Should Medical Costs Be Disclosed in Advance? Standardized?

Finding out healthcare costs isn’t easy. Patients typically don’t learn them in advance. Often even the nurses, doctors, and other medical professionals in a hospital probably don’t know the health care costs for various procedures--billing is typically done by a different department of the hospital.

Indeed, when one faces a medical emergency, the patient and medical professionals are perhaps focused on diagnosing and treating whatever health need prompts the emergency rather than focusing on costs. Often that is the way it should be. In some cases until a patient is properly diagnosed and treated, the total financial cost involved is not known.

But for nonemergency medical needs, it is often (if not always) good for patients to know in advance approximately what the costs will be for various options and what the likely outcomes will be.

Recent Government Action

On November 15, 2019 the Department of Health and Human Services (HHS) announced[1] that “the Centers for Medicare & Medicaid Services (CMS) is issuing two rules . . . to increase price transparency to empower patients and increase price competition among all hospitals, group health plans, and health insurance issuers in the in the individual and group markets.”

The HHS took action in response to President Donald Trump’s June 24, 2019 “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First[2].”

These step seem to be progress toward making medical care costs easier to learn in advance. Such transparency may lead to lower costs and better service.

As I stated in a March 2019 Google Blogger post[3], the greatest need for healthcare reform is better preventive care that can enable us to live happier, healthier, longer lives with lower medical costs. But when persons do seek medical care, we like to get quality care at reasonable prices. More transparency about pricing and quality can help this happen.

United States Healthcare Costs

United States healthcare costs are the highest in the world per capita, yet millions still lack quality healthcare coverage.

To cite just one example of high United States healthcare costs, a March 14, 2019 BBC article[4] notes that U.S. retail prices for insulin and other costs of treating diabetes are much higher than in the other countries discussed in the BBC piece.

Closing Thoughts: Simplify Healthcare Costs?

In addition to making prices more transparent, it could simplify things and reduce paperwork if hospitals charged the same rate to all insurance companies, individuals, etc., while offering a certain amount of pro bono (free) care to the needy, especially for emergency cases.

As it is now, often insurance companies negotiate major discounts off the stated prices for procedures, while persons who lack insurance and have limited funds often are billed for the standard rates which may be double or triple what the insurance companies negotiate. To me, this seems unreasonable. If you disagree, please feel free to explain to me why.

Furthermore, insurance plans often provide many pages of documentation of what’s covered and what’s not. I’m guessing (and I admit this is not based on personal knowledge) that medical professionals may be tempted to perform an unnecessary medical test or procedure that is covered by a patient’s insurance to get revenue for the medical facility and staff. In contrast medical professionals may seek to avoid performing a procedure they find advisable due to insurance not covering it.

Ideally, we’d be better off if we either had health insurance that covered everything, were so healthy we needed no medical care, and/or had the funds and wisdom to pay for all our own healthcare needs without insurance.

We don’t live in this ideal world. But I think the Trump administration’s actions to get more transparency in medical care is a big step in the correct direction.

However, I am writing as an outsider. Is there something I’m missing that medical professionals and/or insurance professionals know?        

DISCLOSURE:

The author’s sisters both work for hospitals, one as a registered nurse and the other in the accounting area of a different hospital. But the author did not consult either of them for information when writing this piece.

ENDNOTES:

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[1] “Trump Administration Announces Historic Price Transparency Requirements to Increase Competition and Lower Healthcare Costs for All Americans”; U.S. Department of Health & Human Services; November 15, 2019 press release; webpage accessed November 23, 2019; https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html

[2] Donald J. Trump; “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First”; Whitehouse.gov; June 24, 2019; webpage accessed November 23, 2019; https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/

[3] James Edwin Gibson; “True Healthcare Reform: Better Preventive Care;” Google Blogger; March 30, 2019; webpage accessed November 25, 2019; https://oneopinionsomeviews.blogspot.com/2019/03/true-health-care-reform-better.html

[4] Ritu Prasad; “The human cost of insulin in America”; BBC News; March 14, 2019; webpage accessed March 23, 2019; https://www.bbc.com/news/world-us-canada-47491964

NOTE:

This article being submitted to Google Blogger on November 25, 2019 is virtually identical to one the author submitted to Craft News Report, a website operated by his friend Paul Craft, on November 24, 2019.

Trump Is an Effective President Despite (Because of?) His Weaknesses

Donald Trump is an effective president. Why? Because he is accomplishing much of what he committed to do during his presidential campaign and what he desires to do.

Please don’t misunderstand me. Trump has numerous weaknesses. He seems egotistical, a megalomaniac. His tweets and comments often contain much hyperbole or blatant lies. His past allegedly includes some shady business dealings and sexual harassment.

I did not vote for him. In fact due to what I perceived as major character flaws of Trump and Hillary Clinton, I voted for one of the other candidates in the November 2016 election. As an independent, I couldn’t vote in the primary election, but if I could, I likely would have voted for a United States Senator from my home state, Kentucky Senator Rand Paul.

Mavericks Versus Political Party Supporters

Both Trump and Paul are mavericks. They seek to do things differently than the standard procedures of the Democratic and Republican machines. A whole lot of people who are fed up with the way things have been done support Trump (and Paul, who agrees with Trump on many things, but not all). Trump and Paul are both Republicans, but they both have some ideas that go against their own Republican party.

Millions of people (including me) are fed up with persons who follow strictly Republican or strictly Democratic principles. Trump probably is not much more popular with traditional Republicans than with liberal Democrats. If a secret ballot were taken, most Republican Senators would probably prefer Vice President Mike Pence to hold the office. For example, Republicans dislike Trump’s plans to rebuild infrastructure and his plans to withdraw U.S. troops from Syria and other areas.

Some of President Donald Trump’s 2016 Campaign Promises  

·         Judges. Trump committed to appointing conservative, pro-life Supreme Court justices. He has done so, appointing two, both confirmed and now on the court. He has also appointed numerous other conservative judges in various positions.

·         Trade. Trump promised to replace NAFTA. He negotiated a new agreement (USMCA) that if confirmed will be a new approach to trade between the United States, Mexico, and Canada. He is also in various stages of new trade agreements with China, Japan, the European Union, South Korea, and the United Kingdom.

·         Environment. Trump, as promised, has rolled-back environmental regulations on coal mining, light bulbs energy consumption, air quality, the Clean Water Act, restrictions on oil and gas drilling in certain areas, and cut the EPA’s budget and scope.

·         Immigration. Trump campaigned on a plan to expand and improve the border wall(s) along the Mexican border, and he sought to greatly reduce illegal immigration. He has worked to do so, with limited success thus far, but he certainly has sought to do it.

·     Obamacare and healthcare. Trump promised to abolish Obamacare. He has succeeded in ending the mandate for persons to purchase health care. And other changes are in court. Trump also seeks for healthcare prices to be more transparent, so persons can see the rates insurance providers negotiate with health care providers and actual costs of procedures, versus the rates the general public pays.  

·       Taxes. Federal tax forms have been simplified and taxes have been lowered.

·      Infrastructure. Trump has sought to rebuild infrastructure. But Democrats seem reluctant to help and it is not an issue Republicans seem interested greatly in spending money on.

·     Worldwide military presence and counterproductive warfare. Trump has sought to reduce the number of U.S. troops in various areas of the world despite opposition from many Republican leaders.

·  Radical Islamic terrorism. Trump’s administration has made significant strides in combatting radical Islamic terrorism.

·  Jerusalem embassy. Trump’s administration moved the U.S. embassy in Israel to Jerusalem.

Even if I disagree with some of President Trump’s accomplishments, I give him credit for coming closer to fulfilling his campaign promises--or seeking to do so--than most (if not all) Presidents of my lifetime.

These accomplishments make him popular with a lot of folks—and unpopular with a lot of others.

The Impeachment Process

A primary reason for the impeachment process may not be that he has abused power, lied, etc. Instead, many are concerned that he accomplished things that the liberal Democrats dislike—and that he may be reelected for another four years. Indeed, the Democrats calling for Trump’s impeachment didn’t get upset about Barack Obama’s frequent executive orders, etc., that seemed to abuse the power of the presidency.

It surprises me that the Trump impeachment proceedings focus on his seeking an investigation of Joe Biden and Hunter Biden. If the Bidens were doing wrong, they should be investigated. If not, the investigation presumably wouldn’t find anything. Maybe other alleged infractions of Trump are worse.

I wrote about the impeachment process in a November 12, 2019 Google Blogger piece.  I still feel Trump will not be forcibly removed from office.

My guess is that the impeachment trial will be over before the end of winter. And the public may tire of seeing, hearing, and reading about it before then. Voters in November 2020 will vote more based on how the United States economy is at that time than based on impeachment proceedings.

Final Thoughts

The nation may be its most divided since the Civil War and its aftermath. Following the Civil War and the installation of Andrew Johnson as successor to President Abraham Lincoln, Radical Republicans were outraged by some of President Andrew Johnson’s actions, such as his support for leniency for the South. Johnson was impeached and saved by one vote from being convicted and removed from office by the U.S. Senate. Some of Trump’s actions outrage people, too.

Donald Trump has not bridged the divisiveness in the country or the huge gap between the income of the working class and the income of the wealthy elite. But, Donald Trump has an impressive list of accomplished campaign promises thus far.

Furthermore, he is working on fulfilling more campaign promises. Many of those who voted for him in 2016 have even more reason to vote for him in 2020. Of course, many of those who voted against him in 2016 have even more reason to vote against him.

Arguably, Trump’s most important unfilled campaign promise is the one to restore economic prosperity, including for coal miners. He has taken positive steps. But a lot of coal miners remain unemployed. A lot of workers in various occupations remain paid relatively little compared to CEOs. The huge gap between the typical wages of workers and the riches of the corporate elites remains huge.

My guess is that the state of the economy will be more important in next year’s presidential election than the impeachment process.

Personally, I seek to pray for President Trump and other officials. I pray that they will seek to make the right decisions and do the right things.

Lots of things need changed. Lots of things need restored. Actions need taken.

And assertive mavericks like Donald Trump and Rand Paul are more likely to take innovative action for change than career lawyer politicians. As long as persons keep Trump under reasonable control to overcome his missteps, his record of accomplishments may keep building.

Depending on who else is on the ballot, God willing, I may even vote for Trump myself in November 2020—though I remain hopeful for a much better maverick candidate. Yes, Donald Trump has major weaknesses, but lack of significant accomplishments as President is not one of them. For better or worse, he has done or sought to do much of what he campaigned promising to do.

NOTE:

This article being submitted to Google Blogger on November 20, 2019 is very similar to one the author submitted on November 17, 2019 to the website Craft News Report, which is operated by his friend Paul Craft.

Will Trump Be Impeached? Convicted? Resign?

Public televised hearings begin tomorrow Wednesday, November 13, 2019, as the United States House of Representatives considers whether or not to impeach President Donald Trump, as noted by Reuters[i], TheHill[ii], CBSNews[iii], and numerous other news sources.

Four things to consider are:

·         Will President Trump be impeached by the U.S. House of Representatives?

·         If so, will President Trump be convicted by the U.S. Senate and removed from office?

·         Will President Trump resign from office voluntarily?

·         Despite much wrongdoing, why has no President ever been convicted by the Senate and removed from office?

I address each of these four questions below.

First, Will President Trump Be Impeached?

The impeachment process is still in its early stages. But this question seems to be the easiest of the four to answer. The majority of the members of the U.S. House of Representatives are Democrats. It only takes a majority vote to impeach the President. And many Democrats have made their dissatisfaction with the President clear on a variety of issues that they apparently consider worthy of impeachment. Therefore, impeachment seems very likely.

Second, Will the U.S. Senate Convict President Trump?

If/when the U.S. House of Representatives impeaches the President, the U.S. Senate will then consider whether or not to convict him of whatever wrongdoing(s) the House charges him with, thus removing him from office.

The United States Constitution[iv] requires the “Concurrence of two thirds of the Members present” to convict him. Since the majority of the U.S. Senate members are Republicans, even if all Democrats in the U.S. Senate vote to remove Trump, many Republicans would need to vote that way also to convict him. So far, few Republicans seem inclined to vote that way.

How the public hearings go, how public opinion goes, and other factors will determine the end result. But in the entire history of this country, there has never been a President convicted and removed from office.

My guess is that since zero Republican U.S. House of Representatives members even voted for opening a formal impeachment inquiry, when all is said and done, that the United States Senate will not get a two thirds majority to convict President Trump.

Third, Will President Trump Resign From Office Voluntarily?

So far, the President shows no sign at all of that. And though he is known to change his mind, I see no evidence thus far that would indicate such a thing occurring. His base of evangelical conservatives seems largely to be sticking with him and so do most Republicans.

Fourth, Why Has No President Ever Been Removed from Office by the U.S. Senate?

We’ve never had a President formally convicted and removed from office by the United States Senate despite some that may have committed numerous wrongs.

Two Presidents (Andrew Johnson and Bill Clinton) were impeached. But neither was convicted by the Senate.

One President (Richard Nixon) resigned before the proceedings were completed, since Republican leaders convinced him he would be convicted and removed from office, as stated by the ChristianScienceMonitor,[v] Politico[vi], and other news sources.

Should any past Presidents have been forcibly removed from office? I’m not an expert on past Presidents, and I am not qualified to make that decision. But I will cite a few examples of Presidents that allegedly committed significant wrongdoing and/or allegedly possessed significant weaknesses:

·         Bill Clinton allegedly had hundreds of extramarital affairs. At least four women accused him of sexually harassing them, including one who said he raped her, according to BusinessInsider[vii] and other news sources. However, his impeachment trial focused on one consensual affair with an intern. Numerous other Presidents have also been accused of adultery and other sexual offenses.

·         Warren G. Harding’s administration involved much corruption though he was never personally implicated in it, as reported by Britannica.com[viii] and other sources.    

·         Abraham Lincoln and some other Presidents are believed by many scholars to have suffered from mental illness during their Presidencies. BPHope.com[ix] claims at least twelve U.S. Presidents suffered from mental illness. Though many scholars consider Lincoln our greatest President, others feel that a better qualified one could have gradually ended slavery peacefully without a war that resulted in hundreds of thousands of deaths, injuries, and divisions that to some extent still exist.

·         A few Presidents were supposedly incapacitated at times and their wives performed many Presidential functions. For example, after President Woodrow Wilson suffered a stroke, his wife Edith Wilson was “functionally running the Executive branch of government for the remainder of Wilson’s second term” according to a piece on WhiteHouse.gov[x] and other news sources. Franklin Delano Roosevelt’s wife, Eleanor Roosevelt, also played a leading role in his administration due to his disability according to a piece on PresidentialProfiles.com[xi] and other sources.

I don’t know why no President has ever been forcibly removed from office. But that fact seems to indicate up the difficulty of doing so. And, I am not going to discuss assassination, since I abhor violence.

Final Thoughts

As an independent voter who didn’t like either Clinton or Trump, I voted for another candidate in the November 2016 presidential election. Independent voters can’t vote in the primary election in Kentucky (where I live), but if I could have voted in the primary, I would have voted for Kentucky Senator Rand Paul. You may consider me biased since Rand Paul and I both live in Kentucky. But Paul is a maverick who has many well-thought-out views as I see it.

Persons who are outspoken mavericks sometimes antagonize people though. That is the case with Trump.

President Trump is perhaps our most communicative President. He sends numerous daily public tweets.

He often offends people with his statements or tweets. He frequently changes his mind when he gains new information. He sometimes says perhaps outrageous things. His seeming spur-of-the-moment comments and/or decisions apparently often need to be altered by his staff.

But his being a maverick can be a benefit compared to Presidents who stick strictly to a political party’s views. Sometimes it’s wise to change one’s mind.

Furthermore, for better or worse President Trump has done or tried to do much of what he promised to do during his Presidential campaign:

·         He has appointed pro-life judges.

·         He has sought (unsuccessfully so far) to rebuild the country’s infrastructure.

·         He has loosened environmental restrictions.

·         He has taken the types of actions on trade and immigration that he campaigned on.

·       And his personality as President seems similar to his personality during the presidential campaign and before. I dislike his hyperbole (lying may be a better more accurate term) and his megalomaniac nature. But I think that’s what he displayed during the campaign. Sadly, hyperbole and megalomania seem common among many in leadership positions, though leaders may typically not have it to Trump’s extent.

Also, the Constitution does not forbid persons who are impeached and removed from office from running again. This impeachment process is occurring during the reelection campaign. In theory, Trump could be impeached and removed from office, then reelected. Would the new Congress repeat the process or would a group of more supportive persons be elected to Congress along with Trump?

Time will tell how it ends. And public reaction to the televised public proceedings may be a key factor (for better or worse).

However, unless the televised proceedings lead to some breakthroughs, I do not expect Trump to be convicted by the Senate or to resign.

The voters may make the decision on the reelection campaign in a year, November 2020.

ENDNOTES

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[i] Susan Cornwell; “Explainer: What to expect from the televised Trump impeachment hearings next week”; Reuters; November 8, 2019; webpage accessed November 10, 2019; https://www.reuters.com/article/us-usa-trump-impeachment-hearings-explai/explainer-what-to-expect-from-the-televised-trump-impeachment-hearings-next-week-idUSKBN1XI22U

[ii] John Kruzel and Olivia Beavers; “Key impeachment witnesses to know as public hearings begin”; TheHill; November 9, 2019; webpage accessed November 10, 2019; https://thehill.com/policy/national-security/469704-key-impeachment-witnesses-to-know-as-public-hearings-begin

[iii] Caroline Cournoyer, Major Garrette, and Nancy Cordes; “What happened in the impeachment inquiry this week”; CBSNews; November 9, 2019; webpage accessed November 10, 2019; https://www.cbsnews.com/news/trump-impeachment-inquiry-recap-house-releases-testimony-transcripts-prepares-public-hearings-2019-11-09/ 

[iv] The Constitution of the United States of America”; GovInfo.gov; July 25, 2007; webpage accessed November 10, 2019; https://www.govinfo.gov/content/pkg/CDOC-110hdoc50/pdf/CDOC-110hdoc50.pdf

[v] Peter Grier: ; “Richard Nixon’s resignation: the day before, a moment of truth”; CSMonitor.com; August 7, 2014; webpage accessed November 10, 2019; https://www.csmonitor.com/USA/Politics/Decoder/2014/0807/Richard-Nixon-s-resignation-the-day-before-a-moment-of-truth

[vi] Andrew Glass; “When the GOP Torpedoed Nixon”; Politico; February 7, 2007; webpage accessed November 10, 2019; https://www.politico.com/story/2007/02/when-the-gop-torpedoed-nixon-002680

[vii] Eliza Relman; “These are the sexual-assault allegations against Bill Clinton”; Business Insider; June 4, 2018; webpage accessed November 10, 2019; https://www.businessinsider.com/these-are-the-sexual-assault-allegations-against-bill-clinton-2017-11

[viii] “Warren G. Harding”; Britannica.com; last updated October 29, 2019; webpage accessed November 12, 2019; https://www.britannica.com/biography/Warren-G-Harding

[ix] “The Surprising Link between American Presidents and Mental Illness”; bp Magazine; webpage accessed November 10, 2019; https://www.bphope.com/bipolar-buzz/the-surprising-link-between-american-presidents-and-mental-illness/

[x] “Edith Bolt Galt Wilson”; WhiteHouse.gov; webpage accessed November 10, 2019; https://www.whitehouse.gov/about-the-white-house/first-ladies/edith-bolling-galt-wilson/

[xi] “The Role of First Lady: Martha Washington to Laura Bush – First ladies with strong impact on their husbands’ presidencies”; PresidentProfiles.com; webpage accessed November 10, 2019; https://www.presidentprofiles.com/General-Information/The-Role-of-First-Lady-Martha-Washington-to-Laura-Bush-First-ladies-with-strong-impact-on-their-husbands-presidencies.html

NOTE:

This article being submitted to Google Blogger on November 12, 2019 is very similar to one the author submitted to Craft News Report, a website operated by his friend Paul Craft, on November 10, 2019.

Fracking Causes Environmental Damage: Should Fracking Stop?

Fracking has been halted in England, as reported by an article November 1, 2019 on the Guardian website and by other news sources. Should the United States take similar action?

Fracking Damage

Energy companies that produce oil and natural gas by fracking, and dispose of huge quantities of wastewater containing chemicals as part of the process, seem to be causing a very large increase in the number of earthquakes in areas where fracking occurs.

A June 10, 2015 United States Geological Survey article titled "6 Facts about Human-caused Earthquakes" states "injecting fluid underground can cause earthquakes, a fact that was established decades ago by USGS scientists."

Lawsuits in the United States Over Alleged Fracking/Waste Water Injection Damage

Numerous lawsuits have been filed regarding damage from fracking. A June 12, 2019 piece on the University of Dayton website titled “Hydraulic Fracturing Tort Litigation Summary” discusses numerous cases.

Last year (2018) three oil companies reached a settlement on a class action lawsuit filed regarding earthquakes in Oklahoma allegedly caused by wastewater injection, as reported by CNHI News Oklahoma in a November 30, 2018 article on the Stillwater, Oklahoma News Press website and other news sources.

I am surprised that there have not been even more lawsuits and more outrage over this practice. While widespread availability of relatively cheap oil and natural gas has many benefits, the risks and damages that occur from producing it also need to be considered.

In cases where it is demonstrated that oil and natural gas producers are directly responsible for the large increase in earthquakes and the damages the earthquakes cause, then these companies are presumably liable for reimbursing those impacted by the damages.

Closing Thoughts

I am not a lawyer and cannot give legal advice. But it apparently has been known for decades that injecting fluids into the ground can lead to earthquakes. Furthermore, it is a fact that the number of earthquakes has increased dramatically in areas where wastewater has been injected into the ground in recent years. Therefore, it is logical that this fluid injection is the likely cause of these earthquakes.

I am not stating that all fracking must stop or even that all the disposal of wastewater by injecting it into the ground must cease. But, I strongly support holding these energy companies liable for the damages they are causing. Even if persons feel that the benefits of the oil and gas production via this method justify allowing it to continue, the persons who suffer damages from the earthquakes deserve compensation for their damages as I see it.

The cost of compensating victims of earthquakes should lead to changes such as:

·         finding more environmentally friendly ways of producing the oil or gas

·         raising oil and gas prices to pay for damages and for lawsuits

·         using alternative energy sources.

Oil and natural gas have provided many benefits over the years as energy sources. But these benefits need to be weighed against the negative impacts of the production, transportation, and consumption of this natural gas and oil.

My view is that fracking may not be economically feasible if oil and gas companies are forced to pay for the damages their procedures cause.

NOTE: This article being submitted to Google Blogger on November 3, 2019 is virtually identical to one submitted to Craft News Report on November 2, 2019 that was revised on November 3, 2019. That article was based on one the author submitted to Google Blogger on November 18, 2016 that was last revised on November 19, 2016.