My Heart Died A Little Bit Today

Editor’s Note: I wrote this poem back in December 2016. It still seems timely six months later.

Editor’s Note II: Still timely, but worse than expected February 2020

My heart died a little bit today
I watched the news and felt it skip a beat
Seeing the death and destruction on the streets
I remembered back when things seemed right
And tried to figure out when I first noticed the slide
Where was I when my country cried?

My heart died a little bit today
It didn’t seem that long ago
But I’m getting confused and not sure I know
There were other times, I’m now remembering
I was lost in my mind and not able to cope
But this seems different – like there is no hope.

My heart died a little bit today
How could this have happened while we just lived our life.
We’ve lost our way and can’t see the strife
Yet it’s all around and hard to miss
But we’re all going on doing the stuff we must
While our leaders have stumbled and lost our trust.

My heart died a little bit today
It’s like we’re drifting in a sea of hate and divide
While serious things keep slipping aside
Simple decisions are hard to make without a fight
Working together seems not an option any more
People are thinking and talking about a civil war.

My heart died a little bit today
We can now see our globe from afar
And know that all our life depends on a little star
We’ve lost respect for land and water
The air we breathe -- the animals and seed
Have lost their value and been replaced with greed.

My heart died a little bit today
It’s becoming hard to find the truth
And I fear what will become of the world’s youth
It is now okay to ignore the facts and make things up
Education and learning may fail to meet the test
As officials and leaders claim they know best.

My heart died a little bit today
We see the oceans rise, the ice melt and the sun beat down
Yet some in power simply reply with a silly frown
They claim it’s a hoax, an international trick and a university scam
Their goals are uncertain but they confuse the masses and increase the gasses
Now with victory at hand they smile with glee and hoist their glasses

My heart died a little bit today
I try to imagine what the rest of the world perceives.
What happened to the global leader of the free world they believed?
Disrupting partnerships, breaking agreements and doing deals
Some countries and individuals may see opportunity and financial gain
But many I suspect may think we’ve gone insane

My heart died a little bit today
We have a new style that seems to be catching on
Civility, statesmanship, politeness and respect are all but gone
Bullying, bigotry, name calling, lying without guilt are now accepted
There’s no excuse; it seems senseless and cruel
But with leadership’s endorsement it is becoming the rule.

My heart died a little bit today
By hook or crook they’re now in control and arrogant in style
Previous enemies shed hate and disgust as they fall into single file
The rest of us wait with our fate in the balance as suspicion abounds
They insist they will act with our best interest in mind
But the actions we witness seem counter to promises and more mastermind.

My heart died a little bit today
I now feel a little hollow, sad and confused – extremely perplexed
Not knowing quite how to react or what to say – seriously vexed
It’s unfamiliar, strange, odd, weird, baffling and inexplicable
My faith and trust is now buried deep in the past
As I hope the Founders’ wisdom and written structures will last.

My heart died a little bit today. . .

Bipartisan, Democratic-Led Health Care Reform

Billy Wynne[1], writing for the Health Affairs Blog has done a wonderful job of outlining some of the essential ingredients necessary to address the national health care insurance issue. The posting on April 4, 2017, entitled, “What Now?: A Four Step Plan For Bipartisan Health Reform” is precisely what I have been saying is needed for Democrats to use in the development of an “Affordable Care Improvement Act” that could provide a sensible alternative to the GOP cobbled up, disastrous proposal known as the American Health Care Act (AHCA)[2]. See my March 27, 2017, post, “Democrats Could Lead The Bipartisan Revolution.”

I have been advocating for Democrats to take the lead now that the GOP efforts have failed and the President has declared:

“I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare.  They own it -- 100 percent own it.”  And this is not a Republican healthcare, this is not anything but a Democrat healthcare. . .”

Following the GOP debacle[3], I said Democrats need to develop the "Affordable Care Improvement Act", designed to do what needs to be done to make the Affordable Care Act work better and introduce it in the House and Senate with 100% of the Democrats in both chambers supporting it. Simultaneously, they need to launch a massive public education and media campaign comparing the Republican and Democratic alternatives.

It is no wonder that the GOP is still divided on Healthcare? The House Freedom Caucus' 30+ votes will continue to block any effort that Speaker Ryan proposes. The GOP is getting so desperate to just pass something that they have now discounted rationale health care reform. The HFC's basic strategy is to reduce insurance costs for their constituents; an admirable goal, and they have found a guaranteed way to do it. Their "Plan" is don't cover anything including preexisting conditions. That should definitely reduce costs.

For example, items to be excluded under various GOP proposals in addition to preexisting conditions would include: outpatient care; emergency services; in-hospital care; pregnancy, maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative services and habilitative services (including treatment for kids with autism or cerebral palsy); lab tests; preventive services (like vaccines, cancer screenings like mammograms and colonoscopies and, coverage of birth control); and pediatric services.

One can only imagine that eliminating coverage for these essential health care services would definitely reduce costs. Speaker Ryan said, "Instead of imposing arrogant and paternalistic mandates [like coverage for the above listed items], it [GOP plan] would increase choice and competition, creating a vibrant market where every American will have access to quality, affordable coverage."

Democrats need to step it up, lead the way, and not just be the party of “No” opposing all of the iterations of the GOP’s American Health Care Act. Instead of trying to get a few Democrats to sign on to a fatally flawed GOP proposal, why don’t Democrats turn the tables, propose a plan that makes sense and get 25-30 moderate, “Main Street” or “Tuesday Group” Republicans to sign on.

Billy Wynne has now provided the substance of what is needed in a Democratic alternative. Below is an extremely brief overview, but I highly encourage reading Mr. Wynne’s complete proposal. Some of this is fairly technical, but I am including it to illustrate the extent of Affordable Care Act (ACA) [Patient Protection and Affordable Care Act (PPACA) 2010 HR3590, or Affordable Care Act (ACA) for short] improvement ideas that exist which could be advanced.

Step 1 – Enhance The Individual Market: Wynne lays out a number of critical “mechanical options” to enhance markets and maintain the basic elements of the existing Affordable Care Act including continued funding the cost-sharing subsidies currently available to individuals in the exchange markets; actively marketing and supporting enrollment in available coverage options; and more substantial changes that would improve competition and reduce costs. Some options suggested have strong conservative support.

One major suggestion is that in lieu of the initial GOP approach of delivering tax credits of equal value to individuals at different income levels, the existing subsidy structure could be expanded to all households so that none are required to pay more than 9.5 percent of their income for coverage, which de facto phases out the subsidy at high income levels. While ensuring affordability for the middle class, this will also entice a broader array of consumers to get into the market.

Other significant suggestions include establishing default enrollment, perhaps into the lowest cost plan available with an opportunity to opt out; and ending the now four-year extension of plans that do not comply with the consumer protections enacted in the ACA.

Step 2 – Rationalize The Employer Market: The majority of Americans with health insurance acquire it via their employer -- two key changes could be enacted to improve that market’s condition. First, the so-called “family glitch,” which denies subsidies to family members if one of them has access to relatively affordable individual coverage from their employer, should be fixed to allow those family members to acquire subsidized coverage elsewhere. Second, access to the small business tax credits in the ACA could be expanded to assist more workers in this market.

Allow small business employees to be merged into the individual market completely over time and provide large employers greater opportunity to provide their employees a fixed allotment with which they can purchase insurance in a private exchange. Finally, addressing the “elephant in the room” “. . .by capping or eliminating the “around four trillion dollars over ten years” of tax exclusion for employer sponsored insurance.

Step 3 – Embrace Medicaid & Step 4 – Don’t Forget The Big Picture: Wynne says “It’s time to drop the ideological divide over Medicaid, a program that covers 74 million Americans who truly have nowhere else to turn.” He also reminds that health insurance coverage is really just a method for helping consumers address the underlying issue: their health -- we need focus on patients and the providers who take care of them.

Yes, there are problems with House leadership putting such an alternative bill up for a vote, but that's why an aggressive education & media campaign is needed. Wynne concludes:

“The bottom line is that there are a host of policies that lawmakers and regulators can embrace to start drastically improving the condition of our health care system. This will not be easy, nor will it happen quickly. Policymakers of all political stripes can come together now, though, to begin the arduous process of identifying evidence-based solutions and building the necessary consensus to enact them. It’s a winning strategy for politics and for the public.”

While I agree, I don’t think the current GOP leadership or Republican base has the desire or will to lead this effort. They are too wedded to the 7-year mantra of “Repeal & Replace Obamacare.” That’s why Democrats must take the lead.

#BetterGovmt

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[1] Billy Wynne, J.D., is the Managing Partner of TRP Health Policy. A division of the Washington government relations firm Thorn Run Partners, TRP Health Policy combines industry-leading, actionable analysis and insight with sophisticated, informed advocacy to help healthcare organizations solve challenges and capitalize on opportunities in the Federal policy space.

                TRP Health Policy is also home to Policy Hub, an online portal and daily digest delivering in-depth intelligence on every important regulatory and legislative development impacting healthcare.

                Previously, Billy served as Health Policy Counsel to the U.S. Senate Finance Committee. He received his B.A. from Dartmouth College and his law degree from the University of Virginia.

[2]CBO report on H.R. 1628, the American Health Care Act, incorporating manager’s amendments 4, 5, 24, and 25, March 23, 2017.

[3]List and summary of opposition to GOP AHCA from nurses, doctors, hospitals, teachers, churches, and others, from Representative Jim Cooper (D-TN)

Articles & Resources of Interest

May 25, 2017: “Obviously we’re all united in opposition to Trumpcare. That’s easy. People know what we’re against, but we want to promote more what we are for.” A quote from Rep. John Conyers (D-Mich.), who has been introducing single-payer legislation (“Medicare for all.”) since 2003. House Democrats See Medicare for All as Answer to ‘Trumpcare’. H.R.676 now has 111 Democratic co-sponsors. There are 193 Democrats in the House.

"Mending Obamacare: Where Do Dems Go from Here?", The Democratic Strategist, Mar 28, 2017,  By J.P. Green https://goo.gl/CMPmh9

"Will GOP leadership work with Democrats? These Republicans hope so." The Christian Science Monitor, Apr 3, 2017. By Francine Kiefer. https://goo.gl/9H3ph5

"No ‘Death Spiral’: Insurers May Soon Profit From Obamacare Plans, Analysis Finds" The New York Times. Apr 7, 2017. By Reed Abelson. https://goo.gl/zPzqhR

HealthSherpa | Fast, Easy Obamacare Policy Information. Enter your zip code & find plans and prices. https://goo.gl/OZgWzn

Health Care Reform News Updates https://goo.gl/3LcBiP

“Funding H.R. 676: The Expanded and Improved Medicare for All Act – How we can afford a national single-payer health plan in 2014,” by Gerald Friedman, Ph.D., Department of Economics, University of Massachusetts, Amherst. https://goo.gl/xaUC9K

Physicians for a National Health Program - PNHP is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance. http://www.pnhp.org/

Medicare for all bill reaches a record-breaking 104 [and counting] co-sponsors in Congress
Posted on Wednesday, April 26, 2017

H.R.676 - Expanded & Improved Medicare For All Act, Sponsor:Rep. Conyers, John, Jr. [D-MI-13] (Introduced 01/24/2017), Cosponsor statistics: 108 current  https://goo.gl/dIx4Bg

Democrats Could Lead The Bipartisan Revolution

Sometimes an impossible situation presents options and opportunity that weren’t visible when your attention was diverted by bizarre happenings that seemed to defy reality. That is the case with the current Congressional health care debacle that unfolded Friday afternoon (March 24, 2017) with Russian spy stories and the fate of the U.S. Supreme Court playing in the background.

The House Republican caucus was frantically getting an education in the new D.C. math game called Freedom Caucus Integration. Woops, after 7 years and 50+ practice votes and with “repeal and replace Obamacare” reverberating in their brains the new math was not adding up -- they had to withdraw their bill.

Here’s how Freedom Caucus Integration math works: (218 votes needed to pass legislation) does not equal (193 Democrat no votes) plus (approx. 30 Freedom Caucus no votes).

Founded on January 26, 2015, the House Freedom Caucus (HFC) says it “gives a voice to countless Americans who feel that Washington does not represent them. We support open, accountable and limited government, the Constitution and the rule of law, and policies that promote the liberty, safety and prosperity of all Americans.”

The nine founding members and the first board of directors included: Scott Garrett (NJ), Jim Jordan (OH), John Fleming (LA), Matt Salmon (AZ), Justin Amash (MI), Raúl Labrador (ID), Mick Mulvaney (SC) [now Trump’s OMB Director], Ron DeSantis (FL) and Mark Meadows (NC). The group of nine founding members in their organizational meeting in Hershey, PA set as a criterion for new members that they had to be willing to vote against then House Speaker John Boehner on legislation that the group opposed. The HFC has now grown to approximately 30 members in districts indicated below.

Congressional District map for Freedom Caucus membership of the 114th Congress. Former members in light color.

Based on the new math, and emboldened by their ability to stop the passage of the American Health Care Act, the HFC is now the major player in Republican politics. They have virtually hijacked the Republican Party. If Democrats continue to hold tight in opposition to one-sided, partisan Republican legislation, nothing will pass the House without the approval of the HFC.

Thus, we’re not just talking about a health care bill, but the complete array of upcoming legislative initiatives that demand attention and political leadership – e.g. the budget; tax reform; immigration; infrastructure; raising the debt ceiling, etc. etc.

After hyping the importance of the need to repeal and replace Obamacare for the last four election cycles and relentlessly by Donald Trump during the Presidential campaign, the Republican response to Friday’s crushing defeat was simply we’re going to drop it and move on to something else.

While controlling the House, Senate and Presidency, the Republican answer to a health care system that according to House Speaker Paul Ryan (R-WI) is on a “death spiral” and according to President Trump is sure to “implode” and “explode” very soon, is to simply let it spin out of control. President Trump’s response: 

“So Obamacare is exploding. . . But we're very, very close.  And again, I think what will happen is Obamacare, unfortunately, will explode. . . It's going to have a very bad year.  Last year you had over a 100 percent increases in various places. . . So what would be really good, with no Democrat support, is if the Democrats, when it explodes -- which it will soon -- if they got together with us and got a real healthcare bill. I would be totally up to do it.  And I think that's going to happen.  I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare.  They own it -- 100 percent own it.”  

"And this is not a Republican healthcare, this is not anything but a Democrat healthcare.  And they have Obamacare for a little while longer, until it ceases to exist, which it will at some point in the near future.  And just remember this is not our bill, this is their bill. . . So now we're going to go for tax reform, which I've always liked. . .”

The Republican response is give up; blame it on the Democrats and move on to something else. Who cares about the millions of people and businesses who are being affected day to day by a broken health care system that is about to explode? It’s not the Republican’s fault.

So now is the time for the Democrats to stand up for what they believe in and take control of the health care debate. After all, the President said, “They own it -- 100 percent own it.” Now is the time for Democrats to lead the way to a bipartisan revolution. How?

Here’s how. The Democrats know there are problems with Obamacare. Some are market based and some have been inflicted by Republican manipulations and actions in D.C. and the states, designed to make the system fail.

Democrats need to develop (if they haven’t already) the Affordable Care Improvement Act, designed to do what needs to be done to make the Affordable Care Act work better and introduce it in the House and Senate with all the Democrats in both chambers supporting it. Simultaneously, they need to launch a massive public education campaign comparing the Republican and Democratic alternatives.

Now, let’s look at the new math again. (218 votes needed to pass legislation) equals (193 Democrat yes votes) plus (25 yes votes from moderate Republicans). Now where could Democrats find 25 moderate Republican votes?

How about the Main Street Republicans, a group of 70-80 that, “. . .share the belief that governing matters. They’re not coming to Washington to shut government down but to make it work more effectively. They’re conservatives, not obstructionists. They want to address the causes of voter discontent by finding solutions rather than trying to prove how uncompromising they are.” [Real Clear Politics, January 31, 2017].

Or, how about tapping Ohio Republican Governor John Kasich who said on the Sunday talk shows (3/26/17) "You cannot have major changes in major programs affecting things like health care without including Democrats from the very beginning." As reported in the Columbus Dispatch, Kasich calls on "reasonable" Republicans and Democrats to unite and craft a bipartisan fix for Obamacare that preserves expanded Medicaid coverage for the drug-addicted and mentally ill. Kasich said that parts of Obamacare are in "very serious trouble," but reforms can be enacted without throwing out coverage for the additional 700,000 Ohioans who gained health coverage under his acceptance of the Medicaid expansion.

So, it’s highly unlikely that Democrats are going to sign on to a Republican led initiative to repeal Obamacare. The Republican’s efforts to “repeal and replace” have failed and the GOP has given up and said it’s moving on to other issues.

It’s time for Democrats to lead the way; start the bipartisan revolution. Remember, the President says “you own it 100%.” If Republican’s won’t work with you and the health care system explodes, at least you will have tried to act responsibly and in the public interest. After all, there’s only so much you can do when Republican’s own the D.C. political system 100%.

#BetterGovmt

Note: the 218 votes needed to pass legislation is based on a full House with 435 members. There are currently 5 vacant seats so the current math changes slightly to 216 votes. But going forward we must assume a full House.

P.S. I also realize that the HFC or Republican leadership could attempt to block a Democratic led solution from coming to the House Floor. But, that's where the public eduction campaign comes in.