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The True American

Arthur Jackson Wheeler, CHC

July 6,2018

First Edition

This is the First Edition of the “new” True American. The “original” True American was published in 1845 by Cassius Marcellus Clay, a relative of the famous speaker and Senator Henry Clay, also from Kentucky. Cassius M. Clay argued unsuccessfully for a gradual emancipation. The failure of the American people to listen to his arguments resulted in the Civil War.                                          

Midterm Common Sense: Democrats are going on the offensive on health care with some Big ideas. According to Ricardo Alonso-Zaldivar’s AP article in January, the Democrats are shifting to offense on health care, emboldened by successes in defending the Affordable Care Act. They say their ultimate goal is a governement guarantee of affordable coverage for all. That’s great for BCS Consultants, because that is what we have been advocating for over a year now. Tim Kaine (D-Va.) is quoted as saying, “Were tired of just playing defense. It is now time to talk about the next Big idea. It is a good time for everybody to put their Big ideas on the table.” So far, in this 115th Congress, the Democrats have introduced at least 5 major Health Reform Bills and come up with a few more proposals that have not yet been introduced as potential legislation.

And in the wake of the last presidential election, the DNC and Bernie Sanders are still making waves with the “Medicare for All” proposal and it will drive votes for the Democrats in the mid-term elections. Elizabeth Warren has successfully urged all democratic candidates running for office to make health care an issue in their campaigns. In the conservative state of Kentucky, Amy McGrath won the Democratic primary in the 6th Congressional District, over the very popular Mayor of Lexington, David Gray, with an Ad decrying Andy Barr's support for Mitch McConnell’s opposition to the ACA/Medicaid expansion. In the liberal state of New York, Alexandria Ocasio-Cortez beat Joe Crowley, the 4th most powerful Democrat in the House, by advocating the expansion of Medicare to people of all ages.

Statue of Liberty

Health insurance is a vital issue in the upcoming midterms and the Democratic candidates have an opportunity to overwhelm the Republicans with this “Medicare for All” issue. Most Republicans are AWOL (absent from one’s post without intent to desert) on this issue.

Our seniors with Medicare Advantage coverage have all the advantages that the democratic politicians are promising right now, present day, here and now. This is doing “Medicare for All” the Right way. Obviously, Medicare Advantage is an important part of the Medicare system and covered by the provisions for Medicare Part C. This program has a proven track record. It started with broad bipartisan support with the passage of the 1997 Balanced Budget Act. Medicare Advantage continues to benefit from strong bipartisan congressional support. There is widespread agreement that competing health plans are the key to re-invigorating Medicare, the nation’s largest health insurance program. So, why do the democrats that advocate “Medicare for All” want to re-invent the wheel? This is a damn good question!? Why don’t you ask them?

Mary in Front of the Capital

Contact Your Congressional Representative: So, “What’s in your Wallet?” What program would you like your political Party to promote? If my arguments for “Medicare Advantage for All” make sense to you, download this document and share it with your friends. If your congressional representatives DO NOT HEAR FROM YOU ON THIS ISSUE, who are they going to hear from? Contact your Congressional Representatives at:

1-202-224-3121 or send them an email from their official web pages. This one telephone number will connect you directly with each one of your representatives and you will be allowed to leave personal voicemail-messages with each one of them. Send them to my website! Their Contact web pages also allow you to compose personal emails. Presumably, their staff will summarize your ideas and relay their substance directly to your representatives. How can you get more responsive?

“We the People” want high quality affordable health insurance coverage for everybody. Democrat candidates are running for their offices advocating “Medicare for All”. Republican candidates are concerned about runaway costs and long-term access to health care and the failure of the ACA. Both of our political parties are very concerned about the up-coming midterm elections. Now is our chance to do something about this problem!

Give your Rep’s this “winning” idea and remind them that if they want to win elections and stay in office, they need to care about this issue and give use some help with it right away, in the Right Way! Please go to: www.bcsconsultants.net for more details.

I ask every politician I write to, the following multi-part questions:

  1.  If there was a health insurance program that meets all of the principles laid out in the various proposals and bills that you have read, signed or introduced, and
  2. If the program had broad bi-partisan support in Congress, and
  3. If the program covered almost 3 x times the number of people as were ever covered by the ACA / Obamacare, and
  4. If it was private market, small governement and growing like a weed, because everybody that uses this program likes it so much, and
  5. If it was less expensive per capita (requiring a lower gov't expenditure per person) than the cost of Obamacare's marketplace insurance programs, and finally
  6. if your political party’s candidates could get behind such a plan and promote it,

Q. do you think it would help their chances of winning their seats in the upcoming mid-term elections?

The answer of course is "yes." If you are a Democrat and you are promoting "Medicare for All", the Republicans are going to counter that proposal with the fact that your program will cost 32.3 Trillion Dollars over ten (10) years.” And, the fee-for-service Medicare Plan A, B and D probably will cost that much! Our country has just exceeded a total of 20.7 Trillion of dollars in debt. There are a lot of conservatives that don’t want this situation to continue. Taking on a burden that may exceed the total national debt we now have over ten years would be insane. This high cost argument against Medicare for All will prevail as long as the Republicans maintain their majority in Congress.

However, what would happen if the Republicans came up with an even more enlightened incarnation of the call to expand Medicare to All? What if they decide to counter the Democrats with a Republican “Medicare Advantage for All” proposal, which is the most cost-effective way to do it?

If the Republicans ever realize that they could propose extending the Medicare Part C - Medicare Advantage Program in a cost effective, conservative, small government fashion, the Democrats will be in real trouble!

Because, once the Republicans propose it, the Democrats will be forced - NOT to support it. This is because the Republicans came up with the IDEA! This is called the Resistance as we all now know it today. The pronounced motus operandi for the Democratic party and the liberal progressive media is to resist anything and everything that Trump and the Republicans are in favor off, no matter how good it is for the people. Honestly, this partisanship is what I hate most about our two-party system.

And so it will go with “Medicare for All”. The Democrats would normally be in favor of extending “Medicare Advantage for All” (because the MA program has some democratic roots and because it extends the Medicare coverage to everybody regardless of age). But now, because the Democrats already have their versions of “Medicare for All”, trying to make the federal government the Big “insurer” or creating a Big Non-Profit “insurer”, they may not want to support “Medicare Advantage for All”(MAA).

The truth is the American Public is not going to know the difference between MEDICARE ADVANTAGE FOR ALL and “MEDICARE FOR ALL, and if Republicans support the Medicare Advantage for All program first, they will be able to vilify the Democrats as being two faced and insincere!

The case that Medicare Advantage for All is the “Right” thing to do has been made! It is, after all extending Medicare to "ALL" (just like the Democrats have been saying they would like to do). Would it be possible for the Democrats to support a Medicare Advantage for All Bill? Maybe, but because MAA is free market, using the public-private partnership, small governement, and real insurance with capitation reimbursement (like the Republicans want in their Medicaid Reforms), it is more likely that MAA will be a solid Republican answer to the need to fix Obamacare.

Background: The republicans have failed with their promise to repeal and replace the ACA/ Obamacare. They have been unable to come up with a viable health insurance reform act of their own. They have muddled the legislative requirements for administering the program, withholding CSR payments and the risk-corridor payments from the carriers. They reduced the ACA open enrollment and cut CMS’s meaningless advertising campaign. They have neutered the individual mandate and refused to defend the ACA’s constitutionality in the courts.

However, both parties are really to blame for the failure of the ACA. The Democrats and Republicans have both failed to pass the necessary market stabilization funding to keep ACA going smoothly. They have virtually stifled competition in the health insurance markets by presided over the creation of a governement sponsored cartel and now the Americans living in most of the official county jurisdictions in the United States have only one health insurance company from which to choose. And, finally, both political parties have critically failed to repeal the onerous “Cadillac tax”, the health insurance tax and the medical device tax that hang over the insurance companies, who are doing their best to extend affordable health insurance to the American people. And, nobody seems to care.

From our perspective, the very structure of Obamacare is the real culprit and until both parties recognize that fact and do something about it, things are not going to get any better. While democratic candidates for federal office may have a degree of flexibility over what they may advocate in their campaigns, they hit a “hot’ button” when they campaign for “Medicare for All” in the wake of Republican failure to repeal and replace Obamacare. Even Republican Party stalwarts are reeling from this failure and still trying to figure out what to do about it. This failure was one of the greatest disappointments for conservative and libertarian activists in our history. This disappointment has turned into anger toward Republicans in general. And, the Democrats that run on the health care issue reinforce their Party’s earthy vitality and the success of their “resistance” in their fight for health care affordability and access for their caring constituents. The problem for both political parties is the absence of a viable health insurance “Plan that will Work”. Medicare Advantage (Medicare Part C) is the Program That Will Work!

We can’t blame Congress for not being able to solve this problem. Our representatives are lawyers, not health insurance executives. They have no idea what it takes to run a health insurance program any more than they understand their own health insurance coverage. In Congress more than 90% of our congressional representatives are covered by comprehensive health insurance contracts through the Federal Employees Health Benefits Program (FEHB). Most of them choose the High Option BCBS coverage. Federal Employees in general have consistently been more favorable toward FEHB than ACA/Obamacare and as a result, congress has exempted itself from the ACA law. They exempt themselves from the laws they pass all the time. Obamacare is good enough for the tax-payers, but it is NOT good enough for our congressional representatives, even though the tax payers cover the cost of both programs for them and they pay next to nothing for their coverage. Even President Obama does not have Obamacare for his family. How can we expect our congressional representatives to know how to fix a program with which they have ZERO (0) experience?

Senator Bernie Sanders Medicare For All Plan: That did not stop Bernie Sanders(D-Vt.) from developing the concept of “Medicare for All”. It sounds great, doesn’t it? He has a Bill in the Senate that has a slew of the democratic senators signed on to it. Representative John Conyers, Jr. (D-Mich.) has also re-introduced a related National Single-Payer Health Care Bill in the House.

Do you know which entity Bernie Sanders has picked as the “insurer” in his proposed Medicare for All program? It is not actually a company or an organization per se, it is a “person”. In his Senate Bill, Bernie Sanders is proposing to make the “Secretary” (presumably the Secretary of Health and Human Services) the “insurer”! What Bernie is trying to do with his legislation is make the federal government into an insurance company. The average American citizen knows our government is NOT an insurance company. The United States Governement was never intended to be an insurance company. Our Founding Fathers did not explicitly include being an insurance company as a responsibility of our government under the Constitution. The very act of trying to legislate making the Secretary of a Department of the Executive Branch of our government, into an “insurer” could be, in and of itself, construed by some, as Un- American! Even that suggestion will have Bernie’s ears burning.

After all, Bernie Sanders is not a business man. He is not an expert on health insurance. He has probably never done anything in this regard beyond making claims for himself and his family under the FEHB. He doesn’t realize that the federal governement is not an” insurer”. The federal government does not insure anything. It is a “payer”, and not even a good single-payer. But Bernie has made a Freudian slip with the verbiage of his “Medicare for All” Bill. He has identified the need for an insurer. However, in my opinion, rather than the Secretary, he needs a real health “insurer”. He needs an insurer that knows how to quantify health risks and underwrite them. A real health insurer that pays claims and takes responsibility for making commitments on the ability to pay claims. In short, Bernie needs an insurer with the ability to meet the obligations of a “Medicare for All” program, deliver the program to the people, negotiate with providers and develop health and wellness programs. Even though Bernie knows that he needs all these things, I don’t see that he has made provision for many of them in his “Medicare for All” Bill in the Senate.

Perhaps this is too strong a criticism of Bernie Sanders? We all understand what Bernie is trying to do. He fervently and admirably believes that health care is a Right for all Americans citizens, like our freedom of speech. He wants everyone to have it and he is just trying to get the government to make that happen. So, we can forgive Senator Bernie Sanders because we understand his passionate good intentions. His followers don’t need to forgive him. They don’t care how he does it, as long as he solves the problem! But here’s the BEEF? We the People do not absolve Bernie, or any of the other senators, from knowing what they are doing. Their virtuous intentions do not absolve them from knowing how BEST to do it, nor their obligation to DO IT RIGHT! After all, isn’t that what we elected them for? OK, so we can disagree on how best to do it, but we don’t have to pretend that there is only “one” way to do it or that the “best” way to do it, is to have Big Government do it.

Bernie Sanders, bless his heart, is a socialist. He looks around the world and he sees that most governments have taken over the responsibility of providing health care for their people. They haven’t done so by treating it as a constitutional Right of the people, as much as they have just backed into doing it, because of their unique circumstances. They needed to provide adequate health care for their people and that was their only path forward.

In the Unites States we DO NOT lack the ability to provide adequate health care for our people. Anyone that can come from other nations around the world, abandon their national health systems. They come to the United States for their health care. We have arguably the best health care system in the world. When the Arabs wanted to build a mega-center for the best health care in the world in Dubai, they came to America and asked our great university medical schools to help them set up their health care facilities, to attain their desired goal. So, when the rich and famous go to Dubai for their health care, it is like coming here. Our health system is an American innovation. Many of our university medical schools, teaching hospitals and interdisciplinary clinics were built by true visionaries in the field of medicine. Our health care system needs to be respected, as being more than a tool of a capitalist elite bent on depriving our own people of health care! It is a huge mistake to try and cheapen the qualities of our medical system by making it more like other government-run systems throughout the world.

Our health care system in the United States has grown to become one of the largest sectors of our economy. It accounts for approximately 18% of our gross national product (GDP) and employs more people than any other single segment of our economy. There is NO reason why we cannot provide adequate health care to all our citizens, but there is a Right Way to do it and a Wrong Way to do it. And, declaring that the Secretary, “shall be treated as the insurer”, as Bernie Sanders has proposed in his Senate “Medicare for All” Bill is absolutely, categorically and unequivocally the “Wrong Way” to do it!

The public-private partnership between health insurance companies and the federal government is arguably the largest and most successful such partnership in the history of the world. It covers well over 110 Million Americans, most of whom are very satisfied with their health insurance coverage and with their health care. Admittedly we are not perfect. Even with Obamacare, we have 12.2% of our adult population without health insurance. This is the last and greatest remaining challenge that we face as a nation with our health care system. And, so far, Obamacare has failed miserably to solve this problem. The ACA program was ill-conceived by politicians and too easily acquiesced to by the health insurance industry. It was an experiment and it has failed, for all the reasons covered here and, on my website, www.bcsconsultants.net/. Now it is time to move on to a New Program that will Work, and that is what I like to call the next generation ACA product – “Medicare Advantage for All (MAA)”.

Representative John Conyers Single-Payer Plan: Let’s consider the approach to covering the uninsured suggested by Senator Bernie Sanders (D-VT.) and his counterpart in the House of Representatives, John Conyers, Jr.(D-MI.). Bernie wants We the People to put it all on the “Secretary” and let him or her sweat out the details. John Conyers has an even better idea. He wants to create a Big non-profit entity to handle a universal single-payer health care system for all. John Conyers wasn’t around forty years ago when we had 60 state chartered non-profit Blue Cross Blue Shield Plans in this country.

In those days the Blue Cross Blue Shield Plans formed a unified system of skilled non-profit corporations dedicated to providing affordable health insurance in every state and in every area they served throughout this fair nation. They generally worked in close concert with one another; and that was right up until Congress decided to tax all of these non-profits. This greedy and arbitrary congressional act basically forced the break-up of the non-profit Blue Cross Blue Shield system. This congressional action was an unnecessarily destructive way to get new federal tax revenues. The for profit commercial insurance companies may have successfully lobbied congress for a more level playing field? Whatever the motivation, you will note that, for the most part, the last health insurance carriers standing by the ACA/ Obamacare are Blue Cross Blue Shield plans. And, that is a testament not only to their expertise but also their commitment to the communities they serve. Many of the for profit commercial health insurers carriers have dropped out of the ACA markets. Absurdly, Blue Cross Blue Shield Plans are now fighting anti-trust allegations in federal court for following their State Charters and serving their customers within the boundaries that the courts themselves restricted them too, to avoid former allegations of racketeering. This only goes to show you that when government decides to take things over, as it did with ACA/ Obamacare, and control or unduly influence an industry or private enterprise, everything gets screwed up.

I have never met an American citizen who disagreed with the above statement. No one in their right mind thinks that our government can do a better job of anything over that of our private enterprise system. They learned this in the Soviet Union and they learned it in China. We see it in Central America and in the economies of Iran and North Korea. We are not talking about a public utility here. If we let our health care system go the way of the VA or of the ACA, we are going to need all the help we can get. The problems with these programs are everyday headlines. Big governement is NOT the answer!

Consider John Conyers Bill in the House. John believes that many Americans are frustrated with the high cost of out-of-pocket, skyrocketing premiums, and many other “serious problems” that are part and parcel of a health care system dependent on private health insurance plans. He thinks his Bill would fix all of these things. He supports Obamacare, which he hails as an important initial reform. He is therefore claiming his support for:

  1. The government telling insurance companies how to rate their products, requiring among other things, community rating even though we know that certain segments of the population end up paying more than their fair share of the cost.
  2. Artificial rating to prevent the true pricing of health care risks that would otherwise lower the cost of health insurance for younger people and those with healthy life styles and raise it for the older people, smokers and high-risk individuals.
  3. Minimum Health benefits regardless of a need for coverage, so that everyone must pay for all the coverage levels regardless of their need for the coverage or that level of benefits, which artificially raises the cost of insurance for everyone.
  4. The need to eliminate deductibles and coinsurance for people at or just above the poverty level, despite the obvious need for incentives for the proper use of the benefits, like emergency rooms, etc. because people of poverty should pay less for their health care than the other people who are not so poor.
  5. Enrollment in a health plan should be through unlicensed non-profit Marketplaces and not through the insurance companies that need the information to pay claims; because of course it is fairer and clearer for the consumer to listen to these disinterested unlicensed third parties, than listening to the companies that are in the business of administering these benefits, paying the claims and legally required to use licensed and trained agents to sell their products.
  6. It is better to regulate the amount of money an insurance carrier can pay out for a consumer even if the regulation forces the company to raise their rates and increase reimbursements to providers to improve their bottom line performance and increase their profitability.
  7. Allow anyone to sign up for health insurance at any time and be placed in the same programs in the same risk pools and at the same rates as those people who have maintained health insurance for many years and paid into the programs under which they have coverage, increasing the cost for everybody due to adverse selection.
  8. Force the non-renewal (cancellation) of non-qualified health insurance plans and the limitation of temporary plans providing affordable coverage for many Americans, because legislators feared people would not join the ACA or drop out of it, even when these limitations forced many Americans to join the ranks of the uninsured.

As a Consultant in this industry, I could go on and on with more examples of what the government did wrong when they passed the ACA. The way the ACA handles the items noted above unnecessarily raises the cost of the product for everybody. Collectively they make health insurance less affordable for the American people. It is no accident that the ACA enrollment is declining, with only 9 Million people left on the program and most of them urban dwellers, 75% of which have their premiums largely paid for by the tax payers. Even though three quarters of Obamacare participants are heavily subsidized by federal government, we can’t call them free loaders because without the government subsidy, they would be just like the rest of the 28 Million people without any health insurance.

We must remember we still have 28 Million people, who don’t want to touch the ACA program with a ten-foot pole, mostly because they can’t afford it. That is why the Republicans eliminated the ACA’s individual mandate. It was a tax burden that did not cause uninsured people to sign up for the program. The penalty was too low, and it had so many waivers, it worked more like a sieve than a bowl. The uninsured population that was aware of the ACA Mandate (those that paid taxes) welcomed the tax penalty as long as they could avoid having to pay the ACA premiums.

John Conyers is quoted as follows: “Passage of the Patient Protection and Affordability Care Act was an important initial reform, which will provide health insurance to millions of our nations uninsured (fake news) and eliminate many of the worst practices of the health insurance industry.” “However, it is my opinion, and the belief of many leading health practitioners and experts, that establishing a non-profit universal single-payer health care system would be the best way to effectively contain health care costs and provide quality care for all Americans.” “It is time for Members of Congress, health policy scholars, economists and the medical community to begin a serious discussion of the merits of a universal single-payer health care system.”

This is an amusing declaration coming from someone, who is partially responsible for the failure of Obamacare. But John Conyers is right about one thing. It is beyond time to have a discussion of the merits of single-payer.

John Conyers Bill H.R. 676 H.R. has been introduced every year in Congress since 2003 and has a broad base of support among universal health care activists, organized labor, physicians, nurses, and social justice organizations across the nation. The bill has been endorsed by 26 international unions, Physicians For A National Health Program, two former editors of the New England Journal of Medicine, National Nurses United, the American Medical Students Association, Progressive Democrats of America, and the NAACP. Last Congress, 77 other Members in the House of Representatives signed on as cosponsors of the legislation. In 2011, the Vermont legislature passed legislation that lays the foundation for a single-payer health care system in the state.

In this documentary discussion we are having; and in contradiction to John Conyers’s statement quoted above, “I believe, along with many leading health practitioners and experts, that establishing a non-profit universal single-payer health care system would “NOT” be the best way to effectively contain health care costs and provide quality care for all Americans.”

With all due respect, in the United States, we have never tried to do such a thing the way John Conyers and Bernie Sanders are suggesting it be done. On the other hand, we have Price Waterhouse projecting that Medicare Advantage (MA) enrollment will grow by 8 percent to a total of 21 million beneficiaries, almost three time bigger than ACA enrollment. The previous research from A.M. Best and the Kaiser Family Foundation also found that MA premium revenues grew from $69.9 billion in 2007 to $187.5 billion in 2016, indicating an upward trend in popularity (Reference). MA now covers over 35% of all Medicare beneficiaries and with 11,000 aging into the program daily, 50% are choosing Medicare Advantage within their first year of eligibility. NOW IS THE TIME FOR CONGRESS TO EXTEND THIS FANTASTICALLY SUCCESSFUL PROGRAM TO ALL AMERICANS.

Medicare Advantage for All: MAA has everything most Republicans want in a national health plan. It is private insurance. MAA does not require more burocracy, because HHS already has everything in place to manage the program. MAA is fully grounded in free market principles. MAA is real health insurance, underwritten by the public-private partnership and paid for by the federal governement through capitation reimbursement. Deficits in the programs funding do not accrue to the national debt and there is no unfunded liability associated with the program. The government regulations in place are flexible enough to permit creativity and experimentation by the insurance carriers. There are minimum standards but few mandates. MAA is slightly less expensive than the ACA and if the extension product is designed properly, it can be a lot less expensive.

There are no ACA type mandates that arbitrarily require carriers to do things that increase rates and cause insurmountable problems like the ones that make the ACA programs so unaffordable. MAA is in place for over 21 Million seniors over age 65. However, the program would have to be modified to be responsive to the needs of a younger clientele. This would include the expansion of Health Savings Accounts and the Medicaid Modernization, especially as it relates to the way we handle pre-existing condition coverage.

None of these additions will take away from the fact that seniors (voters) and their politicians love the Medicare Advantage program. Democrats and Republicans alike will WIN the public’s support for doing the Right thing if they propose extending “Medicare for All” in this responsible fashion. Our nation will benefit from the removal of the threat of government incursion into the health insurance and health care systems. Our economy will benefit from the continued vibrancy of the health care sector and the support we give to the public-private partnership that makes it all possible. Medicare Advantage will be a Winner in 2018 and 2020!