHY? Why are some retirees not covered by Medigap supplemental? Why is there even a need for supplemental?

8. My regular doctor is no longer in network for my plan.
If you deeply want to stay with a doctor, ask directly whether he or she is moving to a different MA plan, accepting OM patients or dropping out of Medicare completely.

If you decide to make a change, make sure a short-term decision won’t affect your long-term coverage (for example, switching to original Medicare to temporarily stay with one doctor but sacrificing Medigap coveragefor the long term).

It might be safer to ask your doctor to recommend a colleague in your current plan.

I’m in need of serious dental care. Original Medicare doesn’t cover routine dental care costs, but many Medicare Advantage plans do.

If you don’t have your own dental insurance and can’t afford dentistry costs out of pocket, consider finding an MA plan that will cover a portion of the costs of your needed work.

Antos warns that figuring out what portion of your dental bills an MA plan will cover is complicated, so it helps to know what services you will use in the coming year.

WHY? Why does a person need to consult a crystal ball to guess what medical coverage will be needed at some unknown time in the future?

WHY?


HERE IS WHY: Our Monetarily Sovereign government has infinite funds. It can afford any expense, even without collecting a single dollar in taxes. It has ultimate control over the value of the dollar, i.e. inflation.

Thus, the federal government has the unlimited ability to fund comprehensive, no-deductible Medicare for every man, woman, and child in America. There is no financial reason why you, your family and everyone you know does not have free, total healthcare protection.

But . . . 

At the behest of the very rich, who run America, our information leaders promulgate the Big Lie that taxpayers fund federal spending, and that the federal government is in danger of running short of dollars if spending increases without tax increases.

You have been sold the bill of goods that “there is no such thing as a free lunch,” and that federal spending causes inflation, and that the phony Medicare “trust fund” is running short of money.

The rich do this to widen the Gap between the rich and the rest, for it is the Gap that makes them rich. The wider the Gap, the richer they are.

Better “Medicare for All” plans have been proposed, but they have been rejected supposedly because tax dollars are needed to pay for it. 

They aren’t. It’s the Big Lie, the sole purpose of which is to make the rich richer.

There is no other purpose.

Rodger Malcolm Mitchell Monetary Sovereignty Twitter: @rodgermitchell Search #monetarysovereignty Facebook: Rodger Malcolm Mitchell

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THE SOLE PURPOSE OF GOVERNMENT IS TO IMPROVE AND PROTECT THE LIVES OF THE PEOPLE.

The most important problems in economics involve:

  1. Monetary Sovereignty describes money creation and destruction.
  2. Gap Psychology describes the common desire to distance oneself from those “below” in any socio-economic ranking, and to come nearer those “above.” The socio-economic distance is referred to as “The Gap.”

Wide Gaps negatively affect poverty, health and longevity, education, housing, law and crime, war, leadership, ownership, bigotry, supply and demand, taxation, GDP, international relations, scientific advancement, the environment, human motivation and well-being, and virtually every other issue in economics. Implementation of Monetary Sovereignty and The Ten Steps To Prosperity can grow the economy and narrow the Gaps: Ten Steps To Prosperity:

  1. Eliminate FICA
  2. Federally funded Medicare — parts A, B & D, plus long-term care — for everyone
  3. Social Security for all
  4. Free education (including post-grad) for everyone
  5. Salary for attending school
  6. Eliminate federal taxes on business
  7. Increase the standard income tax deduction, annually. 
  8. Tax the very rich (the “.1%”) more, with higher progressive tax rates on all forms of income.
  9. Federal ownership of all banks
  10. Increase federal spending on the myriad initiatives that benefit America’s 99.9% 

The Ten Steps will grow the economy and narrow the income/wealth/power Gap between the rich and the rest.

MONETARY SOVEREIGNTY

COVID KID

COVID KID

COVID cases among children soared in September as kids returned to school
September was the country’s worst month for new COVID-19 cases and deaths among children as kids returned to the classroom, federal data shows.

The worrying trend comes as government officials appear poised to approve a vaccination for children under 12 in the coming weeks.

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She buried her 10-year-old who died from Covid. Less than 24 hours later, she was combating misinformation at a school board meeting
By Alisha Ebrahimji, CNN, Tue October 12, 2021
On Sunday, Nicole Sperry said her final goodbyes to her 10-year-old daughter, who died from Covid-19. Less than 24 hours later, she was behind a podium combating misinformation from parents at a Virginia school board meeting.

At a Chesapeake Public School District meeting in September, parents and community members denied the existence of the deadly virus and advocated for the removal of the district’s mask mandate, insisting the pandemic is over.

“My message for you and all that are listening is that Covid is not over, no matter what people who have been standing up here have said,” Sperry, who also teaches in the district, said during Monday’s meeting. “On September 27, during the last meeting, there were parents or concerned citizens that voiced misinformation to you.”

“They said that Covid is basically over and that healthy people do not die. When they were sharing this information, their opinions, the fact was, I was sitting next to my healthy daughter’s deathbed. She died five days after showing symptoms. I am sure they were speaking to what they’ve experienced, but they are wrong.”

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Pediatricians group warns of COVID-19 spread among children
Doctors who specialize in the care of children say in court documents submitted in a federal court case that the rise of the delta variant and beginning of the school year have dramatically increased the risks children face during the coronavirus pandemic
By DAVID PITT Associated Press
September 29, 2021,
DES MOINES, Iowa — The rise of the delta variant and beginning of the school year have dramatically increased the risks children face during the coronavirus pandemic, a group of pediatricians said in court documents submitted in the federal lawsuit against Iowa Gov. Kim Reynolds.

The American Academy of Pediatrics and its Iowa chapter filed a brief Tuesday with the federal court judge who is considering the lawsuit 11 parents of Iowa children and the disability rights group The Arc of Iowa filed last week. It seeks to strike down a Republican-passed measure that Reynolds signed into law in May that prohibits school boards from imposing mask mandates in schools.

The AAP said in the document filed with the court that their review of the research and the experiences of the front-line pediatric practitioners “prove beyond any doubt that universal mask policies in schools significantly reduce the spread of COVID-19 in school populations.” The group said the prevalence of pediatric COVID-19 has skyrocketed since the school year began, with 20% of all child cases since the beginning of the pandemic diagnosed between Aug. 13 and Sept. 16.

“This surge appears to be due to two principal factors: the resumption of in-person schooling (and particularly schooling in places without masks), and the emergence of the delta variant, which is more than twice as contagious as previous variants,” the AAP said in the court document.

The document said more than 5.5 million child COVID-19 cases have been reported in the United States as of Sept. 16, which is more than 15% of total cases in the country. Iowa has reported more than 56,000 child cases, the group said.

The testimonial challenges Reynolds’ longstanding opposition to mask mandates. She has questioned the effectiveness of cloth masks in schools and has suggested they may cause harm, saying parents should decide whether to mask their children.

The AAP said the state’s claims that masks are harmful to respiratory function, to children’s social or language skills, or for children with anxiety lack any scientific basis.

The AAP said more than 3,200 children were hospitalized due to COVID-19 between Aug. 13 and Sept. 16 among 24 states. That data coincides with reporting from Iowa hospitals that more children have been admitted for treatment of COVID-19 in recent weeks. Data released by state public health officials Wednesday indicated cases of COVID-19 in children age 17 and younger made up 24% of new positive virus cases in the state in the past week.

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COVID Vaccine For Kids Ages 5 To 11 Is Safe And Effective, Pfizer Says

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Anti-Vax Radio Hosts Keep Dying From COVID

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Thank goodness we have a Democratic President, so there is at least more intelligence in the White House. The Dumb Trumpers we fired. the rest of the staff is healthier and the patients are safe.

Vaccine mandates stoked fears of labor shortages. But hospitals say they’re working.

At Houston Methodist — one of the first American health-care institutions to require workers to get vaccinated against the coronavirus — the backlash was short-lived.

More than 150 employees were fired. There were legal battles and protests. But President and CEO Marc Boom has no regrets: 98 percent of staff have been vaccinated, and they and patients are safer as a result, he said.

“I can unequivocally say [it was] the best decision we ever made,” Boom said in an interview.

Houston Methodist is not alone in requiring its employees to be vaccinated. About 41 percent of hospitals nationwide — roughly 2,570 facilities — have some sort of vaccine mandate, according to data collected by the American Hospital Association, a trade group.

Others are expected to follow after President Biden announced last month that he would require most health-care facilities that accept Medicaid or Medicare funding — many of which also treat immunocompromised people who are at high risk of getting severely ill from covid — to vaccinate their employees.

Libertarians and Republicans sell the inflation myth to widen the Gap between the rich and the rest.

Let me begin at the end, with a summary: “Inflation,” or “price inflation” as some prefer to call it, never is the traditional “too much money chasing too few goods.” It always is “too few goods (and services).” Never, “too much money.”

Inflation always is caused by shortages of key goods and services, most often, energy, food, and/or labor.

I’ll explain by quoting from the following article:

High Inflation Is Here To Stay
But the people in power won’t even say as much, let alone do something about it.
BRUCE YANDLE
News that the September Consumer Price Index (CPI) rose by 5.4 percent on a year-over-year basis should be evidence enough for Federal Reserve Chair Jerome Powell, White House economists, and even the president to admit that we have more than a temporary inflation uptick on our hands.

Better yet, it’s proof that we should avoid adding fuel to the fire, even if it means cutting back on President Joe Biden’s multi-trillion-dollar American Rescue Plan.

“Fuel to the fire” means federal deficit spending. Mr. Yandle wrongly believes federal deficits lead to inflation. So let us address that myth directly.

If the myth were true, an increase in federal deficit spending should correspond to an increase in prices. But does it?

There is no relationship between inflation (red line) and changes in federal deficit spending (blue line).

We see absolutely no evidence that deficit spending has led to today’s, or any day’s, inflation. Sadly, the myth is taken for granted as truth, and seldom do we see anyone daring to doubt it.

Until recently, evidence of inflation exceeding 2 percent—the Fed’s traditional goal for inflation—has been dismissed as temporary or transitory, and for good reason.

Newly printed stimulus money has been passing through the system.

This, accompanied by serious supply-chain disruptions, might be over in another 12 months—if we’re lucky.

Ah, “supply-chain disruptions,” (aka shortages). Here, too briefly, Mr. Yandle hints at the fact that shortages are primary cause of inflation.

Does that give Mr. Yandle a clue? Apparently not:

Then in August, the Biden administration indicated that 2021’s economy would show as much as 4.8 percent inflation—but, with an optimistic spin, would fall to 2.5 percent the next year.

Meanwhile, there is some stimulus money pending in the yet-to-be determined infrastructure bill, and that complicates the issue.

Avoiding the hard truth or waiting before countering inflationary forces carries a cost. In this case, delays could mean harsher action later when, for example, the Fed hits the money brakes harder to cool the economy.

In such a case we might see interest rates head to the ceiling, construction activity and high-tech investment plummet, and the economy roll into a recession.

Mr. Yandle, staying with the false “spending causes inflation” trope, is not clear about what he means by “money brakes.” 

If he thinks that raising interest rates would lead to recession, you would expect there to be an inverse relationship between interest levels and Gross Domestic Product growth.

Is there?

There is not the expected inverse relationship between interest rates (brown) and GDP growth (green).

The above graph does not indicate Mr. Yandle’s expected inverse relationship between interest rates and GDP growth. In fact, we see something of a positive relationship.

Contrary to the knee-jerk, temporary reaction of the stock markets, high interest rates seem to correspond with high GDP growth.

Why? Probably because higher rates force the federal government to pump more interest (i.e. growth) dollars into the economy.

If by, “hit the money brakes,” Mr. Yandle means add fewer dollars to the economy, he undoubtedly is correct. Economic growth, by formula, requires money growth.

GDP = Federal Spending+ Non-federal Spending + Net Exports

Clearly, GDP growth relies on spending growth, and one seldom will see spending growth without money growth.

In 1978, the CPI was exceeding 7.5 percent and economic growth was slowing because of deliberate Fed action to cool the economy.

“Cool the economy” surely is not anyone’s goal, if “cooling” means reduced economic growth. But Mr. Yandle, and other economists love to use ambiguous terminology, to protect themselves from error.

Increasing interest rates does not “cool” an economy, but reducing federal deficits does “cool” economic growth.

Fed chair Paul Volcker “hit the brakes” long and hard and squeezed out inflation, along with employment growth.

 

Although rising interest rates didn’t cut into GDP, there is a very close relationship between the money supply (approximated by total debt) and GDP growth.

Again, Yandle, intentionally or unintentionally uses imprecise terms. In what way did Volker “hit the brakes”? We assume Yandle means “raised interest rates.”

If so, that clearly does not hit any economic brakes, nor ever has. Higher interest rates do not cause recessions.

But increases in money supply do cause increased GDP growth.

No one in authority wants to admit that the dollars we hold are systematically losing their purchasing power.

“No one”? Actually, everyone understands and says we are in an inflation. The only questions being, Why?” “How deep?” and “How long?”

The “why” is shortages. The “how deep” and “how long” depend on what the government does. If it spends to reduce shortages, the inflation will not be deep or long. If it does as Mr. Yandle wants — cuts spending — we probably will fall into a stagflation.

We are being quietly robbed by Washington’s dollar-printing press, with politicians calling the shots. The presses are not operating without drivers.

Wrong, wrong, wrong. As we have shown in the first graph (above), the “dollar-printing press” does not cause inflation.

Seemingly, it’s okay for the Fed chair to recognize CPI heading north, but only if he qualifies the trip by calling it temporary.

And while Washington analysts argue that COVID-19 disruptions are affecting just some key items, such as used cars and lumber—

“Just some key items”? Really? How about, virtually all items and labor? How about oil, food, electronics, rare earths, etc., etc.

— and that ports clogged with container ships waiting for workers, drivers, and trucks to be unloaded are the culprit—an analysis of the price movements in the July Consumer Spending Index, which is the Fed’s preferred inflation measuring rod, shows 84 percent of included items rising.

That’s right. Clogged ports and a shortage of workers and drivers, also leads to the product shortages that are the causes of inflation. Amazing that Mr. Yandle doesn’t see it.

The price increases are widespread, which suggests they are embedded.

“Embedded” into shortages.

What Mr. Yandle doesn’t recognize is that increased federal spending can cure inflation by curing shortages.

No matter how analysts choose to slice and dice the data, the answer is the same: The U.S. inflation rate calls for taking offsetting actions, such as avoiding direct distributions of stimulus or minimum family income dollars (though not harsh, invasive measures to cool off the economy).

The perfect right-wing solution to everything: Cut family income.

Let us not forget that inflation is not about rising prices. The rising price level is the result of an inflated money supply—all those trillions of stimulus dollars now out and chasing harder after goods and services.

Exactly and diametrically wrong. Inflation IS about rising prices and IS NOT about money supply. Despite all the counter-evidence, Mr. Yandle promulgates the “deficits cause inflation” myth.

Why does he avoid fact in favor of fiction? Here’s a hint:

BRUCE YANDLE is a distinguished adjunct fellow with the Mercatus Center at George Mason University.

Wikipedia: The Mercatus Center at George Mason University is a libertarian, non-profit, free-market-oriented research, education, and outreach think tank.

The Koch family has been a major financial supporter of the organization since the mid-1980s. Charles Koch serves on the group’s board of directors.

And there you have it. Yandle is a Libertarian being paid by a think tank that is supported (bribed) by the infamous and wealthy Kochs. Their goal in life seems to be to widen the Gap between the rich and the rest.

Widening the Gap is how the rich become richer. (Without the Gap no one would be rich. We all would be the same.) The rich widen the Gap, i.e. become richer, by gaining more for themselves or by forcing the rest to have less.

By blaming federal deficits for inflation, Yandle, Mercatus, and the Kochs are able to demand the next “logical” step, cut deficit spending on such social programs as: Social Security, Medicare, and all poverty aids.

Along with the military, those constitute the largest federal deficit expenditures.

Libertarians and Republicans falsely claim that deficit spending should be cut to cure inflation. They are deceptive and wrong.

The rich widen the Gap by bribing thought leaders:

  1. Economists are bribed via “think tank” salaries and payments to universities
  2. The Media are bribed via ownership and advertising dollars
  3. Politicians are bribed via political contributions and promises of lucrative employment later

Libertarians and Republicans wrongfully claim that deficit spending should be cut to cure inflation.

But, cuts to federal deficit spending do not cure inflation. Rather, spending cuts cause recessions and depressions, while punishing the poor and middle classes.

Yandle’s suggested cuts simply would make the rich richer and the rest, poorer. In short, Yandle’s cuts would widen the Gap between the rich and the rest, and we believe that is what he is paid to want.

Rodger Malcolm Mitchell
Monetary Sovereignty
Twitter: @rodgermitchell
Search #monetarysovereignty
Facebook: Rodger Malcolm Mitchell

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THE SOLE PURPOSE OF GOVERNMENT IS TO IMPROVE AND PROTECT THE LIVES OF THE PEOPLE.

The most important problems in economics involve:

  1. Monetary Sovereignty describes money creation and destruction.
  2. Gap Psychology describes the common desire to distance oneself from those “below” in any socio-economic ranking, and to come nearer those “above.” The socio-economic distance is referred to as “The Gap.”

Wide Gaps negatively affect poverty, health and longevity, education, housing, law and crime, war, leadership, ownership, bigotry, supply and demand, taxation, GDP, international relations, scientific advancement, the environment, human motivation and well-being, and virtually every other issue in economics. Implementation of Monetary Sovereignty and The Ten Steps To Prosperity can grow the economy and narrow the Gaps:

Ten Steps To Prosperity:

  1. Eliminate FICA
  2. Federally funded Medicare — parts A, B & D, plus long-term care — for everyone
  3. Social Security for all
  4. Free education (including post-grad) for everyone
  5. Salary for attending school
  6. Eliminate federal taxes on business
  7. Increase the standard income tax deduction, annually. 
  8. Tax the very rich (the “.1%”) more, with higher progressive tax rates on all forms of income.
  9. Federal ownership of all banks
  10. Increase federal spending on the myriad initiatives that benefit America’s 99.9% 

The Ten Steps will grow the economy and narrow the income/wealth/power Gap between the rich and the rest.

MONETARY SOVEREIGNTY

There are some things only the government should do.

Liberals think the purpose of government is to protect the poor and powerless from the rich and powerful. Conservatives think the purpose of government is to protect the rich and powerful from the poor and powerless.

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We are social animals. Rules, laws, codes, and mores are the natural consequence of that shared life. We establish governments to organize and formalize those rules.

The fundamental purpose of governments is to improve and protect the lives of the governed.

Those of a libertarian bent decry government as being intrusive upon their freedoms. Yet, the very purpose of laws is to limit any individual’s freedom to do harm to society. For humans, anarchy tends to devolve into chaos.

For arch Libertarians, every law (or at least every law they dislike, today) is pejoratively defined as “Socialism,” and that supposedly ends the argument. They opt for “small government” which tends to translate into, less taxing of the rich and fewer benefits for the poor.

But Socialism, like most “isms,” neither is bad nor good, in of itself. The assessment depends on conditions and how the “ism” is applied.

When Ronald Reagan famously declared, “Government is the problem,” he was President of one of the more successful governments on this planet — successful in the sense that it oversaw one of the freest, wealthiest, most powerful nations in history. Clearly, Reagen was not a Libertarian when he uttered those words, which in any event have been misconstrued and twisted over time.

And as it turned out, Reagan was not a small-business President.

Today’s Libertarianism leans heavily toward a form of Conservatism that favors the rich over the poor, to the point where virtually any benefit for the poor is denounced as encroaching on “our” (meaning the rich’s) freedoms.

Despite the “Socialism!” howls of today’s Republicans, and the “Big Government!” screams of the Libertarians, some things truly are better left to the federal government. Three of these things are discussed at: The military, the nation’s banks, and healthcare.

Sure you paid us insurance premiums, but do you really expect us to pay for your healthcare?

When deciding what should be done by government and what should be done in the private sector, here are five of the key issues:

Coordination:
America is a huge nation, huge in area, huge in population, with huge demographic and legal diversity. Very few businesses are able to coordinate nationwide projects. National coordination is best handled by a national government.

Labor supply
Even the federal government doesn’t employ sufficient labor to handle large projects. Example: The National Highway System. But the federal government has the means and political power to hire, set the rules for, and supervise private contractors nationwide.

Expertise
Some projects require a wide range of technical expertise. The federal government, far more than any single business, benefits from the extensive military and non-military research projects it funds.

Affordability and financial risk
Here is where the federal government really shines. It literally can afford anything and when speculative projects don’t work, the government can afford to absorb the loss.

Profit motive
This may be the most important reason for the government, rather than the private sector, handling a project: The profit motive. The federal government doesn’t have one.

It can go “where no man has gone before.” It can try experiments. It can fail and try again. It can focus on the mission rather than on the profit.

When NASA was instructed to send a man to the moon, all its attention was on that mission, not on whether moon flights might be profitable. Subsequently, it has sent missions all over the solar system.

Now, fifty years later, private industry has decided there might be money to be made in sending a few rich people briefly into space, though not even yet to the moon. That is the difference between the federal government’s efforts and private industry’s.

Left to its own devices, private industry might never travel to the moon. The financial risk too great; the profit, too uncertain.

And in that vein, I give you the following article:

Major Insurers Running Billions of Dollars Behind on Payments to Hospitals and Doctors

Posted on October 10, 2021 by Lambert Strether: “We should bail them out. Obviously.”

Jay Hancock, of Kaiser Health News.

Anthem Blue Cross, the country’s second-biggest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctorsbecause of onerous new reimbursement rules, computer problems and mishandled claims, say hospital officials in multiple states.

Anthem, like other big insurers, is using the covid-19 crisis as cover to institute “egregious” policies that harm patients and pinch hospital finances, said Molly Smith, group vice president at the American Hospital Association. 

Hospitals are also dealing with a spike in retroactive claims denials by UnitedHealthcare, the biggest health insurer, for emergency department care, AHA says.

What is the underlying problem? Money, or more specifically, the profit motive.

While the primary mission of Medicare and Medicaid is to pay for medical expenses, the primary mission of private-sector health care insurance companies is to make a profit.

A government agency can be inefficient, uncaring, and downright ignorant. So can private insurance companies. The single biggest difference is the profit motive, or the lack thereof.

Disputes between insurers and hospitals are nothing new. But this fight sticks more patients in the middle, worried they’ll have to pay unresolved claims.

Hospitals say it is hurting their finances as many cope with covid surges — even after the industry has received tens of billions of dollars in emergency assistance from the federal government.

“We recognize there have been some challenges” to prompt payments caused by claims-processing changes and “a new set of dynamics” amid the pandemic, Anthem spokesperson Colin Manning said in an email. “We apologize for any delays or inconvenience this may have caused.”

“Any delays or inconvenience” sounds benign, but it is a serious, often existential problem. Nurses rely on their salaries. Doctors, too. Hospitals have creditors who rely on repayment. And patients suffer emotionally and medically from those delays and inconveniences.

When an insurer reneges on its payment responsibilities, a falling domino effect occurs, where thousands of people are injured, some permanently.

Virginia law requires insurers to pay claims within 40 days. In a Sept. 24 letter to state insurance regulators, VCU Health, a system that operates a large teaching hospital in Richmond associated with Virginia Commonwealth University, said Anthem owes it $385 million. More than 40% of the claims are more than 90 days old, VCU said.

For all Virginia hospitals, Anthem’s late, unpaid claims amount to “hundreds of millions of dollars,” the Virginia Hospital and Healthcare Association said in a June 23 letter to state regulators.

Clearly, Anthem values its own finances above the finances and health of many thousands of people.

Nationwide, the payment delays “are creating an untenable situation,” the American Hospital Association said in a Sept. 9 letter to Anthem CEO Gail Boudreaux. “Patients are facing greater hurdles to accessing care; clinicians are burning out on unnecessary administrative tasks; and the system is straining to finance the personnel and supplies” needed to fight covid.

Complaints about Anthem extend “from sea to shining sea, from New Hampshire to California,” AHA CEO Rick Pollack told KHN.

Substantial payment delays can be seen on Anthem’s books. On June 30, 2019, before the pandemic, 43% of the insurer’s medical bills for that quarter were unpaid, according to regulatory filings. Two years later that figure had risen to 53% — a difference of $2.5 billion.

Anthem profits were $4.6 billion in 2020 and $3.5 billion in the first half of 2021.

While Anthem thrives, everyone else suffers. The villain all of this is not just Anthem, but the profit motive. That is where the problem begins.

If Anthem were like the federal government and wasn’t concerned about profits, everyone would have been paid, and those payment dollars would have benefitted the entire economy.

Alexis Thurber, who lives near Seattle, was insured by Anthem when she got an $18,192 hospital bill in May for radiation therapy that doctors said was essential to treat her breast cancer.

The treatments were “experimental” and “not medically necessary,” Anthem said, according to Thurber. She spent much of the summer trying to get the insurer to pay up — placing two dozen phone calls, spending hours on hold, sending multiple emails and enduring unmeasurable stress and worry.

It finally covered the claim months later.

Apparently, the claim was a good one. Anthem paid it, not out of the goodness of their hearts, but because the claim should have been paid. The delay was unwarranted. The fundamental purpose of the delay was the profit motive.

“It’s so egregious. It’s a game they’re playing,” said Thurber, 51, whose cancer was diagnosed in November. “Trying to get true help was impossible.”

Privacy rules prevent Anthem from commenting on Thurber’s case, said Anthem spokesperson Colin Manning.

When insurers fail to promptly pay medical bills, patients are left in the lurch. They might first get a notice saying payment is pending or denied. A hospital might bill them for treatment they thought would be covered. Hospitals and doctors often sue patients whose insurance didn’t pay up.

Yes, there are times when Medicare refuses to pay, but those have to do with disagreements about the rules and coverages. The federal bureaucrats making those decisions are not constrained by profits or affordability.

They simply interpret the rules. They have no m oneyreason to lean away from the creditor.

Hospitals point to a variety of Anthem practices contributing to payment delays or denials, including new layers of document requirements, prior-authorization hurdles for routine procedures and requirements that doctors themselves— not support staffers — speak to insurance gatekeepers.

“This requires providers to literally leave the patient[’s] bedside to get on the phone with Anthem,” AHA said in its letter.

Ah, the old “prior authorization” insurance scam. How many millions of patients have been tripped up by that one?

A frightened, inexperienced patient is told he/she needs a procedure. In a panic about her health, her personal life, and the future, she neglects to tell the insurance company in advance. Payment is denied, not because the procedure isn’t proper, but simply because she didn’t go through the formality of prior authorization.

Gotcha!

Medicare seldom requires prior authorization.

Anthem often hinders coverage for outpatient surgery, specialty pharmacy and other services in health systems listed as in-network, amounting to a “bait and switch” on Anthem members, AHA officials said.

“Demanding that patients be treated outside of the hospital setting, against the advice of the patient’s in-network treating physician, appears to be motivated by a desire to drive up Empire’s profits,” the Greater New York Hospital Association wrote in an April letter to Empire Blue Cross, which is owned by Anthem.

Medicare and Medigap do not use provider networks. With Original Medicare and Medigap you can use any healthcare provider that accepts Medicare-assignment.

With Original Medicare, you do not have to wander through the “in-network, out-of-network” jungle.

Anthem officials pushed back in a recent letter to the AHA, saying the insurer’s changing rules are intended partly to control excessive prices charged by hospitals for specialty drugs and nonemergency surgery, screening and diagnostic procedures.

A for-profit organization has to worry about “excessive prices. For the government, “excessive” prices merely mean that the federal agency will pump more stimulus dollars into the economy.

Claims have gotten lost in Anthem’s computers, and in some cases VCU Health has had to print medical records and mail them to get paid, VCU said in its letter. The cash slowdown imposes “an unmanageable disruption that threatens to undermine our financial footing,” VCU said.

“Lost” is the way a for-profit organization increases its profits.

United denied $31,557 in claims for Emily Long’s care after she was struck in June by a motorcycle in New York City. She needed surgery to repair a fractured cheekbone. United said there was a lack of documentation for “medical necessity” — an “incredibly aggravating” response on top of the distress of the accident, Long said.

The Brooklyn hospital that treated Long was “paid appropriately under her plan and within the required time frame,” said United spokesperson Maria Gordon Shydlo. “The facility has the right to appeal the decision.”

United’s unpaid claims came to 54% as of June 30, about the same level as two years previously.

When more than half of all claims are not paid, something is terribly wrong. There simply cannot be that many false claims.

When Erin Conlisk initially had trouble gaining approval for a piece of medical equipment for her elderly father this summer, United employees told her the insurer’s entire prior-authorization database had gone down for weeks, said Conlisk, who lives in California.

“There was a brief issue with our prior-authorization process in mid-July, which was resolved quickly,” Gordon Shydlo said.

Brief issue” is private insurance-speak for “the longer you have to wait, the more money we make. Maybe you’ll just give up, altogether.”

When asked by Wall Street analysts about the payment backups, Anthem executives said it partly reflects their decision to increase financial reserves amid the health crisis.

Decision to increase financial reserves” is insurance-speak for “decision to make more profits.”

“Really a ton of uncertainty associated with this environment,” John Gallina, the company’s chief financial officer, said on a conference call in July. “We’ve tried to be extremely prudent and conservative in our approach.”

Translation: “To be really prudent and conservative, we’ve decided not to pay claims. You’d be amazed at how that reduces our costs. But you better send in your premiums on time.”

Several health systems declined to comment about claims-payment delays or didn’t respond to a reporter’s queries. Among individual hospitals “there is a deep fear of talking on the record about your largest business partner,” AHA’s Smith said.

“Business partner” is a synonym for “the guy who is squeezing my reproductive organs in his fist.”

Alexis Thurber worried she might have to pay her $18,192 radiation bill herself, and she’s not confident her Anthem policy will do a better job next time of covering the cost of her care.

“It makes me not want to go to the doctor anymore,” she said. “I’m scared to get another mammogram because you can’t rely on it.”

And that is exactly what your insurance company wants. Plenty of premiums with no costs. An excellent business model.

That is where the profit motive can devolve in the health care business.

Health should be a recognized basic human right. In a Monetarily Sovereign nation, federal support of healthcare costs taxpayers nothing. Comprehensive, no-deductible Medicare for All is the correct solution.

But, until the public realizes it, it won’t happen. The politicians are too well-bribed by the insurance industry.
Rodger Malcolm Mitchell
Monetary Sovereignty
Twitter: @rodgermitchell
Search #monetarysovereignty
Facebook: Rodger Malcolm Mitchell

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THE SOLE PURPOSE OF GOVERNMENT IS TO IMPROVE AND PROTECT THE LIVES OF THE PEOPLE.

The most important problems in economics involve:

  1. Monetary Sovereignty describes money creation and destruction.
  2. Gap Psychology describes the common desire to distance oneself from those “below” in any socio-economic ranking, and to come nearer those “above.” The socio-economic distance is referred to as “The Gap.”

Wide Gaps negatively affect poverty, health and longevity, education, housing, law and crime, war, leadership, ownership, bigotry, supply and demand, taxation, GDP, international relations, scientific advancement, the environment, human motivation and well-being, and virtually every other issue in economics. Implementation of Monetary Sovereignty and The Ten Steps To Prosperity can grow the economy and narrow the Gaps:

Ten Steps To Prosperity:

  1. Eliminate FICA
  2. Federally funded Medicare — parts A, B & D, plus long-term care — for everyone
  3. Social Security for all
  4. Free education (including post-grad) for everyone
  5. Salary for attending school
  6. Eliminate federal taxes on business
  7. Increase the standard income tax deduction, annually. 
  8. Tax the very rich (the “.1%”) more, with higher progressive tax rates on all forms of income.
  9. Federal ownership of all banks
  10. Increase federal spending on the myriad initiatives that benefit America’s 99.9% 

The Ten Steps will grow the economy and narrow the income/wealth/power Gap between the rich and the rest.

MONETARY SOVEREIGNTY