Let's All Help to Reduce the National Debt and Fight Gridlock

Well, the election is over, but we seem to still be where we left off.  The United States is rapidly approaching a debt ceiling crisis, and will hit the $16.4 trillion mark at the end of the year.  The debate on reducing the deficit will begin as well.  Obama wants to let the Bush tax cuts expire for those making over $200,000 ($250,000 for those filing jointly).  John Boehner is still opposed to raising any taxes, in spite of the fact that if an agreement isn't made and the debt ceiling extended, we will go into sequestration.  Obama says that will not happen, but I don't know what he can do to prevent it if the Republicans don't give in on the tax issue.  Here we go again with gridlock, and this time it could lead to disaster.

We need to let our elected officials know that they must come to a bipartisan agreement.  Perhaps one of the ways is for all of us to make a donation to the special agency which is set up by the Treasury Department to receive gifts. You can actually make a gift by check or credit card that will be used to directly pay off the national debt.  If everyone who voted gave only $10, our national debt would be reduced by over a billion dollars a year.   After making the gift, we should send a message to our  representatives informing them that Americans of both parties know to take action to lower our national debt, and that they should take our lead and come to an agreement on these critical issues.

I've already made my donation.  If you're interested in this idea, and want to join me, visit the following link:

http://mperrottet.hubpages.com/hub/How-You-Can-Help-Reduce-the-National-Debt-Right-Now

Why Medicare Needs to Negotiate Part B Drug Prices

Allowing private health care providers to negotiate prices for drugs is not keeping drug prices down.  It seems to me that, in fact, it is forcing many drug prices up artificially.   Here are two examples:

When generic Lipitor (atorvastatin)  was first put on the market, it cost much more through many Part B health care plans than it did buying it on the open market.  The private providers had cut deals with Pfizer, the manufacturer of Lipitor, to keep the generic price higher than the price of the brand name Lipitor.  This was meant to encourage members to pick Lipitor instead of the generic.  These artificially high prices lasted for about 6 months, then the price of the generic finally came down.

Now generic Plavix (clopidogrel) has hit the market.  When I checked on how much this would cost my husband through his Medicare Part D plan provider United Healthcare, we were told the price was $70.00 for a thirty day supply of clopidogrel.  My husband is in the doughnut hole, and so we have to pay full price for whatever we purchase.  I checked the regular pharmacy price for this drug, and it was being sold for as low as $15.00 for a thirty day supply.  Why the discrepancy?  I have to think that once again, the negotiated price through our health care provider was ridiculously high because some kind of deal was cut with Bristol-Myers Squibb, although I have no proof.  Whatever the case, the cost of $70.00 compared to $15.00 can't be justified.  Obviously the negotiated price is out of whack.

If Medicare was allowed to negotiate the prices of drugs, this type of thing would no longer happen.  It is a fact that the prices negotiated through the Tricare military health care plan are cheaper than that negotiated through private health care providers.  An analysis by the National Committee To Preserve Medicare and Social Security showed that Tricare prices on the top 10 drugs being used were 48% cheaper than Medicare Part D prices.  That's a huge difference.

Allowing the negotiation of drug prices through private health care providers was passed along with the Part D legislation.  Also, it prohibited the purchasing of drugs from Canada, another bad move.  Initially, the Affordable Care Act had provisions to allow Medicare to take over the negotiations, but this was taken out.   This should absolutely be brought up again, and passed.  Obama has promised to repeal the prohibition and let Medicare negotiate prices, but it hasn't happened yet, and certainly won't even be brought up again unless he gets reelected.  Whoever wins needs to look at this critical issue.  It would greatly help seniors and would bring down the skyrocketing cost of pharmaceuticals.

NAFTA Was SHAFTA

Today I read another installment running in the Philadelphia Inquirer from the book "Betrayal of The American Dream". It discussed the huge loss of progamming jobs that flew out of this country from 2002 and has continued ever since.

Here are the figures:

1990 - 558,880

2002 – 499,000

2006 – 435,000

2008 – 427,000

These were jobs that used to be thought of as used to be high paying jobs – jobs that required a higher education, but ensured a bright future. I worked in this field, and remember when you could look in the Want Ad section and there would be pages of job opportunities. Now it's down to a single page or two.  How sad. 

The book states that for years we have been given misleading information concerning the benefits of outsourcing. The line has always been that outsourcing will bring other jobs back to the country. For example, Gary Clyde Hufbauer, former assistant secretary at the Treasury Department made a prediction that NAFA would generate 7-9 billion dollars in trade, and produce 170,000 jobs. What actually happened? An immediate trade deficit with Mexico that in 2012 has amounted to $700 billion as well as the loss of thousands of decent paying manufacturing jobs in this country.

I voted for Ross Perot, and it seems as if my vote was justified. NAFTA was SHAFTA. And what do our two presidential candidates have to say on the subject?

Well, mostly they're calling each other outsourcers, and giving misleading facts without anything to back their accusations up. Romney is calling Obama the “outsourcer-in-chief” because of green energy jobs in other countries, and Obama is saying that Romney will be an “outsourcer-in-chief” because while he was in charge of Bain Capital, there were lots of jobs outsourced. I checked, and neither claim can be backed up. Check these links:

http://factcheck.org/2012/06/obamas-outsourcer-overreach/

http://www.washingtonpost.com/blogs/fact-checker/post/obama-and-outsourcing-a-guide-to-the-gops-charges/2012/07/11/gJQA1LBIeW_blog.html

What I'm interested in is this - what is either candidate going to do about it? Obama wants to tax companies that take jobs out of the country. He also wants to offer tax credits that would stimulate the manufacturing of goods in this country (especially green energy). However, he reneged on his pledge to renegotiate NAFTA. Romney talks about making fairer trade policies with China, and stopping them from manipulating their currency. Obama has talked about this problem as well.  Romney wants to reduce taxes on overseas profits, which would only increase outsourcing. Mother Jones has an interesing article that claims neither candidate is really interested in changing things, and that both support globalization, and therefore the inevitable outsourcing that is a result of it. I hope that Mother Jones is mistaken. 

The bottom line is that we should be listening carefully for real solutions to this problem, not just name calling.  Let's hope that both candidates can offer concrete policies that can stop the bleeding of our American jobs.

In the meantime, you may want to check out this link to What Went Wrong .  It's a real eye-opener.

Romney Should Release Tax Returns - And So Should Others

It it beyond me why Mitt Romney refuses to release more of his federal tax information.  So far he has only released part of his 2010 tax return, withholding a separate document with the IRS that provides additional details on overseas bank holdings.  The part of the 2010 that he did show revealed that he had a Swiss bank account, but the Report on Foreign Bank and Financial Accounts that is required when such an account is held would show more details concerning the Swiss bank account.  He hasn't released this yet, and seems to be refusing to do so.  Romney says that he will release his 2011 return, but will go no further. 

It seems to me that to quell any suspicions he should reveal more than two years, and he should also make sure to hand over any documentation concerning the Swiss bank account.

Should there be a law requiring a certain number of years of disclosure?  Probably every president as well as members of the Congress and Senate should have to reveal at least three years of tax information when running for office, and should have to produce such information on an annual basis while in office.  Recently members of Congress were asked to reveal tax information by McClatchy Newspapers.  Only 17 of 536 members released their most recent tax information.  This is a disgrace!

By the way, there's a site where you can see tax information from different candidates - 

http://www.taxhistory.org/www/website.nsf/Web/PresidentialTaxReturns/

Barack Obama's returns are there from 2000 on.  Mitt Romney's 2010 and 2011 returns are there as well. Take a look. 

Why Are Medical Costs So High In The United States?

The United States has the highest costs for medical care of any other developed nation, and yet we do not get better health care for that cost. We are not sicker, we don't go to the doctor more often, and yet our costs are sky high, and rising every year. It is projected that we will pay $13,708 dollars per capita by 2020, or 19.8% of our GDP.

In research I did for on my article  “Why Are Medical Costs So High In The U.S.A.?”,  I found that there are four major reasons of these escalating costs:

1. We pay doctors more in the United States – in 2008, general doctors make an average of $186,582 as compared to Australia at $92,844 and France at $95,585. There is an even wider gap among specialists – the average in the U.S. Is $442,450 next to Britain at $324,138, with all other countries coming in at less than $210,000.
2. Drugs are more expensive in the U.S. - In fact we pay 60% more in this country than our European peer countries. Why? Perhaps the power of lobbyists in Washington has much to do with the lack of regulations regarding these prices and with not allowing importing drugs from other countries.
3. Administrative Costs are more – in fact, for every office based physician there are 2.2 administrative personnel, more than the number of nurses, clinical assistants, and technical staff put together.
4. We overuse diagnostic tests – The overuse of diagnostic tests has been estimated to cost about $250 billion dollars a year. This is 10% of the entire cost of health care. Doctors may overuse diagnostic tests because of fear of litigation.

What can be done about these excessive costs? Solutions I've seen have included

1. Encouraging more care from primary physicians rather than specialists
2. Allowing drugs to be imported
3. Better negotiation of drug prices by medicare
4. Adopting more uniform procedures for payment and billing
5. Have centralized database of electronic records
6. Tort Reform to prevent frivolous law suits
7. Promote wellness and preventative medicine

Some of these cost cutting solutions will be introduced under the Affordable Care Act. It has provisions in it to encourage wellness, such as discounted premiums for participants in wellness programs. It also introduces regulations to streamline administrative costs through the use of electronic record keeping. There will be a 15 member Independent Medicare Payment Advisory Board whose task is to study ways to contain Medicare costs and offer solutions. These solutions are supposed to reduce the growth rate of medicare costs while still maintaining or enhancing beneficiary access to quality care. Many are critical of this panel saying that they will ration out health care to seniors and cut access to services. However, it states in the Affordable Care Act that the board is not allowed to offer solutions that ration health care, restrict benefits, raise beneficiary cost sharing or raise premiums. Hopefully their solutions will help bring down the unbearably high cost of medical care, and serve as a model for the rest of the health care industry.

An Example Of Why Medical Costs Are So High

I am very careful about checking on the Medicare site to see what tests and procedures I'm eligible for.  Last November I noticed I was due for an Annual Wellness Exam, and so I scheduled it.  I specifically told the office to make sure it was scheduled as a Wellness Visit, so that there would be no problem with payment.

The Annual Wellness visit is an attempt at preventative medicine.  The purpose of this visit is to sit down with your physician and evaluate your medical history, your current health status and what medications you are taking.  The physician is supposed to check your blood pressure, vision, weight and height, make sure you're current with all your preventative screenings (shots, colonoscopy...).  Further tests may then be ordered depending on what the physician determines from this evaluation.  (For some reason, Medicare doesn't pay for a complete annual physical.  However, I don't think that many doctors are aware of the difference, and incorrectly carry out a complete physical, then bill Medicare incorrectly.)

When I arrived for the Wellness Visit, one of the nurses weighed me, gave me an eye exam, took my blood pressure and gave me a hearing test.  I of course assumed that this was part of the Wellness Exam, and that nothing being done was extra.  The doctor then carried out a brief physical, talked to me about my health in general, and that was the end of the visit.  The visit took probably about 15-20 minutes.

Imagine my surprise when I got a bill for $70.00 six months later.  The office had billed Medicare $160.00 for the Wellness Exam, $45.00 for the hearing test, and $25.00 for the eye exam.  Medicare would not pay for the hearing test and eye exam that was being billed on top of the Wellness Exam.  I wouldn't expect them to - the eye test should have been covered under the $160.00 that they got from the Wellness Exam itself, and the hearing test probably should never have been done at all.

Now it is up to me to fight this bill, and spend possibly hours trying to get things straight.  I have already made six phone calls to the billing department and the doctor's office, arguing that the $70.00 charge should be dropped.  The doctor's office has told me that they don't know what insurance providers cover, that they just go ahead and do a regular physical, and that they are billing the way that they were taught.  They claim that it is not up to them to know what's covered by each patient's insurance.  I tried to explain to them that the Wellness Exam is not a regular physical, and that they should know what's covered so that their patients don't incur unexpected costs, but I got nowhere with that.  I also argued that they are actually double billing for the eye exam, and that the ear exam was something that I never asked for, and that if it wasn't covered they shouldn't have done it.  Again, I got nowhere.

My point to all of this is that in order to bring down costs, the medical providers should know what is covered by Medicare.   It may be difficult to figure out what procedures are covered by other providers, but in the case of Medicare,  it's pretty straight forward.  I believe that there's software to assist the medical establishment with such issues.  Whenever they are going to do anything that will not be covered, they should specifically ask the patient before they carry out a procedure.  Certainly if I had been asked if they should do the ear exam for $45.00 I would have given them a resounding NO!

Under Rick Santorum We Would Have A Theocracy

According to the dictionary, a Theocracy is a a system of government in which God or a deity is held to be the civil ruler. Well, according to Rick Santorum, that is what he wants for this country. Recently in Idaho he stated once again “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their — ” (pausing for the crowd to shout “Creator!”) “with certain unalienable rights.”

“That is who we are, that’s where our rights come from,” he said, eliciting “Bless the Lord!” from the audience.

Based on this, Santorum is saying that the creator should be the ultimate authority that determines our governmental policies, not the constitution. Hmmm – isn' t that a theocracy? With Rick Santorum you can expect that his interpretation of what the creator wants from us will be the rule of the land. Of all the scarry Republican candidates, Rick Santorum is the worst, because he is so firmly convinced that he is capable of interpreting God's will. Therefore, It is his destiny that he march forth with his trumpet and make us buckle under to that interpretation. Don't get me wrong – I have some strong personal religious beliefs, and am not anti-religious. What I am is for the seperation of Church and State. I am also strongly for religious freedom. That means freedom for those that do not believe as I do as well as for those that do. Under Rick Santorum, that is not what we would be getting.

I think that Mitt Romney, even though he is not all that popular with Republicans, even though he is a known flip-flopper, is the best that the Republicans have to offer. Rick Santorum just has too much of a religious agenda, and would cross the line of division between church and state.