The non-negotiable aspects of the ‘replace’ part of health care include some key points that will not bode well for most people

• The rich no longer have to pay into Medicare [why is this a good thing?] while everyone else still does.
• Corporations no longer have to promise to minimize profits on health insurance [profits drive companies to cover only the sick, include high deductibles, refuse to sell to ‘risky’ people, and add cost while reducing coverage]
• Subsidies will move away from helping those with limited financial resources to helping older people more
• Medicaid expansion will end – and responsibility will move to the states without the funding behind it

Hmmmmmm

The changes will drive competition – but is health care really a place for for-profit motivations?

If you own the rights to a treatment, drug or cure, wouldn’t a for-profit model drive you to charge as much as possible?  If you can charge $1,000,000 a treatment instead of $100, you can make the same amount of money with one patient as you would with 10,000 patients.  And business knows your margins are best when the cost / transaction is low.

If your life is on the line, do you shop for the cheapest or the best care if you can afford both?

Mergers were growing – which reduce competition – and there were no provisions that discouraged mergers.

And the companies that pulled out of the Health Exchange did so because they couldn’t find a way to make enough profits.  It wasn’t because the people didn’t buy their products.  It was because people bought their products and used them.

And the cost for doctors and hospitals go up by a lot if they have to deal with collecting money and writing off bad debt.  That emergency room care is the least efficient, most expensive way to get non-emergency care. People who think it is free because they can’t turn you away don’t really understand how it works.  To get care, you sign paperwork promising to pay the bills.  If you don’t, the hospital can come after you.  And they can sell your debt to debt collectors.  The ‘cost’ of uninsured and under-insured patients is like the cost of shoplifting in retail.  To stay in business, others must cover the cost of those that can’t pay for services.  Which means costs go up for all.

And doctors can’t practice their best medicine if their patients can’t afford treatments.

Perhaps the real issue with the ‘repeal’ is that it is being crafted by people who firmly believe that only a for-profit, ‘free-market’ system works.

But how ‘free’ is the market if your options are to buy or die?

The proposed changes are great for the already well off.  They get more tax help for the coverage they can already afford, they get better tax breaks for hiding money in Health Savings Accounts so that they can use it for medical care, pass it along to their heirs, and avoid ever paying taxes on this money.  And they can go back to getting Medicare for free – not having to pay in while they earn millions and get a capped insurance premium once they are eligible.  Great for them.

But for the rest of us, it keeps us in a model where we need great health care but can’t really afford it.  Even if we don’t buy an iPhone……

The sales pitch will go into full force.  They hope to scare or cajole you into going along.

They will claim they have a mandate to do this.

That is the biggest lie.  The President ran on NOT doing what the proposed bill does – reduce care and increase cost and hurt Medicare and Medicaid.  More people voted for democrats, 3rd parties or opted to sit this one out than voted for replublicans.

And they are pushing this through quickly.  Because most of us are catching on to what a very very very bad deal this repeal thing really s.

They had 8 years and the reason they have no plan is that they don’t believe that you should get ANY help buying insurance.  You should be on your own.  This is the 1st step in getting rid of Medicare and Social Security, programs they have never liked.

When you start with helping those who don’t need help, you are signaling your real intentions.  Which is to take a bit for yourself, and screw the rest of us.  All under the banner of ‘conservative values’.

Well I value life, liberty and the pursuit of happiness for ALL.  And that means I think we need to find a way where we focus on how to provide quality care for all – without consideration for how much they can pay.  Because when it comes to providing health care, equal should mean equal.

MLR is another hidden gem within ACA.   It stands for Medical Loss Ratio.

It was added by  Senator Al Franken of Minnesota.  Its purpose is to set boundaries on the amount of money an insurance company can keep for administrative costs including profits.

It means that if the people that the insurance company insures don’t use very many services, the insurance company may have to refund some money to the people that paid premiums because they aren’t allowed to make too much profit.

This made sense because the ACA also made people buy health insurance or pay a penalty. Without some regulation like the MLR, the insurance companies could increase their rates and increase their profits.

Another rule meant that companies that offered policies on the Health Exchange could not charge a different amount for the same product if sold anywhere else and could not deny coverage to anyone that applied.

Other rules removed the ability of insurance companies to charge people more based on gender or medical conditions.

Before the ACA some companies would price their products so that anyone other than young healthy people would shop somewhere else. Since healthy people used less services and companies didn’t have to make sure wellness services were covered without first having to meet the deductible, some companies made lots of profits for these policies.

The policies did not provide very good coverage but they were good for business.

Part of the reason that insurance companies are pulling off the Exchanges is because they can’t make the kind of profits.

Repeal / Replace removes all those corporate regulations.

And people who need coverage get hurt.  And insurance companies go back to being in control and able to set policies to maximize profits not providing health benefits.

Insurance is intended to share risk.  The best model is one that has everyone in one large risk pool.  This is what Medicare does – and why it is the most efficient health insurance plan in place today.  This is what single-payer would do.

Competition and for-profit models actually don’t work well in insurance models.  The only thing insurance companies can compete with is negotiating lower costs to deliver benefits [possible only when an insurance company has enough members to be able to negotiate discounts] or reducing their profit margins.  Since all insurance involves some amount of risk, companies cannot survive if their risk margin is too small.

High-risk corridors were put in place for the ACA to help prevent insurance companies from facing losses if they happened to have a lot of people who all needed more care than those covered by other policies.  The ACA had a model to share risk across private companies – and to set up high-risk corridors where some portion of premiums would be shifted across companies if some companies had more risk that others.

But Congress went back on the promise to fund high-risk corridors.  And this made insurance companies lose money -because they already took on the risk.  And this made them pull out of the Health Exchanges.  Sort of a self-inflicted death-spiral

All of this stuff is complicated.

Removing regulations in the ACA will return us to a time when for-profit insurance companies had the power.

How is this better for most of us?

Ask your representatives why they think this is a good deal.  Start with asking if they even understand it.   Because they aren’t passing laws like they understand the consequences.

It is easy to aim all of our frustrations at our elected officials.

Who really feels that their elected officials truly represent them?

Few people are happy about our current state of politics.  Being unhappy with the status quo is different from making things better.

But this is politics- and it involves a diverse group of people.  Not everyone can get their way.  Sometimes, we have to accept the undesirable to get the more important desirable things we want.  This is part of being an adult.

If you are an elected official, how do you really ‘represent’ your constituents?  How do you know what they want as well as what they need?  How do  you now what they are willing to ‘pay’ [in time, energy, resources and lost opportunities] to get what they want?

I think  elected officials need to listen.  But how do you really listen to hundreds of thousands of people?

Listening is tricky.  Because we, as humans, don’t really hear the words that others speak.  We hear the stories we make up about what we ‘heard’ [what our senses picked up].  This is why you can have a person say something to a group and the group will disagree about what was said.

And if you are an elected official, you can’t talk with everyone you represent.  But you are forced to talk with those that you need help from – which includes those that you need to fund your campaigns.  Without another option, elected officials just might think the people they talk to to get help funding their campaigns are the same as the people they are supposed to represent.

Candidates could try to find things out with polls, but those are imperfect at best.

Why put the burden on the elected officials or those considering running for office?

Why can’t we citizens create listening spaces?  These could be Forums where citizens get together and discuss issues and concerns in a group setting.  A place where there is real dialogue about the issues and about what could possibly be done to fix things.  A place where the consequences of change can be talked about as well – what are we willing to give and what are we willing to lose to get change.

Elected officials or those running for office could come to these forums and listen.  It would give them a chance to watch their ‘bosses’ [remember they were supposed to work for us citizens, right?] and see what they care about.

And the conversations will be messy – because people working together is messy.

But these respectful listening spaces – forums where citizens talk with each other and where elected officials – or those who want to lead – can come and listen might just produce a space where we can all realize that we share many things with other people. And if we started to talk to each other, maybe we can find the time when the labels of party did not separate us as they do today.

I watch the ‘Town Halls’ on television and the portions that make the news are not examples of listening.  They aren’t even examples of dialogue.  And they are rarely respectful.

But what if they were?  What difference could that make?

A listening space for elected officials is also a learning space for citizens.

It is a place where ideas come to discover the impacts those ideas have on others.

It is a place for your beliefs to get tested. Maybe you believe something to be true that isn’t really true, or at least doesn’t work the way you thought it did.  Maybe you hadn’t considered a situation from someone else’s point of view.

We live in a complex world with a global marketplace enabled by technology that is changing at a faster rate than every before.  We cannot isolate ourselves.  We cannot go back to the way the world worked before the technology created the global marketplace.

We cannot deny that technology makes things possible that were not possible before.  We could give everyone renewable energy if we wanted to.  We could produce clean water for everyone if we wanted to.  We could end hunger if we wanted to.  Technology also makes some things, perhaps many things, obsolete.  Are we ready for the disruption that this is bringing and will continue to bring?

Sometimes change makes us wish for simpler times – but that is usually because we remember the past fondly, forgetting the messy parts, the painful parts, the ugly parts.

I would love a listening space to connect to the people around me.  The ones that are in my community.  I don’t interact with them routinely – because I work far away from where I live and so do most of the people who live near me.  We don’t have a town square where we just hang out.

Social media like twitter, Facebook and even blogging, provides a forum to speak.

But not to listen – really listen.  And not to connect.

What if we, the citizens, committed to produce such a space – a place where we would show up to learn,  listen and share.  What if we were committed to gather in respectful exchanges of ideas and opinions?

And what if our elected officials would come just to listen.  No speeches – just listening.

I believe this is possible.  I believe it could produce an end to the we-they conflict that keeps us at odds with each other.

Would you attend such an event?  Why shouldn’t we try to do this at least for awhile?

Democracy – most effective when we have informed, actively-engaged citizens.

The last election and is ‘victors’ appear to adopt a “Win-Lose” mentality.  Once elected, they win and get to do whatever they want.

But the job of an elected official is to represent ALL of their constituents and to support and defend the Constitution.

So going out and LISTENING to what the constituents say and factor that into their positions – or have a DIALOGUE to reach common ground is part of the job.

We are not ‘divided’ as much as we are ‘diverse’.

Labeling everyone in one lump or thinking one question polls are an accurate depiction of what Americans think is too simplistic.

What is really happening out there is that the MAJORITY – people who did not vote and those that did not vote Republican – are trying to have their positions heard.

And are doing whatever they can do when confronted with ‘You lost, get over it.’ reactions.

The person holding the elected office got the job – but the job doesn’t include ignoring everyone that didn’t vote for them or doing whatever you want to do.

Our representative has his office in a private building – so that anyone coming to see him can be evicted / blocked and escorted away or arrested for trespassing.  How is this possible?   Taxpayers fund those offices.  The representative works for us – represents us.  Why is it allowed to have an office in a private building – he is a public official?

Laws effect all of us and tend to impact those with the least power.

It took the ACA to finally have the top 1% pay into Medicare while they work – even though they receive its benefits when they become eligible.  The repeal will end that and hurt the funding of Medicare.  And yet this gets lumped into bad taxes that must be repealed – with no mention of repealing all of the taxes that fund Medicare and figuring out how else to pay for it.

Repeal could just be hiding the fact that the top 1% get a big tax break while Medicare gets weakened – making the case for having to take it private.

The protests around the ACA are thoughtful and heartfelt and sincere.  Real people got care and people really had their lives saved from this law.  The majority of people want it improved but do not want to risk a repeal that puts them back at risk or takes them away from care.  And no replacement plan will do that.

Most of us know we need help to protect our water, our air, our environment and that regulations are needed to dos so.  Most do not favor positions that lead to decisions that allow oil spills to occur but do not hold the corporations involved accountable for their clean-up or that lead to water that poisons citizens in Flint to save a few bucks.  The majority did not vote to have the regulations that protect our water and our air removed.

Why is it assumed that protesters must be paid?  Is it because representatives no longer do anything unless they are getting paid [by their donors]?

Or is it inconvenient to have to deal with the consequences of your positions with those that you are supposed to represent?  It was easier when we thought that elected officials had some level of  ethics and we could watch from the sidelines and things wouldn’t be that bad…

But 2016 proved that lack of engagement has consequences.  And We, the People, have an obligation to fix it and produce consequences for not representing the interests of the majority of us.

So don’t expect the protesters to go away any time soon.

Because this is what democracy looks like.

How to think about things you hear others say that you believe are not true…..

Truth – there is such a thing.  It is not as simple as you think.

We, as humans, live in language.  We tell ourselves stories about the interpretations we make up by the way our nervous system is perturbed.

Two people walk outside.  One says it is hot and the other says it is cold. Is someone lying?

Assessments of temperature reflect how someone interprets their experience of their surroundings.  But there is a measurable temperature.  So the measured temperature is the fact – the truth..  The assessment of warmth or cold is an interpretation of how one human body experienced the temperature.  When one is warm and the other is cold, each may authentically be assessing their experience.  They are declaring their truth about the temperature as they experience it.

So what is ‘lying’?

Lying requires you to know something is true – verifiable by independent sources.  And then you speak as if something else is true – you intentionally say something you know to be false.  This is what lie detectors detect – the physical aspects it takes to say something you know to be false.

But what if you think something is true but it isn’t.

Is that lying?

Maybe…..

At first,  you can just be ignorant.  You can think something is true that isn’t.

Birthers thought that President Obama wasn’t born in America.  For them, this was ‘true’.  So at first, you heard them express their interpretation – often based on what they saw [he is black] and what they heard or perhaps read [on the internet?].  They demanded proof. But then the facts came out – a birth certificate, first short-form then long-form.  Yet some persisted – he wasn’t born here…..

When a ‘Birther’ declares that Obama wasn’t born here, are they lying?

For them, the truth wasn’t true. The facts were rejected.  They chose to believe something to be true to fit their view of the world – to fit into the rest of the stories they tell themselves.

So this isn’t being ignorant, but what is it?

I call it living in a world you choose to create based on what you want to be true.  You aren’t trying to convince anyone but yourself that the world works the way you want it to.

But there is another set of actors that operate outside the truth.  They don’t lie – because they actually don’t care if what they say is true or not.  They often contradict themselves….  because they don’t care.  Over time, they may even lose track of what is true.

They have an agenda – a hidden one.  They may want to be liked and say whatever they think it will take to be liked or popular.  They may be trying to sell you something and will say anything to get you to buy what they are selling.  They may want to distract you from what they are up to  and will say anything it takes for you to stop paying attention to what they want you to ignore.

This is what it means to bullshit.  This is the con.  And some people do this so much they, too, lose track of the truth.

What we are watching play out in our country – the United States of America – is a combination of people who want to believe the world is other than it is, liars who are deliberately saying things they know to be untrue and bullshitters who are working a con.

And our President seems to be a combination of all three.

And the danger is that he sometimes seems like he can’t tell the difference and neither can his supporters.

How do we tell?

Well, votes are counted and there are real numbers that are certified and become the official results of an election.  There are real statistics based on real numbers of murders or crimes.  And when someone says they won the popular vote when they didn’t or that the murder rate is the highest in years when it isn’t, they are not speaking the truth.

And when others believe it – they aren’t lying.  They are just trusting someone who should not be trusted.  Because the ‘truth’ isn’t in the person they choose to believe.

So watch the polls for how many people believe things to be true that we know are not true.  That tells us how many people are rejecting facts for living in a world they prefer.

Birthers preferred a world that didn’t have a black president of the United States.  They were conned or lied to – does it matter?  They were ready to accept the falsehood because it produced a world they preferred.

So watch out.

Keep an open mind – you might hold things to be true are not.  You bought the story because you wanted it to be true.

Because this is what the Russian hack may have done.  They may have created so many sources of things that people wanted to be true – about Hillary, about our president, about the democrats – that they created hundreds of thousands of people who believed what they read.  And those people may not even realize that they made their choice based on ‘facts’ that were manufactured by the Russians to get people to either stay home and not vote or to vote for Trump and the Republicans.  And those people spread the lies as if they were true and convinced others to believe – for there is safety in numbers and we can’t all be wrong, can we?

It is hard to prove what really happened.  Because people have a rough time locating why they believe what they do.

But when many people still believe President Obama was not born in America, you know that the fantasy is alive and well.  And when people believe that President Trump won the popular vote or that the murder rate is the highest in years, they remain in that fantasy world.

The danger of the liar and the bullshitter is that they produce people who no longer know what is true and yet who think they operate from truth.

This is one source of the bitter divide – one side believes things that they hear but are not true and the other adopts the truth and cannot accept those that can’t ‘see’ that they believe lies.  There is no compromise here – the war is a war of what is real not of policy.  And behind it is a war of values.  Some believe that all are created equal – others believe that some are more equal than other.  Rights are rights vs. rights are earned.

So what do we do?

Start talking to each other more.

Question into the things we do not agree on.   Are we dealing with different ways to interpret something or different facts.  If is a difference of fact, be careful.  Some hold onto facts because they reject the truth.  It will be hard for them to let go  – because their world will become less to their liking.  But the conversations are important.

Because we, the people, are supposed to care about truth and justice.

Care enough to be willing to find out what we want to be true isn’t.  And to help others see that what they want to be true isn’t.

Trump came in 3rd -with people who did NOT vote being 1st and Hillary voters being 2nd.

Republican gerrymandered many districts to be ‘safe’ where the only worry was being primaried out by more right facing candidates.

Citizens United confused them more – corporations aren’t people; money isn’t speech.

And with the Presidential ‘win’, Republicans are governing like they have a majority behind them because they have the corporations and the money from the powerful – and that is who they have been representing.

But ‘We, the People’ are pissed.

Most don’t want the things that are being put into law or put in place by Executive Whim [disguised as Orders].

And the more than two-thirds that did NOT support this set of policies, that care about rights, that care about the environment, that care about inequality, that care about getting money out of politics are trying to let government leaders know that this is not what they voted for.  Because it isn’t.

Corporations aren’t people and they don’t vote. And when you hang around the corporate lobbyists and wealthy donors too much because you need their money and you like the power it provides, you forgot who you actually are supposed to work for – We, the People.

In frustration, they are taking to the street.  They are calling their representatives.  They are not being listened to.  So they are getting mad and getting frustrated.

They are demanding that Congress do its job and defend the Constitution instead of their agenda and their party.  Because MOST of us didn’t back them – they just didn’t like the options and were blind to the policies of the Republicans that would go in place if the President were a Republican.  And since the candidate is a con man, they believed he would be different and get Congress to listen.  And they were wrong.

People do not like to feel they are wrong.  They don’t want to admit it.

During this campaign, the excitement was for an Independent candidate running as a democrat.  He convinced the successful candidate to adopt his platform – very progressive.  That candidate didn’t win and the Senate and House stayed Republican.

The protestors are the people who always held those progressive beliefs about basic fundamental rights and that government ought to work for the People and not Corporations or Money.

And they won’t go away.

And they shouldn’t  – because there are more of them.   He came in 3rd.

Those that did NOT vote are mostly more progressive but didn’t like Clinton.

Many that say they don’t like the ACA, want a Public Option not repeal.

And now they want a Congress with ethics and oversight – so I would start there. Act like it matters.  Act like you are ok if you find out that Russian Influence DID make a difference – that the Russians attacked us from within and their attacks worked.  And then figure out what you are going to do when you learn that is true so you are willing to start the Independent investigation that is required.  And follow that with an independent investigation into the FBI actions.  And follow that with an independent investigation into the impacts on voting starting with the states where the outcome was other than predicted.

He came in 3rd – and you are making the people angry.

“A White House official said the two countries would launch a new task force called the United States Canada Council for the Advancement of Women Business Leaders-Female Entrepreneurs. The official said Trudeau’s office reached out to discuss working on a joint effort, noting that this was seen as an area of shared interest between both leaders.”

Every once in a while, the administration will say something that sounds normal and positive.  The kudos erupt and we are all supposed to breathe a sigh of relief and sit down.

But take note, the council focuses on entrepreneurs not workers.  And was suggested by the Canadian leader – not ours [follow the leader is not a powerful move].  There are also discussions of this being championed by Ivanka Trump – who caused ethics violations to occur in her defense.

But the proposals put forward by Ivanka have all benefited those with much and altered programs that benefit women with less.  Tax Credits require you to have income and the capacity to fund the costs upfront and to fund the difference between cost and credit.  All while giving tax benefits to those who already have the capacity to fund the services / help.

Our president nominated people who are largely rich, white men.  They hold positions that have not supported women’s rights.  One appointment is the wife of the Senate Majority Leader – who just silenced another senator for saying things on the floor that were tolerated on the same floor.  The president then resumed use of a nickname when referring to this Senator – challenging her legitimacy and showing no respect.

The focus on de-funding Planned Parenthood hurts women – but mainly the young and less affluent.  Loss of services provided by Planned Parenthood can hurt the health of women.  Yet this is a widely held position of this administration and of the Republican party.

The appointment of the massively incompetent but very wealthy donor, Betsy DeVos, as head of Education insults women everywhere.  There are competent women who would take this role and use it to elevate our public schools and overall education of our kids to be competitive.  He selected someone whose policies caused Michigan’s standings to drop from middle of the pack to the bottom.

It is the actions that matter.

So don’t get distracted by what looks like one good deed.

Pay attention to the continued silence over the slams against women.  The lack of any outrage over the silencing of Elizabeth Warren is unacceptable.

It is the real issue with women’s rights and of the remainder of the human rights concerns.  You point to a specific situation where  you take action that is positive in some way.  You use this to claim you are ‘for’ women’s rights, because you are not against all rights that some women are given.

This human rights thing is simple.  If you tolerate the challenge of basic rights to any group, you are simply not for human rights.

The same is true of women’s rights.

And this president, the Republican Party and far too many others are fine with selective acts being sufficient to make this issue go away.

But most of us will not go away.

This was the lesson of the Women’s March.  Democracy will not end quietly and Women are not going away.  We, the people, want equality for all.  We want the principles of our country was founded on to finally rise to their full measure.  To end the wink-wink exceptions of privilege.

What do we expect?  Wrong question.  What will we accept?  You need to acknowledge the past acts as being wrong.  You need to declare the new thinking that you are committed to adopt.  And you need to act in ways that are fully aligned with your new thinking for a sufficient time that it is possible to begin to trust you.

Otherwise, we will consider this one more pile and we no longer look for the pony.