Something some politicians obviously don't understand about healthcare

We (the media, the politicians, regular people who care) are all agog about the most recent development in the discussion about the nation's health care:  the GOP proposal to repeal (partially) the Affordable Care Act.

I've heard a quote from a Congressman that uninsured people can always use the emergency room for their health care.

No!  That is wrong on so many levels, so let me hit the high points.

The emergency room is the most expensive environment to receive routine care.  The reason, primarily, is that the fixed costs associated with an ER are high because the ER has to be prepared to treat the most critically injured or ill patient.

Next high point:  An ER, by law, cannot turn a patient away regardless of the patient's ability to pay.  When an ER sees an uninsured patient (at an average cost in excess of $1200, that patient must pay out of pocket.  Since few of us are prepared to fork over that much money, the care falls into the category of "uncompensated".  But a hospital has to stay in business, so how does it cover the cost of that care?

A public hospital, underwritten by a city or county government, turns to the taxpayer to make up for the loss.  In addition, it may, like the private hospital, attempt to shift costs to insured patients, by raising prices to recover the costs, hopefully, from those patients' insurance companies.

One of the motivations behind the Affordable Care Act  was to provide insurance coverage to more people so that they could go to their doctor for their routine care and not strain the health system's emergency rooms' resources.

Twenty odd years ago, when Tennessee conducted the great Tenncare experiment, converting Medicaid to a managed care model and expanding Medicaid coverage, the hospitals were primary supporters of the effort, for precisely this reason.

So reducing the number of insured lives will eventually hit everyone's pocket, either through taxes or through higher insurance costs.

So, please, get it out of your head that the ER is the best safety net for uninsured people.  It doesn't provide appropriate level care and it is too expensive (especially when you multiply one visit by 24 million lives).

What do you think?

The Military

Let me say from the outset that I'm going to try to avoid getting myself into a lot of trouble, but am likely to fail.

This issue most recently made it into my thought processes during the Republican presidential primary season.  Everyone, it seemed, felt that the military needed to be rebuilt and that more money needed to be spent on the military.

That led me to investigate just how much money we appropriated for the military.  The first thing I learned was that the spending is divided into two categories, discretionary and mandatory.

The latter is formula driven and consists of Social Security, Medicare and Health (including Medicaid), Veterans' Benefits, Transportation, Food and Agriculture, and some other areas.  It is the larger portion of the budget (about $2.45 trillion for FY 2015).  However, it should be noted that some of the largest portion of these expenses are offset by the Social Security and Medicare Trust funds, into which payroll taxes have been paid over the course of the working lives of citizens.  

The smaller portion, discretionary spending, (about $1.11 trillion for FY 2015) is determined by Congress.  Congress decides how much is going to be spent and on what.  For FY 2015, the appropriation for all things military was $598.49 billion or about 53% of the total for discretionary spending.  So, defense spending is clearly the highest priority when it comes to discretionary spending.  Lower priority categories include government (to fund the executive, legislative, and justice departments), education, additional Medicare and Veterans' Benefits spending, housing, etc.)    See Federal spending for additional details and an informative description of the budget process.  

Do we ever think about the details of that spending?

We pay the salaries and benefits for military personnel, we pay for equipping those personnel and for the development of weaponry.  We pay for the upkeep of some 800 military bases throughout the world.

I'd like to raise a couple of questions for pondering.  First, does anyone else wonder about our having military bases all over the world?  Does this trace back to the "manifest destiny" philosophy of the 1800s?  For an excellent summary, read US bases in foreign countries.
Most of the growth took place during World War II and the Cold War.  Has anyone noticed that WWII is over as is the Cold War?  Why do we still have all these bases?  Does anyone wonder why we even have a military base on Cuba of all places?

Now, the Trump Administration wants to increase defense spending by 50+ billion dollars, alleging that our military has fallen into disrepair.  Really?  Does anyone really believe that?  If so, what has the Congress been doing with the incredible amounts of money we've already spent on defense?  How could they let it fall into such a tattered condition?

Why do we spend more on our defense than the next 10 countries combined, at least 8 of whom are considered allies?

What do you think the reaction would be if, say, Russia built a base in Canada?  Or France built a base in New York state?  Wouldn't we complain of imperialist intentions?

We do not have an emperor, yet, but with the number of bases we have girdling the globe, it looks as though we have an empire.

Let's assume that we really don't need that extra $50 billion to be spent on the military.  Let's also assume we really don't even need the $600 billion we're spending now, that we could "live" on spending $400 billion.  Imagine what could be done with that extra $200 billion dollars.  How much infrastructure could we address?  How much healthcare and research into cancer, ALS, diabetes, and other debilitating diseases could we support?  How could education benefit?

I think we should rethink our priorities.  What do you think?