American Pharmaceutical Company Keeps HIV Risk High

One of the reasons for America's sky high health care costs is the daily gauging of consumers by large pharmaceutical companies.  Americans pay in some cases, thousands of times more for crucial drugs that cost a relative pittance in other countries.  A prime example is Truvada, the brand name for a type of HIV pre-exposure prophylaxis, or PrEP, which is up to 99 percent effective at preventing HIV infection.  The cost in America?  Thanks to the monopoly of Gilead Sciences, over $20,000 per year, far outside the reach of even many affluent individuals even with insurance (assuming carriers do not deny coverage).  The cost elsewhere?  In other countries, a one-month supply of generic Truvada costs less than $6.00. If widely administered, PrEP could largely eliminate HIV/AIDS in America.  But just like the opioid manufacturers behind the crisis in many parts of America, money is Gilead Science's god.  Human lives mean little.  A piece in the New York Times looks at this shocking example of corporate greed.  Here are excerpts:

On July 3, 1981, this newspaper wrote about a “rare cancer” killing gay men in New York and California. . . . Today, after 37 years, we finally have a proven pathway to ending the AIDS epidemic in this country.

The only catch? Poor policy and pharmaceutical price-gouging have blocked the way, making critical drugs a luxury rather than an imperative.

The solution comes in a pill: Taken daily, Truvada, the brand name for a type of pre-exposure prophylaxis, or PrEP, is up to 99 percent effective at preventing H.I.V. infection; it also lowers the amount of H.I.V. circulating in infected patients' blood streams. Used as directed, it’s one of the most effective methods of preventing a viral infection ever discovered, as good as the polio vaccine, the miracle of modern medicine. When you combine that protection with the discovery that people with H.I.V. cannot transmit the virus to others once Truvada has suppressed it to undetectable levels, we could be on the verge of a swift end to the epidemic.

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be. Gilead Sciences, the company that makes Truvada, maintains a monopoly on the drug domestically. In other countries, a one-month supply of generic Truvada costs less than $6, but Gilead charges Americans, on average, more than $1,600, a markup from the generic of 25,000 percent. Infuriatingly, American taxpayers and private charities — not Gilead — paid for almost all of the clinical research used to develop Truvada as PrEP. Yet the price stays out of reach for millions, and will for at least several more years.

The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men . . .

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

So how can we import such progress into the United States? Faced with more than half a decade of inaction by the federal government, activists have developed their own national strategy to begin the end of the H.I.V. epidemic. At the International AIDS Conference later this month, our organization, the PrEP4All Collaboration, will release its plan for a national PrEP program to ensure all Americans who need PrEP can get it.

A critical component of this plan is insisting that federal agencies use their statutory authority to break Gilead’s undeserved monopoly. With low-price, generic Truvada, the cost to cover every American who needs PrEP — including both drug costs and clinical care — would be less than a tenth the amount that the federal government already spends on H.I.V. care. The billions saved could pay for vital services to ensure those who need PrEP the most can get it and those living with H.I.V. can keep the virus suppressed. If the patent on Truvada remains, the plan will cost over $20 billion. Science has delivered answers, but Gilead’s greed and the government’s inaction are keeping it from those who need it most. There’s a pill that stops H.I.V. We can make it possible for everyone who needs that pill to get it.

Gilead's greed is replicated across the medical spectrum and is a prime reason why Americans pay far, far more for healthcare than in any other nation in the world.  We need a single payer system with government negotiation of drug prices. 

Vladimir Putin - Investor of the Year

Donald Trump - or Der Trumpenführer, if you prefer since I will never use the title "president" in conjunction with his name - continually boasts about the record high stock market and how well investors have done over the last eleven months.  He, of course, ignores the way the market had been soaring under Barack Obama and the role that Obama played in setting the stage for future market increases.  And as foreign affairs columnist Thomas Friedman, points out, Forbes or some other financial publication will likely be naming an "investor of the year" for 2017.  But the man who has likely reaped the biggest return on his investment made in 2016 and into 2017 is likely Vladimir Putin.  Putin, who has an ego as big as Trump's, and who views himself as Russia's new Tsar, wants to return Russia to its lost glory days on the international arena and to check America's power.  For his investment in meddling in the 2016 presidential election (by some estimates it was a paltry investment of $500,000), Putin has seen America diminished on the global stage and torn asunder domestically by Trump and the GOP Congress who seem obsessed with plundering the nation environmentally and financially to benefit 1% of the population.  None of this will make America great again.  Here are highlights from Friedman's column:

At the end of this banner stock market year, you can bet that major business publications will be naming their investor of the year. You can stop now. I have the winner, and nobody is even close when it comes to his total return on investment: Vladimir Putin, the Russian president.

A recent report in The Washington Post, quoting intelligence sources, said Putin may have spent less than $500,000 to hack our last election and help (though Hillary helped much more) Donald Trump become president. And Putin’s payoff is Trump’s first year: a president who is simultaneously eroding some of our most basic norms, undermining some of our most cherished institutions and enacting a mammoth tax bill that will not make America great again.

If you assume, as I do, that Putin wants to see an America that is not an attractive model for his own people or others to emulate, and that he wants an America run by a chaos president who cannot lead the West, then Trump is his dream come true, whether or not there was any collusion between them.

Just do the math:

On norms, we’ve grown numb to a president who misleads or outright lies every day. Different newspapers measure this differently. The Washington Post says Trump has averaged 5.5 false or misleading claims every day in office, putting him on pace for 1,999 in his first year. According to The Times, Barack Obama told 18 “distinct falsehoods” over his entire eight-year presidency, while Trump, in his first 10 months in office, “has told 103 separate untruths, many of them repeatedly.”

[I]t’s chilling to imagine what four years and 8,000 lies or misleading statements from Trump will do to trust in government in America — and how deeply that will filter into society, giving permission to anyone and everyone to lie with impunity.

In terms of institutions, Trump has personally disparaged the F.B.I., the C.I.A. and the Justice Department. His head of the Environmental Protection Agency has turned the E.P.A. over to the fossil fuel industry. Ditto at Interior. His I.R.S. is being starved of funding to do its job. And his secretary of state is gutting the State Department, shedding our most experienced diplomats and replacing them with … no one.

The Treasury secretary’s economic “analysis” of the G.O.P. tax bill consisted of a one-page — fewer than 500 words — assessment, claiming that the $1.5 trillion plan would more than pay for itself, assuming a whole set of perfect circumstances come true. Your kid’s third-grade book report was longer than the Treasury’s analysis of our biggest tax overhaul in 30 years.

And then there’s the future: Putin never could have dreamed up this deformed Trump-G.O.P. tax bill, but it is precisely how you don’t make America great again. . . . .

First, we’ve always educated our citizens up to and beyond whatever the main technology of the day was — when it was the cotton gin, that meant universal primary education; when it was the factory, that meant universal high school; and now that it is the computer and artificial intelligence, it should be some form of postsecondary education for all — and then lifelong learning. . . . . Instead, this bill will spend money preserving unfair tax breaks for hedge fund billionaires and shrinking the inheritance tax on their heirs.

Second, we invested in the best infrastructure — roads, rail, ports, airports, telecom. This tax bill not only makes no provision for that, it actually erodes such investments in many states.

Third, we had the best rules to incentivize risk-taking and to prevent recklessness. I am all for cutting corporate taxes — and payroll taxes — but I’d offset them with a carbon tax that would simultaneously combat climate change and stimulate renewable energy, the next great global industry, to make us more resilient and innovative. It never occurred to Trump.  Trump and his allies actually tried to get rid of all the regulatory subsidies to stimulate wind, solar and electric car production . . . .

On health care regulations, though, the whole G.O.P. bought into Trump’s nonsense, eliminating the Obamacare requirement that all individuals buy health insurance. It means we are returning to socialized medicine. Now lots of healthy young people, and others, will forgo health care, and when they get sick, they’ll go to hospital emergency wards to get treated — and those of us with health insurance will pay for their care through higher premiums or higher hospital bills. That’s called socialism.

Fourth, we had, in the last century, the most open immigration policy to attract the most high-I.Q. risk-takers, the people who often start new business, as well as high-energy lower-skilled workers. I don’t have to tell you where Trump is on that.

Fifth, we had the most government-funded research to push out the boundaries of science so our companies could pluck the best ideas — witness the internet and GPS — to start new industries. The surge in the deficit created by this tax bill will curtail precisely such research.

So there you have it: a tax “reform” bill that defies all five principles that made us great for two and half centuries.

Even Putin surely could not have imagined that Trump would be this foolish and the G.O.P. this cynical. It’s just the extra dollop of caviar on Vladimir’s Christmas blini.

The Republican Dream of Killing Medicare

For a political party that claims to uphold Christian values - which one would think should include the Gospel message of feeding the hungry, clothing the naked and caring for the sick - today's Republican Party has an obsession with throwing as many Americans as possible into the gutter, including the elderly.  The GOP's claim of being "pro-life" only lasts until a fetus is born and thereafter party policies are aimed at making life as squalid and difficult as possible.  In the Scrooge like agenda, the GOP is fully supported by the Christofascists who seemingly want anyone who isn't one of them to simply die off.  A column in the New York Times looks at this GOP obsession and Jeb Bush's double speak on his goal of harming older Americans.  Here are excerpts:

Medicare turns 50 this week, and it has been a very good half-century. Before the program went into effect, Ronald Reagan warned that it would destroy American freedom; it didn’t, as far as anyone can tell. What it did do was provide a huge improvement in financial security for seniors and their families, and in many cases it has literally been a lifesaver as well.

But the right has never abandoned its dream of killing the program. So it’s really no surprise that Jeb Bush recently declared that while he wants to let those already on Medicare keep their benefits, “We need to figure out a way to phase out this program for others.”

In this, as in other spheres, Mr. Bush often seems like a Rip Van Winkle who slept through everything that has happened since he left the governor’s office — after all, he’s still boasting about Florida’s housing-bubble boom. There are two things to say about this claim. First, it’s clearly false: in context, Mr. Bush was obviously talking about converting Medicare into a voucher system, along the lines proposed by Paul Ryan.

And second, while raising the Medicare age has long been a favorite idea of Washington’s Very Serious People, a couple of years ago the Congressional Budget Office did a careful study and discovered that it would hardly save any money. That is, at this point raising the Medicare age is a zombie idea, which should have been killed by analysis and evidence, but is still out there eating some people’s brains.

The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.

What Medicare’s would-be killers usually argue, instead, is that the program as we know it is unaffordable — that we must destroy the system in order to save it, that, as Mr. Bush put it, we must “move to a new system that allows [seniors] to have something — because they’re not going to have anything.” And the new system they usually advocate is, as I said, vouchers that can be applied to the purchase of private insurance.

Medicare costs per beneficiary have consistently grown more slowly than private insurance premiums, suggesting that Medicare is, if anything, better than private insurers at cost control. Furthermore, other wealthy countries Still, conservatives scoffed at the cost-control measures included in the Affordable Care Act, insisting that nothing short of privatization would work.

And then a funny thing happened: the act’s passage was immediately followed by an unprecedented pause in Medicare cost growth. Indeed, Medicare spending keeps coming in ever further below expectations . . .

Right now is, in other words, a very odd time to be going on about the impossibility of preserving Medicare, a program whose finances will be strained by an aging population but no longer look disastrous. One can only guess that Mr. Bush is unaware of all this, that he’s living inside the conservative information bubble, whose impervious shield blocks all positive news about health reform.

Meanwhile, what the rest of us need to know is that Medicare at 50 still looks very good.  . . . The only real threat it faces is that of attack by right-wing zombies.

A Pill to Prevent HIV Goes Largely Unused

A piece in the New York Times looks at the failure of an effective HIV preventative pill to gain wide traction in the LGBT community.  The article recites a number of possible reasons but I suspect that perhaps the largest is the cost - roughly $1,000 per month.  Even with decent insurance, the out of pocket cost is beyond the reach of many.  The phenomenon is part and parcel with America's ass backwards approach to health care: skimp on preventative care and then have to face huge costs once severe conditions have developed.   It's a kin to never maintaining one's house and then being shocked when suddenly huge repair costs become unavoidable.  There is also the possible fear by many with job derived health care coverage that use of the preventative may cause one to be stigmatized.  Lastly, some HIV/AIDS organizations have opposed use of the drug fearing that it may encourage risky practices - a mindset akin to the Christofascists' opposition to reality based sex education in favor of abstinence only programs.  Just like unwanted pregnancies, risky behavior will continue, so why not prepare for it?  Here are article highlights:

[A] daily pill that studies show is highly effective in protecting people from infection. 

The very existence of that option represents a startling turn in the too-long history of the AIDS epidemic. Many health experts hoped that the medication — Truvada, a combination of two antiviral drugs that has been used to treat H.I.V. since 2004 — would be exuberantly embraced by H.I.V.-negative gay men. Instead, Truvada has been slow to catch on as an H.I.V. preventive in the 18 months since the strategy’s approval by the Food and Drug Administration. In some quarters, the idea that healthy gay men should take a medication to prevent infection — an approach called pre-exposure prophylaxis, or PrEP — has met with hostility or indifference. 

“It’s gotten tons of attention at H.I.V. meetings as a new tool for prevention, and I consider it an important option for the right person,” said Dr. Lisa Capaldini, a primary care doctor here who treats many gay men. “And yet there’s been very little interest among my patients. There’s a fascinating disconnect.”

Many experts hailed Truvada as an opportunity to reduce new infections among high-risk groups like young gay men, people in relationships with H.I.V.-positive partners, and prostitutes. The F.D.A. called for prescriptions to be accompanied by counseling, frequent H.I.V. testing, and continued promotion of safer sex, although research suggests that daily use of the pill alone confers close to full protection. 

For many gay men, and for some public health officials, the new option has brought both hope and confusion. 

“We’ve had several decades of the recommendation to use condoms,” said Dr. Kenneth H. Mayer, a professor of medicine at Harvard University and the medical research director at Fenway Health, a community center in Boston with many lesbian and gay patients. “Now we’re saying, ‘Here’s a pill that might protect you if you don’t use condoms.’ So it’s flying in the face of community norms.”

Certainly, fewer people have tried PrEP than many experts had anticipated. . . . So why haven’t more gay men signed up? 

Some men have reported receiving negative reactions from their health care providers when they brought it up. Use of the drug as a preventive can be stigmatizing among gay men as well: the term “Truvada whore” has been bandied about on some social networks. 

And many simply may not know much about the strategy. 

Potential side effects like kidney damage and a loss of bone density, although rare, are also a concern. And Truvada is expensive: more than $1,000 a month. So far, private and public insurers, including state Medicaid programs, have generally covered the drug for prevention. 

But a generational shift in attitudes toward H.I.V. among gay men may also be playing a role, some experts say. With advances in treatment, many younger men who did not experience the worst years of the epidemic are less fearful of the consequences of infection. Moreover, current medications can lower viral levels in H.I.V.-positive people to the point where the risk of transmission is negligible, further reducing the perceived need for PrEP among H.I.V.-negative partners.

Adherence to the drug regimen is another thorny issue. The major trial that confirmed Truvada as an effective H.I.V. preventive among men who have sex with men, also found that many participants did not take the pill every day, leaving them more vulnerable to infection. 

Michael Weinstein, president of the AIDS Healthcare Foundation, warned that drug adherence will continue to be a problem, likely leading to more infections and the emergence of drug-resistant H.I.V. strains. “If you don’t take the medication every day and you don’t use condoms, and you’re highly sexually active, you’re going to get infected,” Mr. Weinstein said.

In any event, the protocol for pre-exposure prophylaxis is itself likely to undergo significant changes as findings emerge from current and upcoming research into other formulations of Truvada such as gels or injectables, less frequent dosing regimens, and the use of other medications altogether. 

“People are not lining up, but I’m not pessimistic,” said Dr. Mayer of Fenway Health. “It’s going to take time. It’s really early days.”

The Shame of America's Health Care System

In recent posts I have looked at the findings of studies that have shown the true nature of America's health care system (assuming one can even use the term "system" to such a broken scheme) as the most expensive in the world and one of the least efficient in its delivery of medical care.  America places dead last compared to systems in other advanced nations in terms of quality of care for money spent.  The New York Times picked up on these same findings and made it the focus of its main page editorial yesterday.  Here are excerpts:

Even as Americans struggle with the changes required by health care reform, an international survey released last week by the Commonwealth Fund, a research organization, shows why change is so necessary.  

The report found that by virtually all measures of cost, access to care and ease of dealing with insurance problems, Americans fared poorly compared with people in other advanced countries. The survey covered 20,000 adults in the United States and 10 other industrial nations — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and Britain, all of which put in place universal or near-universal health coverage decades ago. The United States spends far more than any of these countries on a per capita basis and as a percent of the national economy. 

For that, it gets meager results. Some 37 percent of American adults went without recommended care, did not see a doctor when sick or failed to fill prescriptions in the past year because of costs, compared with 4 percent in Britain and 6 percent in Sweden. Nearly a quarter of American adults could not pay medical bills or had serious problems paying them

The complexity of the American insurance system is also an issue. Some 32 percent of consumers spent a lot of time on insurance paperwork or in disputes with their insurer over denials of payment for services they thought were covered. 

The Affordable Care Act was created to address these problems by covering tens of millions of uninsured people and providing subsidies to help many of them pay for policies; by setting limits on the out-of-pocket costs that patients must bear; and by requiring that all policies cover specified benefits. 

The reform law, however imperfect, is needed to bring the dysfunctional American health care system up to levels already achieved in other advanced nations. 

Frighteningly, the Republicans want to scrap the Affordable Health Care Act and slash Medicare and Medicaid thus leaving even more Americans without access to health care.  And this from the political party that pretends to honor Christian values.  The hypocrisy is unbelievable.

America's Highly Inefficient Health Care System

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As longer term readers know, I am a proponent of a single payer health care system for America.  A new Bloomberg study confirms that Americans pay for - much more in many cases - for a far less efficient health care system than the majority of modern nations.  Admittedly, my view is soured by my time doing legal work for a health care system and seeing almost daily how providing quality health care was a low priority compared to playing monopoly wars with other health care providers and devising ways to bind doctors to particular hospitals for patient referral purposes.  The map above compares different nations on the level of efficiency of their health care systems.   Here are highlights from a Huffington Post story:

As supporters and opponents of the Affordable Care Act debate the best way to overhaul a clearly broken healthcare system, it's perhaps helpful to put American medicine in a global perspective.

The infographic [above] is based on a recent Bloomberg ranking of the most efficient countries for healthcare, and highlights enormous gap between the soaring cost of treatment in the U.S. and its quality and effectiveness. 

It's remarkable how low America places in healthcare efficiency: among the 48 countries included in the Bloomberg study, the U.S. ranks 46th, outpacing just Serbia and Brazil. Once that sinks in, try this one on for size: the U.S. ranks worse than China, Algeria, and Iran.

But the sheer numbers are really what's humbling about this list: the U.S. ranks second in healthcare cost per capita ($8,608), only to be outspent by Switzerland ($9,121) -- which, for the record, boasts a top-10 healthcare system in terms of efficiency. Furthermore, the U.S. is tops in terms of healthcare cost relative to GDP, with 17.2 percent of the country's wealth spent on medical care for every American.

In other words, the world's richest country spends more of its money on healthcare while getting less than almost every other nation in return.

The systems that rank highly on Bloomberg's list are as diverse as the nations to which they belong. The unifying factor seems to be tight government control over a universal system, which may take many shapes and forms -- a fact evident in the top-three most efficient healthcare systems in the world: Hong Kong, Singapore, and Japan.

Ranking third on Bloomberg's list, the Japanese system involves universal healthcare with mandatory participation funded by payroll taxes paid by both employer and employee, or income-based premiums by the self-employed. Long-term care insurance is also required for those older than 40. As Dr. John W. Traphagan notes in The Diplomat, Japan controls costs by setting flat rates for everything from medications to procedures, thus eliminating competition among insurance providers. While most of the country's hospitals are privately owned and operated, the government implements smart regulations to ensure that the system remains universal and egalitarian.

Meanwhile, Singapore's healthcare system is largely funded by individual contributions, and is often hailed by conservatives as a beacon of personal responsibility. But as conservative David Frum notes, the system is actually fueled by the invisible hand of the public sector: individuals are required to contribute a percentage of their monthly salary based on age to a personal fund to pay for treatments and hospital expenditures. In addition, the government provides a safety net to cover expenses for which these personal savings are inadequate. Private healthcare still plays a role in Singapore's system, but takes a backseat to public offerings, which boast the majority of doctors, nurses, and procedures performed.

The truth is, America's system is seriously  broken yet the GOP seeks to destroy Obamacare and in the process throw millions of Americans to the wolves.  The hypocrisy is off the charts because meanwhile, the GOP base claims to be worship the Gospel message.

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The Real Cost of the Romney-Ryan Plan to Virginians

It's no surprise that the Romney-Ryan ticket doesn't want to explain the details of its plan for deficit reduction, jobs creation and a host of other issues.  The excuse is that "it's too complicated" to address.  Truth be told, if the details are fully disclosed, I suspect that even more voters would be fleeing the GOP and its pro-wealthy agenda.  Think Progress has analyzed precisely what the Romney/Ryan plan would mean for Virginians.  The picture presented is not pretty, but it is something that Virginia voters and voters elsewhere need to grasp and understand.  Here are highlights from Think Progress' analysis (NOTE: watching the debates, Romney now suddenly seems to be disclaiming much of what he's been campaigning on for 18 months): 

Behind dramatically different economic visions and a deluge of attack ads, this election comes down to numbers. Many Virginians—and many families across the United States—are asking what this will mean at the kitchen table. What will be the cost of a second term of President Barack Obama and Vice President Joe Biden or a first term led by former Massachusetts Governor Mitt Romney and his running mate, Rep. Paul Ryan (R-WI)? The answer is that, in concrete and quantifiable ways, a Romney-Ryan presidency would mean higher taxes for the middle class, out-of-pocket health expenses for current seniors, fewer college loans and fewer health care options for young people, and the re-introduction of corporate outsourcing tax loopholes that have sent so many jobs overseas.

The nonprofit organizations ProgressVA and the Center for American Progress Action Fund examined the economic and tax agenda of Gov. Romney and Rep. Ryan, taking a close look at how their policies would affect the way Virginians live and work. The price tag includes:

• Middle-class Virginians would pay more in taxes while millionaires pay less. Millionaires in the state would receive an additional $87,000 in tax breaks under the tax plans of Gov. Romney and Rep. Ryan while middle-class families would pay up to $2,000 more in health care taxes and $1,066 more in taxes on their mortgages.
• Jobs would decline across Virginia. Gov. Romney and Rep. Ryan plan to provide extra tax incentives for corporations to outsource jobs and are pushing policy proposals to cripple the clean energy industry, jeopardizing 90,000 jobs across the state.
• Drastic cuts to federal spending would shrink Virginia’s middle class. The state stands to lose more than $46 billion in federal funding from 2013 through 2022, an average of more than $4.6 billion a year, from cuts to schools, law enforcement, highway repairs, job-training programs and more. These cuts would fall predominantly on middle-class and low-income families, especially cuts to education programs that would result in nearly $156 million in reduced federal support for education and job training in the state in 2013 and $361 million in 2014 alone.
• Seniors in Virginia would lose health care benefits and pay more. Gov. Romney and Rep. Ryan would force seniors in the state to pay at least $639 more for their prescription drugs each year. At the same time, the Romney-Ryan plan to turn Medicare into a voucher would cost current seniors at least $11,000 more out of pocket.
• Women in Virginia would pay more for health care but receive less bang for their buck. Gov. Romney and Rep. Ryan would once again allow insurance companies to charge women more than men while taking away preventive care from at least 1,376,205 women in the state.
• Young adults in Virginia would lose access to their families’ health insurance. Gov. Romney and Rep. Ryan promise to dismantle Obamacare, which would directly result in 66,000 young adults in Virginia losing the insurance they have today due to the Affordable Care Act.

The Romney-Ryan plan asks the vast majority of Americans to pay more, and then spends this revenue not on balancing the budget but rather on more tax breaks for the richest Americans. Gov. Romney’s top direct donor would receive over $2 billion in direct tax benefits from under the Romney-Ryan plan, while a typical police officer in Richmond making a little over $48,760 a year would see their taxes increase by $ 1,660. These lopsided priorities are not a coincidence or a cruel joke. They are the logical extension of a trickle-down economic policy that failed under President George W. Bush but would be revived by Gov. Romney and Rep. Ryan.

The Republican contenders for the White House have tried to avoid details, but have nonetheless gone on the record with proposals that have enormous consequences for the economy, taxes, women’s health, health care, and energy security. ProgressVA and the Center for American Progress Action Fund believe facts should matter in elections because they will certainly matter to families trying to live the American Dream. This report outlines the real cost of Romney-Ryan policies to Virginians.
It is tempting for people across Virginia to start tuning out the election, defined too often by gaffes and thirty-second sound bites. But behind the politics are deep policy differences with profound consequences for the middle class.

Here is how this hidden part of the Romney-Ryan tax plan would affect low-income and middle-class families in Virginia:

• 4.3 million. The number of families in the state that rely on health insurance from their employer, which is currently not taxed.
• $1,200-2,000. The amount those middle-class families would pay in higher taxes if the exemption for employer health insurance is reduced by 58 percent.

• 1.1 million. The number of middle-class families in the state that file for the mortgage interest deduction on their federal taxes.
• $1,066. The average loss in mortgage interest deduction for middle-class families in the state if the deduction is cut by 58 percent.

• 1.4 million. The number of middle-class families in the state that deduct state and local taxes from their federal income taxes.
• $670. The amount on average that middle class families in the state will pay in higher taxes if the deduction for state and local taxes is cut by 58 percent.

• 610,000. The number of middle-class families in the state that benefit from the child tax credit.
• $580. The amount that families in the state will pay in higher taxes per child if the child tax credit is reduced by 58 percent.

• 171,000. The number of low-income and middle-class families in the state that claim the child care tax credit (in addition to the child tax credit detailed above).
• $318. The amount that families in the state will pay in higher taxes per child if the child care tax credit (in addition to the child tax credit detailed above) is reduced by 58 percent.

• 1.1 million. The number of low-income working families in the state that qualify for the earned income tax credit or the refundable portion of the child tax credit.
• $736. The tax increase for 275,000 of those families (with a total of almost 494,000 children) would pay on average if the improvements to those tax credits passed under President Obama are rolled back, as the Romney-Ryan plan proposes.

• 231,000. The number of middle-class Virginia families and students paying for college educations that use President Obama’s American Opportunity Tax Credit.
• $2,100. The average benefit these families and students receive from the American Opportunity Tax Credit. The Romney-Ryan tax plan would eliminate this credit, leaving families in the state with no credit or a less valuable tuition credit.

There's much more in the piece that details each of these areas and I recommend that readers check out the full article.

America's Broken Health Care System

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The Republicans are Hell bent to repeal "Obamacare" yet they have no realistic proposal of how they would fix the nations broken health acre system which is an embarrassment relative to other industrialized - and even some recently industrializing - nations. The fact is that (as the chart above illustrates) the per day cost of hospital stays in America are astronomical compared to other nations. Could it be because our non-profit 501(c)(3) hospitals are writing off huge amounts related to those millions of Americans with no insurance and redirecting those costs to paying patients with health care insurance?

As I note frequently, what is really horrible - or is hypocritical a better term? - is that the political party that wraps itself in Christianity and feigned religiosity is the party same that could care less for those without adequate health care access. Their attitude is basically just as callous as that of the Caledon Hockley in James Cameron's movie "Titanic."

If "Obamacare" is Struck Down, Will It Lead to a Single Payer System?

There's an old saying "be careful what you wish for" that may come back to bit the GOP and conservatives in the ass big time if the conservative faction on the U. S. Supreme Court succeed it killing what the far right derisively calls "Obamacare." And what might that be? Demands for a single payer system so derided by the far right. When asked about individual parts of "Obamacare," a majority of Americans support these programs/policies. Now imagine that the Supreme Court strikes down Obamacare and these benefits disappear and millions find themselves uninsured or unable to afford sky rocketing health care insurance premiums. The resulting chaos and unhappiness might reignite a demand for a total overhaul of the health care delivery system and calls for a Canadian or European style health care system. Personally, I am all for it. As should be those who actually believe in the Gospel message of caring for the sick and the unfortunate. Here are highlights from a Washington Post column that looks at the possible fallout:

If Obamacare is struck down, the short-term implications are uncertain. Conservatives may be buoyed by an election-year victory; progressives may be energized by a ruling that looks more political than substantive. The long-term consequences, however, are obvious: Sooner or later, a much more far-reaching overhaul of the health-care system will be inevitable.

At the heart of the legislation is the requirement that individuals purchase health insurance or pay a fine. It became clear by their questioning that the court’s five conservatives — including Justice Anthony Kennedy, the swing vote who sometimes crosses the ideological divide and votes with the liberals — see this mandate as a significant expansion of the federal government’s reach and authority.

Verrilli gave him [Justice Kennedy] one. The market for health insurance is inseparable from the market for health care, he argued, and every citizen is a consumer of health care. Those who choose not to buy health insurance require health care anyway — often expensive care at hospital emergency rooms — and these costs are borne by the rest of us in the form of higher premiums.

I think Verrilli made his case. The court is supposed to begin with the assumption that laws passed by Congress are constitutional. Justices don’t have to like the Affordable Care Act in order to decide that it should remain in effect.

[I]t’s going to be a close call. What if they strike down the law? The immediate impact will be the human toll. More than 30 million uninsured Americans who would have obtained coverage under Obamacare will be bereft. Other provisions of the law, such as forbidding insurance companies to deny coverage based on preexisting conditions and allowing young adults to remain on their parents’ policies, presumably would also be invalidated; if not, they would have to be modified to keep insurance rates from climbing sharply. The United States would remain the only wealthy industrialized country where getting sick can mean going bankrupt.

Eventually, however, our health-care system will be restructured. It has to be. The current fee-for-service paradigm, with doctors and hospitals being paid through for-profit insurance companies, is needlessly inefficient and ruinously expensive. When people talk about out-of-control government spending, they’re really talking about rising medical costs that far outpace any conceivable rate of economic growth.

Our only choice is to try to hold the costs down. President Obama tried to make a start with a modest approach that works through the current system. If this doesn’t pass constitutional muster, the obvious alternative is to emulate other industrialized nations that deliver equal or better health-care outcomes for half the cost.

I’m talking about a single-payer health-care system. If the Supreme Court strikes down Obamacare, a single-payer system will go from being politically impossible to being, in the long run, fiscally inevitable.

America's refusal to learn from the successes of other nations drives me crazy. Yes, a single payer system would mean that doctors would cease to make near obscene salaries in some cases. But the availability of preventive care and no need to pass the costs of the uninsured to everyone with insurance would lower costs in the long run. Moreover, families would no longer see their finances wiped out by a serious illness - something I experienced some years back when first my oldest daughter was stricken with bacterial meningitis and then my former wife was stricken with cancer. Medical emergencies should not mean bankruptcy or something close to it - even for those with supposedly quality insurance coverage.

Gays Happier and Healthier Where Gay Marriage Is Legal

I referenced a report from a new study in passing on the correlation between gay males leading healthier and happier lives in states where same sex marriage is legal. The savings in health care costs and benefits to human capital in general should make anyone truly concerned about run away health care costs reconsider banning gay marriage. Of course, the Christianists and their boot licking whores in the GOP will not do so since the Christianists' goal is to make life as much of a living Hell for gays as possible since we dare to reject their fear and hate based (emphasis on hate) religious beliefs. But if anti-gay Republicans were true to the supposed conservative economic beliefs and desire for social stability, they would support same sex marriage which is actually a conservative social approach by these measurements. An article in LGBTQ Nation looks at the study and here are some highlights:

Gay men who live in U.S. states where same-sex marriage is legal make fewer doctor visits, have lower healthcare costs, and in general lead happier and healthier lives, according to a new study being published in the American Journal of Public Health.

The researchers surveyed the demand for medical and mental healthcare from more than 1,200 gay men registered with a Massachusetts health clinic in the 12 months prior to the 2003 change and the 12 months afterwards and found a 13-percent drop in healthcare visits after the law was enacted.

This was regardless of whether the men were in a stable relationship, the American Journal of Public Health reported.

There was a reduction in blood pressure problems, depression and “adjustment disorders,” which could be the result of reduced stress, researchers said.

A spokesman for the Terrence Higgins Trust, a UK-based sexual health and HIV charity, told the BBC that “there is a known link between health and happiness.”

“It’s no surprise that people who are treated as second class citizens tend to have low self esteem, which in turn makes them more likely to take risks,” the spokesman said. “Whether this is drugs, alcohol abuse, or unsafe sex, treating gay men unequally has lasting repercussions for their health.”

More coverage on the study findings can be found here in the American Journal of Public Health. I especially like this policy finding that anyone honest about reducing health care costs ought to embrace:

Conclusions. Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.

I continue to believe that Christianists hate gays intensely because we - like evolution - represent a huge threat to their house of cards religious belief system that is based on a selective reading of an increasing factually and scientific unreliable document: the Bible. If the Bible is wrong about the creation story, wrong about the existence of Adam and Eve and wrong about its condemnation of same sex relationships, the entire house of cards collapses and the fear stricken Christianists are left with nothing. Worse yet, many will be faced with the realization that they led their lives based on a lie. They will go to any lengths to avoid facing this truth - including seeking vengeance on those whose lives and loves underscore the falsity of their belief system.

Today's Conservatism Has Lost Touch with Reality

Fareed Zakaria has a piece in Time magazine that looks at today's conservative and analyzes how it has lost touch with reality. A situation that is in stark contrast to the old school type of conservatism that I grew up with and which used to pride itself on objective fact and reality. Personally, I attribute part of the decline in rationality to the rise of far right Christians within the GOP. Their entire "Biblical world view" is untethered from objective reality and scientific fact. Throw in the more ignorant elements of the Tea Party and the problem becomes exacerbated. The other factor, of course, is the fact that those in leadership positions in the GOP - who certainly knew or should have known better - chose short term expedience over what was best long term for the GOP and the nation. Now, ignorance and wild theories that sound almost drug induced are embraced and fact and reason are flushed down the toilet. Here are highlights from Zakaria's article:
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Conservatism, he [George Will] explained, was rooted in reality. Unlike the abstract theories of Marxism and socialism, it started not from an imagined society but from the world as it actually exists. From Aristotle to Edmund Burke, the greatest conservative thinkers have said that to change societies, one must understand them, accept them as they are and help them evolve.
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Watching this election campaign, one wonders what has happened to that tradition. Conservatives now espouse ideas drawn from abstract principles with little regard to the realities of America's present or past. This is a tragedy, because conservatism has an important role to play in modernizing the U.S.
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The U.S. is among the lowest taxed of the big industrial economies. So the case that America is grinding to a halt because of high taxation is not based on facts but is simply a theoretical assertion. The rich countries that are in the best shape right now, with strong growth and low unemployment, are ones like Germany and Denmark, neither one characterized by low taxes.
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[R]ight now any discussion of government involvement in the economy — even to build vital infrastructure — is impossible because it is a cardinal tenet of the new conservatism that such involvement is always and forever bad. Meanwhile, across the globe, the world's fastest-growing economy, China, has managed to use government involvement to create growth and jobs for three decades. From Singapore to South Korea to Germany to Canada, evidence abounds that some strategic actions by the government can act as catalysts for free-market growth.
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Of course, American history suggests that as well. But that history has been forgotten. When considering health care, for example, Republicans confidently assert that their ideas will lower costs, when we simply do not have much evidence for this.
. . . . We need more market mechanisms to cut medical costs, but Republicans don't bother to study existing health care systems anywhere else in the world. They resemble the old Marxists, who refused to look around at actual experience.
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Conservatives used to be the ones with heads firmly based in reality. Their reforms were powerful because they used the market, streamlined government and empowered individuals.
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Today conservatives shy away from the sensible ideas of the Bowles-Simpson commission on deficit reduction because those ideas are too deeply rooted in, well, reality. Does anyone think we are really going to get federal spending to the level it was at under Calvin Coolidge, as Paul Ryan's plan assumes? Does anyone think we will deport 11 million people?
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We need conservative ideas to modernize the U.S. economy and reform American government. But what we have instead are policies that don't reform but just cut and starve government — a strategy that pays little attention to history or best practices from around the world and is based instead on a theory. It turns out that conservatives are the woolly-headed professors after all.

Vouchercare Is Not Medicare

Paul Krugman has a column in the New York Times that looks at the reality of the GOP proposal to "reform" Medicare. It seems the GOP extremists are growing increasingly testy over news reports that accurately describe what would really happen to Medicare - a program relied on by countless senior citizens. I'm not saying that reforms to the program are not need. What I am saying is that it would be nice if members of the GOP had the balls to tell the truth about what their proposal would mean for so many of the elderly - and their families who will have to take up the financial slack that would hit their family members. Sadly, honest and the GOP seem to be increasingly mutually exclusive - I guess they think they are like the Christianists who have deleted the Commandment against lying from the Ten Commandments. Here are some column highlights:
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What’s in a name? A lot, the National Republican Congressional Committee obviously believes. Last week, the committee sent a letter demanding that a TV station stop running an ad declaring that the House Republican budget plan would “end Medicare.” This, the letter insisted, was a false claim . . .
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Comcast, the station’s owner, rejected the demand — and rightly so. For Republicans are indeed seeking to dismantle Medicare as we know it, replacing it with a much worse program.
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I’m seeing many attempts to shout down anyone making this obvious point, and not just from Republican politicians. For some reason, many commentators seem to believe that accurately describing what the G.O.P. is actually proposing amounts to demagoguery. But there’s nothing demagogic about telling the truth.
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[Y]ou can name the new program Medicare, but it’s an entirely different program — call it Vouchercare — that would offer nothing like the coverage that the elderly now receive. (Republicans get huffy when you call their plan a voucher scheme, but that’s exactly what it is.)

Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead. Specifically, the program would pay a fixed amount toward private health insurance — higher for the poor, lower for the rich, but not varying at all with the actual level of premiums. If you couldn’t afford a policy adequate for your needs, even with the voucher, that would be your problem.
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And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan . . . the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.
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Vouchercare, by contrast, would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.
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Yes, Medicare has to get serious about cost control; it has to start saying no to expensive procedures with little or no medical benefits, it has to change the way it pays doctors and hospitals, and so on. . . . . But with these changes it should be entirely possible to maintain a system that provides all older Americans with guaranteed essential health care.
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Canadian Medicare, then, looks sustainable; why can’t we do the same thing here? Well, you know the answer in the case of the Republicans: They don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it.

Cost Forcing More Americans to Delay Medical Visits

It is ironic that after my last post the first article I looked at is this one from America Blog and MSNBC that details how more Americans are foregoing or delaying medical care due their inability to bear the cost. In my own case, I stopped therapy and anti-depression medication mostly because I could no longer afford the monthly cost involved given my firm's significant decline in revenue due to the collapse of the real estate market and slow down in business expansion. Here are some highlights from the MSNBC story:

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WASHINGTON - Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey by Thomson Reuters released on Monday. That figure is up since 2006 . . .

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"The results of this survey have serious implications for public health officials, hospital administrators, and healthcare consumers," Gary Pickens of the Healthcare division of Thomson Reuters, who led the study, said in a statement. "We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare."

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In the most recent survey, 21 percent of U.S. adults expected to have difficulty paying for health insurance or healthcare services in the next three months. Pickens added that "if this trend continues, it will ultimately have an impact on our collective well-being." Thomson Reuters Healthcare is part of the same company as the Reuters news agency.

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Despite such data, far too many in the GOP maintain that the USA's health care system "is the best in the world." That may be true for the wealthy and those with deluxe health insurance plans but for more and more of us we are headed towards health care catastrophe. As noted by America Blog, it all "comes back to the critical issue of a national system that benefits the general population and not only the wealthy, doctors, insurance companies and pharmaceutical companies."