In 2017, Federal Government Healthcare spending will surpass one trillion dollars ($1,050,000,000,000), about 25% of the CBO projected 2017 U.S. Federal Budget Outlay; and along with military spending will create a Deficit of nearly $700 Billion – increasing the current $20.3 trillion National Debt ($20,300,000,000,000 – October 2017). This paper will: provide some Background to U.S. Healthcare & National Debt Crisis, offer a brief Timeline of U.S. Healthcare & Government Programs, view the current system and Obamacare, reveal projections, examine factors directly related to the current U.S. Healthcare Crisis: 2017 and offer SOLUTIONS to the HEALTHCARE CRISIS.
BACKGROUND (13 pages)
Mid-1400s Black Death (Bubonic Plague) came from Asia and killed 30% to 50% of Egypt’s and Europe’s population (100+ million deaths). The 1500s were a period of exploration, colonization and advancement in civilization. Printing presses were being manufactured, the Bible and books were being translated into common languages, the New World was being conquered and built, and universities were found in most of the great cities. The 1600s were a time of mass immigration and establishment of governments, churches, schools and military presence.
In the 1700s writers and universities spoke of ‘enlightenment’ which would come through government and science, as opposed to strictly religious means. Nevertheless, before the 18th century, war, persecution and hardships were a way of life in many countries. Most people desired freedom, but few countries were prepared to seek it, find it and pay its cost. During the Late Colonial Period in America, in 1763 the British ended a war with American Indians with a Treaty agreeing to prohibit colonists from settling west of the Appalachian Mountains.
It would be a moot point to the British, because after a progression of taxation without representation (Sugar Act tax 1764; Stamp Act tax 1765; Townshend Acts taxes on imported goods and tea in 1770) the colonists protested and then revolted – leading to the American Revolution and declared independence by the Continental Congress in July 1776. It would be 1789, when after the U.S. Constitution was ratified (1788), that George Washington was elected the first president of the United States of America.
In 1700, America’s Colonial population was 250,000. In 1800, America’s second Census revealed a population of about 5.3 million people, of which over 893,000 were slaves. The U.S. had 15 states at that time. In 1803, America negotiated the Louisiana Purchase with Napoleon and France – adding 530 million acres or 828,000 sq.’ miles (14 states lie in the area) – and doubled the size of the United States.
In 1751, Benjamin Franklin co-founded Pennsylvania Hospital. Columbia University’s College of Physicians and Surgeons was founded in 1767 (King’s College); Harvard Medical School was established in 1782 (Harvard – 1636); the first U.S. Medical Journal was the Medical Repository (1797); and the New England Journal of Medicine began in 1812. In 1867, Congress created the Commissioner of Education and “established at the City of Washington, a department of education, for the purpose of collecting …statistics… (NCES.ed.gov)”
According to the National Center for Education Statistics, 120 Years of American Education: A Statistical Portrait (1993), “From colonial times, America has recognized the value… of a basic education. …In 1869-70, millions of young people were enrolled in public elementary schools… (and) the large enrollment in high schools is one of the many success stories of American education during the 20th century… In 1869-70, there were only about 2 persons receiving high school diplomas per 100 17-year-olds… In 1939-40, the ratio rose above 50 percent… Immediately after (World War II) the graduation ratio resumed… reaching 70% in 1959.”
Continuing from NCES’ Statistical Portrait, “Development of American Institutions of higher education began early in the colonial period… Harvard University was founded in 1636 to prepare ministers… Public colleges expanded westward… as states made higher education available to their citizens… Another major development of the early 19th century was the creation of normal schools. These institutions were designed to help prepare teachers for the expanding school systems… In 1839, Horace Mann established the first public normal school in Massachusetts… Some 37 of today’s colleges were founded prior to 1800… During the first two decades of the 1800s, 31 more colleges were founded… the next two decades brought 102 more colleges that still exist today, and between 1840 and 1859, an additional 210 colleges were founded… Today, many of the 380 colleges founded prior to 1860 are independent or public, but most were originally controlled by religious groups…” https://nces.ed.gov/pubs93/93442.pdf
As universities gained accreditation and graduated educated professionals, industries looked to these graduates and their professors to help develop and advance best practices in their fields. Associations and Boards were formed by business and industry professionals and the government maintained a connection with those that were reputable.
During the 20th Century, Universities and Colleges worked with professional industries and Federal and State Governments to development guidelines and requirements for professional industries. Courses and curriculums were established by schools, licenses and practices were development and requirements set by governments and trade associations or industries. The medical industry was at the forefront.
According to the Federation of State Medical Boards (www.fsmb.org 2017), FSMB History: “Since its inception in 1912, the FSMB has grown in the range of its services to state medical and osteopathic boards charged with protecting the public health and interests in their respective states…” Prior to the FSMB, the North Carolina Medical Board was established in 1859 and many states began licensing laws in the 1870s. Nevertheless, in 1900 rural population still out measured urban.
According to The American College text Group Benefits: Basic Concept and Alternatives (1991), “…During the 19th century the United States made the transition from an agrarian economy to one characterized by increasing industrialization and urbanization. The economic consequences of death, sickness, accidents, and old age became more significant as individuals began to depend more on monetary wages than on self-reliance and family ties to meet their basic needs…” In 1900, life expectancy was much lower then – 46 years for a male and 48 for a female (UC Berkeley’s Population Research Centers).
Although in 1900 there were 76 million people and 45 states, with America controlling all the land within the Continental United States, there was no INCOME TAX, the NATIONAL DEBT was $2.1 Billion, and cities were growing. Still, as most of the population and jobs were rural, many Americans helped each other build their houses and exercised humble contentment; they also traditionally dealt with HEALTH CARE through families and country doctors.
In 1790, the United States had four National or Commercial Banks; by 1800 the number reached 29 with about $27 million in capital and $50 million in assets. After the defeated renewal and closure of the Bank of the United States in 1811; Rothschild and others Central Bankers backed the British against America in the War of 1812. According to historians, the War led to chaos in shipping and banking and an increase in government debt. In 1816, Congress approved a second Bank of the United States and owned a fifth of its stock. The Bank issued currency, purchased government debt and served as a central depository.
In 1835, under President Andrew Jackson, the U.S. National Debt was paid off. In 1850, immigrates were flowing into North America and the population increased over 35% from a decade earlier to reach 23.2 million – of which 3.2 million were slaves. That year California became the 31st state. To keep and expand territory since 1803, Americans had fought and made treaties with Indians, Mexicans (Mexican-America War), the British (War of 1812) and Russia.
In 1865, after the Civil War and the enforcement of President Lincoln’s 1863 Emancipation Proclamation ending slavery, America entered a slow period of healing and reconstruction. Though steel, cotton and tobacco were big industries, there was little infrastructure and technology to advance ‘civilization’ as in the 1900s.
In 1861, the National Debt was $90 million, and by the end of the war it reached $2.6 billion – more than a 2,780% increase in less than five years. To help pay this July 1, 1862 Congress passed the INTERNAL REVENUE ACT and first income tax – primarily on the wealthy. Yet even during three decades of reconstruction after the war, and during the expansion of railroads into the west, Congress adhered to a reasonable budget – actually decreasing the National Debt to $2.1 billion in 1876 and removing Income Taxes in 1873. And Congress held debt in check reducing it to $1.5 billion in 1893 and just under $2 billion in 1899.
By the 1880s petroleum or oil was an important part of American’s economy. Also banks and railroads were chief industries pushing forward the growth of the nation. By the 1890s, the names of Vanderbilt (Railroads), Carnegie (Steel), Morgan (GE, US Steel, Railroads, Chase Bank) and Rockefeller (Oil, Chase Bank) were well known and their enterprises well established.
According to the ‘Historical Timeline’ at Federal Deposit Insurance Corporation: “1901: First National City Bank (Citibank), …Stillman and …Rockefeller, with Standard Oil money, buys $115 million of Northern Pacific Railroad’s stock and triggers a stock market panic. Thousands of small investors are wiped out. Theodore Roosevelt… continues …McKinley’s trust-busting efforts. John P. Morgan creates U.S. Steel, the first billion-dollar corporation… U.S. Steel elevates both Wall Street and U.S. Industry… 1904: the Bank of Italy is chartered in California… renamed Bank of America (1927) …1905: there are 9,018 state banks and 5,664 national banks… 1907: …the New York Stock Exchange goes into drastic decline… President T. Roosevelt provides Morgan with $25 million …to use to control the panic. Morgan, acting as a one-man CENTRAL BANK, decides which firms will fail and which firms will survive… 1909: Taft establishes the National Monetary Commission… to propose a banking reform plan… 1911: The Supreme Court rules that Standard Oil… is a monopoly… House Committee on Banking and Currency… hearings reveal …J. P. Morgan and First National City Bank (Citibank) with 341 directorships on 112 companies …controlling $22 billion in resources. 1913: The FEDERAL RESERVE ACT …establishes the Federal Reserve System… the Fed, as the CENTRAL BANK – the nation’s third… with a 20-year charter (permanent 1927). World War I: 1914-1918… The economy booms… The financial havoc reigning in Europe presents U.S. banks with new demands for services. The U.S. economy is the largest in the world in terms of GNP. The FINANCIAL CENTER of the World shifts from London to Wall Street.”
In 1903, automobile production surpassed 12,800 units; and in 1908 it was more than 43,000; about 318,000 in 1913; and by the end of World War I (1918), over 800,000 vehicles had been produced that year and in 1919 over a million vehicles were being produced. The second decade of the 20th century also saw significant expansion, industrialization, advancements in communication, power plants and changes in American homes.
In 1911, Nelson Aldrich (whose son was President of Chase and daughter married John D. Rockefeller, Jr.) chaired the Senate Finance Committee and worked to create the Fed Central Banking system. In 1912, there was NO INCOME TAX, but there were signs of a coming Great War. Years before World War I began the main Allied Powers and Central Powers had their alliances. The United States would build up its military, and it would support the British Empire and French Republic. However, where would the money come from to build a massive war machine, how would Congress pay for it and what about its Veterans?
The answer was the FEDERAL RESERVE ACT. It passed 43 to 25 with only 68 of the 100 senators voting just before Christmas 1913. The Reserve Bank issued shares to Banks such as National City Bank (Rockefeller major shareholder), Chase National, First National Bank (Morgan), Rothschild’s Banks of London and Germany, Warburg’s German Banks, and Goldman Sachs. In 1911, Paul Warburg became a naturalized US citizen and in 1914 the German Banker was on the first Federal Reserve Board (and 1921, he was a founding member of Council on Foreign Relations with Wilson’s advisor, Colonel House). William McAdoo, the Sec. of Treasury, became the first Chairman of the Federal Reserve Board. He owed J. P. Morgan for bailing out his Railroad Company; he was also President Wilson’s (who signed the 1913 Federal Reserve Act) campaign manager.
In 1913, to pay back Central Bank loans for the coming World War, Congress enacted INCOME TAXES starting at 1% and up to 7% on $500,000 and above. The NATIONAL DEBT in 1913 was about $2.9 billion. By 1919 it reached $27 billion; knowing their future debt crisis, Congress in 1917 raised Income Taxes significantly – less than 7% on middle class families, but 65% on incomes over $1 million – raised in 1918 to 77%; and 15% to 20% on incomes from $10,000 to $20,000 (over 50 brackets that year). The rate on the top Income bracket continued at 73% several years until 1922 being reduced to 58%; then 46% on amounts over $500,000 in 1924 and 25% on amounts over $100,000 in 1925 to 1931 as the National Debt was reduced to $17 billion.
Thus, the National Debt from 1789 to 1931, after about 142 years, was $17 billion. And in order to maintain it, Congress used taxes – primarily on the very wealthy. Nevertheless, at that time families bore the burden of their healthcare and life expectancy in 1931 was about 60 for males and 63 for females.
In 1915, about 1 in 12 (8%) homes had electricity. By 1920, the U.S. Census revealed that over half of the population was urban. Additionally, by that year about 35% of U.S. households had electricity; though less than 3% of America’s 6 million farms had electricity. Between 1840 and 1850 over 1.7 million Europeans came to America; and from 1880 and 1930 about 27 million European immigrates came to the United States. In 1930, the U.S. population was 123 million; at that time only about 10% of farms had electricity.
In 1929, the stock market crashed and by 1933 nearly half of the banks failed and two million Americas were homeless. In 1936, Congress passed the Rural Electrification and Telephone Act to help fund electrical distribution to rural areas. The Act also helped to deal with high unemployment during the Great Depression; but building infrastructure comes at a cost – DEBT. President F. D. Roosevelt’s took office saying in his inauguration address, “…rulers of the Exchange of mankind’s goods have failed through their own stubbornness and their own incompetence… unscrupulous money changers…”
The Federal Emergency Relief Administration began to aid many unemployed workers, the Federal Trade Commission increased its powers and in 1934, the Securities and Exchange Commission was created to regulate Wall Street. In 1935, the SOCIAL SECURITY ACT was passed, giving federal ‘grants to states for old-age assistance,’ and ‘grants to states for aid to dependent children;’ as well as ‘assisting the States in the administration of their unemployment compensation laws.’
After centuries of colonialization, border disputes and wars in Europe, Asia and Africa; Italy invaded Ethiopia (1935), Japan invaded China (1937) and Germany invaded Poland (1939) and then Denmark, Norway and France (1940). The British entered World War II in 1940. In 1941, Germany invaded the Soviet Union (Russia) and Japan attacked the Philippines and Pearl Harbor, Hawaii. Japan did not surrender until America dropped 2 atomic bombs. Just before the war ended, FDR had finished 12 years as president (1933-1944) and the NATIONAL DEBT increased from $22.5 billion to $201 billion.
During the next 8 years, President Truman and Congress would hold the National Debt steady at about $255 billion. This was done in large part by increased taxes on the wealthy. Seeing the oncoming war the income tax on the top bracket was 63% on income over $1 million in 1935; then raised to 77% in 1936 and 79% in 1941 (81% portion over $5 million). During 1942, all American taxpayers carried the War burden with the lowest bracket at 19%, 38% at $10,000, 55% at $20,000 and 88% over $200,000. In 1944, as the Allies were advancing, Americans paid 23% in the lowest bracket, 50% at $14,000 and 92% at $100,000 (94% – $200,000+). The lowest bracket remained at 20% and the top at 91% (with slight variations and increases) until J. F. Kennedy took office and Congress made changes for 1964.
From 1945 to 1963, the National Debt increased from about $250 billion to $305 billion – that is from 1789 to 1963 (174 years) it was $311 billion. Or from 1913 (Federal Reserve and Income Tax) to 1963, after two World Wars and 50 years it increased from $2.9 billion to $305 billion. In order to maintain it, Congress used budget constraints and taxes on high incomes. At that time (1963) the average medical and legal professional made nice but reasonable incomes, average life expectancy was about 67 for males and 73 for females, and HEALTHCARE was affordable.
In 1960 the U.S. population was about 180 million and the average family size was 3.1. The Average Annual Costs per person for Healthcare was $146 and the Average Family Income was $6,691. There was 1 person in 16.8% of households. Male workforce participation was 83.3% and female at 37.7%. Median family income was $5,620; 36.1% of families had incomes below $5,000 and 18.9% had incomes under $3,000. Housing was the largest expense at 29.5%; and food was second at 24.3%, followed by clothing at 10.4% and average family’s charitable giving increased from $165 in 1950 to $303 in 1960. (Source: bls.gov ‘100 Years of U.S. Consumer Spending’ using data from the U.S. Bureau of Labor Statistics, Consumer Expenditure Survey). If healthcare cost $450 a year in 1960, than it was < 7% of the average family incomes.
November 1963, the Federal Reserve’s ASSETS for ‘all member banks’ was $251 billion (source: FRASER, St. Louis Fed). That was up from about $25 billion before WWII in 1940 when Gold Reserves back nearly all of the funds; whereas Gold represented less than $20 billion in 1963. Thus, over the last two generations, our currency has been backed by increased Debt Ceilings.
As education and technology increased in the 20th century, professionals were restricted with governmental regulations, subjected to litigation, required to hold licenses and keep up continuing ethics and education. However, Congress and the Fed has no such requirements.
From 1964 (L. B. Johnson) to 1980 (J. Carter) the NATIONAL DEBT rose from just over $310 billion to just over $900 billion (3x in 17 years). Moreover, the $600 billion increase in 17 years was TWICE as much as all the accumulation from 1789 to 1964 (175 years); thus each of those years with created INFLATION and MONETARY POLICIES were equal to 10 years during a time that Americans sacrificed and lived much more humbly. According to the Social Security Administration the National Average wage index for 1964 was $4,576 and was $12,513 in 1980 (less than 2.75 times that of 1964). Federal Reserve Assets of all commercial banks surpassed $1.5 trillion in 1980 up 6 times that of 1964. The Income tax rates at tax brackets $20,000 and $200,000 were 34% and 76.5% (MFJ) in 1964; and 28% and 70% in 1980 (MFJ).
In 1980, health care cost increased from $146 per person in 1960 to $1,110 per person or 9% of GDP according to Kaiser Family Foundation using the OECD Health Statistics database. Note that since the 1970s the United States has spent more on health insurance as a share of GDP than any other OECD Country. The M2 Money Stock increased from less than $300 billion in 1964 to $1.6 trillion by the end of 1980. The Dow Jones Industrial Average high in 1964 was 874 and in 1980 it was 964. The Federal Spending for 1964 included: Defense $65.4 billion – 35%; Education $27.2 B – 14%; Pensions $16 B – 8%; Welfare $12.9 B – 6.8%; Health Care $6.7 B – 3.5%). In 1980 the Government collected $1.2 trillion in tax revenues and spent $1.36 trillion. Government Spending for 1980 (based on $940 billion) included: Defense $167 B – 18%; Education $152 B – 16%; Pensions $148 B – 16%; Welfare $95 B – 10%; and Health Care $87 B – 9%.
During the 12 years of the Ronald Reagan and George H. W. Bush period from 1981 to 1992 the NATIONAL DEBT increased from $1 Trillion to just over $4 Trillion. In 12 years, the National Debt increased FOUR TIMES (4x) as much as all the accumulation from 1789 to 1980 (190 years); each 1 of those (12) years equaled an average of 15.8 years from America’s preceding history. In 1982, the Individual Income Tax rate on $36,000 MFJ was 39% and 50% on amounts above $85,600. By 1992, the SIMPLIFIED three brackets for Married Filing Jointly were 15% to $35,800; 31% on amounts over $86,500 and 28% for in between. Single Filers paid 31% on amounts over $51,900. Reducing taxes during this ‘trickle down’ philosophy directly affected increases in the National Debt.
And how did the government pay 14% on 10-year T-bills in 1980 and how did banks pay out over 10% rates on savings accounts and CDs? In great part due to the fact that the Federal Reserve freely increasing M2 and dumping billions of extra dollars into their 2000 banks which were in turn charging an average of 21.5% on 5-year Mortgages, 14% on auto loans and 36% on Credit Cards (should be illegal; don’t give the loan if they don’t qualify – but charging high risk customers 10 times more than low risk citizens is one of the worst forms of discrimination).
In 1916, John Rockefeller was said to be the world’s first billionaire (over 2,000 in 2017). In 1982, Forbes began publishing its Forbes 400; in 1992 there were 73 U.S. billionaires. These billionaires could not have been so without government contracts, increased M2 Money Supply, massive bank loans, the Federal Reserve, and dramatically reduced income taxes that were supposed to create more jobs through ‘trickled down economics.’
During ‘Bill’ Clinton’s eight (8) years the National Debt increased from over $4.3 trillion in 1994 to $5.6 trillion in 2000. Congress increased the top income bracket from 1992 to 2000, to 39.6% on incomes over $250,000 to approach their budgets and monitor debt. In 2000, following ‘mandatory outlays,’ Congress spent $408 billion on “Social Security… to provide a comprehensive package of protection against the loss of earnings due to retirement, disability or death… The Government will collect $473 billion in Social Security taxes in 2000… In 2000, the Federal Government will spend about $152 billion and allocate about $92 billion in tax incentives to provide direct health care services, promote disease prevention, further consumer and occupational safety, conduct and support research… Estimated life expectancy reached a record-high of 76.5 for those born in 1997… (Source: Budget… Fiscal Year 2000).”
According to data from the Tax Policy Center (Urban-Brookings Institutes) only 5 years since 1960 saw Congressional Budget Surpluses – 1969 and 1998 through 2001. Clinton increased the CHIP program and Medicaid spending; and the average health insurance premiums saw double digits increases 1998-2001 from their previous years.
Reports by RAND Corporation and the Bureau of Labor revealed that health insurance costs relative to payroll increased 34% between 1996 and 2005; and RAND cited studies that revealed over a 90% increase in total health spending during the same period; and that during the same 1996 to 2005 GDP rose 51%. They more importantly said that “most economists believe that health insurance premium costs are ultimately passed back to employees in the form of reduced wages… (Monthly Labor Review, June 2008)”
Actual revenue for 2000 was just over $2 trillion and total expenditures $1.8 trillion or 17.6% of GDP. The National Debt ($5.6T) was about half of GDP ($10.2 T). Half of the revenue came from Individual Income Tax, 32% from Social Security and payroll taxes; 10% from Corporate; 3.4% Excise taxes; 1.4% Estate/Gift taxes; 1% Customs and 2% misc. Outlays included: Social Security ($409 – 23%); National Defense ($294B – 16.5%); Income Security ($253 B – 14%: Unemployment, Food Asst., Housing Asst., Disability); Medicare ($197 – 11%); Health ($154B – 8.6%); Veterans Benefits ($47B – 2.6%) and Net Interest on Debt ($223B – 12.5%).
M2 Money Supply in 2000 surpassed $4.8 trillion – doubling in 16 years from 1984, and ten (10x) the amount from 1967. Additionally, Federal Reserve assets December 2000 reached $619 billion with only $11 billion in Gold certificates, but $515 in U.S. Government Securities or Debt instruments (source: Board of Governors of the Federal Reserve System). Moreover, the Federal Reserve was paid to increase M2 (and thus inflation). The Federal Reserve Act of 1913 and laws that followed up guaranteed a 6% DIVIDEND paid out to the banks that held stock in the Federal Reserve Center Banks (this was about a 1% rake over the 10-year US Treasury).
In January 2001, George W. Bush became the 43rd President of the United States. September 11, 2001 (9-11) al-Qaeda terrorists killed 2,996 people in America – in the worst attack on the U.S. since Pearl Harbor in 1941. This Islamic terrorist attack would significantly change government regulations, operations, expenditures and of course the National Debt.
The National Debt in 2001 was $5.8 trillion and by the end of Bush’s 8 years in 2008 it surpassed $10 trillion – thus, it was obvious that the U.S. Government could through the Federal Reserve electronically create M2 money and funds to cover our chosen Debt Ceilings – the Fed is the best Government Credit Card ever schemed – it surpasses all the EU and Vatican Euro printing presses combined. Nevertheless, after 2001 would come: America’s longest war, outrageous corporate profits to international corporations, increased inflation, the creation of billionaires, millions of dead civilians in the Middle East and the creation of ISIS in a US prison camp.
UNLIKE after all the previous 20th century wars, INCOME TAXES were not raised to pay for the Middle East Wars. In fact the top bracket DECREASED from 38.6% in 2001 to 35% in 2008. By choice or coercion, Congress placed agendas of corporate lobbyists, the UN, Bilderberg, Trilateral Commission, the CFR, and the like above the future and cares of average citizens.
As to Healthcare, there was little risk of losing mandatory Medicare and Medicaid spending for Hospitals, the vastly growing LTC Facilities, Medical Professionals, and Pharmaceutical corporations (sued for their anti-depression industry which came from failed weight loss drugs converted to being anti-depressants which had serious side effects to many users).
In 2008, the federal government received $2.5 trillion and spent $3 trillion. Total outlays for discretionary programs increased from $117 billion in 1968, to $464 billion in 1988 and $1.1 trillion in 2008. In 40 years, U.S. population had increased from 200 million (1968) to 304 million (2008) or 52%, but the government’s discretionary spending increased 849%.
In 2008, MANDATORY Spending was almost $1.8 trillion and DISCRETIONARY the $1.1 trillion. Spending included: Social Security $608B – 20%; Medicare $386B – 13%; Medicaid/CHIP $209 B – 7%; Interest on the National Debt $261B – 9%; Defense $481B + Global War on Terror $145B + Veterans Affairs $40B + Off-budget Discretionary Spending for Iraq and Afghanistan Wars $20+B? – 23%; and Homeland Security $34B – 1%. In 2002, White House advisers estimated that cost of invading Iraq between $50 billion and $200 billion; and by October 2007 the CBO reported that $600 billion had already been spent in Iraq and Afghanistan, including related cost such as Veterans care. At that time, before Obama would take office, the CBO estimated the wars in Iraq and Afghanistan could top $1 trillion.
The Watson Institute of Brown University estimated in September 2016 that “as of August 2016, the US has already appropriated, spent or taken on obligations to spend more than $3.6 trillion in current dollars on the wars in Iraq, Afghanistan, Pakistan and Syria and on Homeland Security (2001 – 2016). To this total (add)… fiscal year 2017… the total …reaches $4.79 trillion.” The U.S. paid $4 million per foreign casualty ($4.8T ÷ 1.17 million deaths).
January 2009, Barack Obama took office as the president of the United States. One year later, March 2010, he signed into law the Patient Protection and Affordable Care Act – Obamacare. For many years the majority of the public wanted pre-existing conditions to be covered; yet, the 1996 Health Insurance Portability and Accountability Act (HIPPA, signed by Clinton) did not meet the needs of a great percentage of Americans. HIPPA did significantly increase health insurance cost – primarily due to its new Group Health Plans laws.
According to eHealth (‘first-ever health insurance application online 1999’) the Average Individual Health Insurance Premium (PER MONTH) in 2008 was $159 with an average $2,084 deductible; Family coverage was $369 in 2008; and by open enrollment 2017 the average individual premium was $393 with a $4,328 average deductible and Family premiums averaged $1,021 with an average deductible increasing from $2,760 in 2008 to $8,352 in 2017.
The average family premium had increased about 177% in 7 years or an average of 25% per year – more than 20% a year beyond average wage increases and nearly 20% of GDP. Family premiums in 2017 are about 25% of median household income ($59,000) and equaled to the median 30-year mortgage ($1,050). Thus, housing and healthcare cost equaled about 50% of the average middle class budget; and with 15% in fed (income & S.S.), state and sales taxes; 10% for utilities; 13% for transportation costs and 10% for food – that often left nothing for clothing, education, charity, entertainment and occasional vacations.
Sad that in a land so free and full of resources, so few can easily enjoy life. And thus, overall U.S. household debt has increased 12% in the past decade and credit card balances average more than $17,000 or nearly $800 billion owed by Americans; plus about $9 trillion in mortgages, $1.2 trillion in auto loans, $1.4 trillion in student loans and $13 trillion in other loans.
As America was entering wars in the Middle East region, Rupurt Murdoch and many of his News Corp 170+ media outlets and millions of weekly papers were supporting a full war effort by claiming as Murdoch said in 2003, “the greatest thing to come out of this for the world economy… would be $20 a barrel for oil. That’s bigger than any tax cut…” Yet, the opposite occurred as the price of oil per barrel would soon skyrocket and America would find a newly organized global terrorist group – IS/ISIL/ISIS.
After World War II, by 1947 oil price per barrel passed $2.15 but remained stable from $2.77 in 1948 to $3.60 in 1972. Then since the 1973 oil crisis and politics with OPEC nations, prices spiked from $4.75 to $29 in 1983; and settled down to less than $20 from 1986 to 1999 (except for 1990). Then from 1999 oil prices increased from $16.50 to about $27.50 when Murdoch and many government advisors made their claim that oil prices would fall because of the war(s). Yet, the increase was from $27 at the beginning of the Second Gulf War (2003) to $91 in 2008 with a high of $147.30 in July 2008. During Bush’s 2 terms the top five Oil Corporations made more than $650 billion in profits.
Medicare and Medicaid Services’ NHE Fact Sheet (June 2017) reported, “NHE (National Health Expenditures) grew 5.8% to $3.2 trillion in 2015, or $9,990 per person, and accounted from 17.8% of Gross Domestic Product (GDP)… Hospital expenditures grew 5.6% to (over $1 trillion)… Physician and Clinical Services Expenditures grew 6.3% to $634.9 billion… Prescription drug spending increased 9.0% to $324.6 billion in 2015… (after) 12.4% growth in 2014… The largest shares of total health spending were sponsored by the FEDERAL GOVERNMENT (28.7%) and the Households (27.7%)… private business share …accounted for 19.9%… state and local governments accounted for 17.1%…”
The U.S. Money Supply (M2) increased from $286 billion in 1959 to about $8.2 trillion in 2009 when Obama took office to over $13.2 trillion in 2017 when he left office. Uncontrolled mandatory and entitlement programs, war spending, foreign aid, debt interest, monetary policies, rates of interest on loans, low taxes on the wealthy would all contribute to the historical high health premiums on Americans accompanied by historically high Debt Ceilings and National Debt. And the Office of Management and Budget shows estimated deficits are more than a half trillion dollars per year from 2017 to 2021.
According to Kaplan’s, Long-Term Care and Partnership Programs (Initial 8-Hour Course, Online 2017), ‘The Challenge of Long-Term Care: The Graying of America:’ “Rapid advances in medical care and health care technology have eliminated many major causes of premature death and terminal illness. As a result, the older population in the United States is growing rapidly. Since 1900, the percentage of Americans 65 and over has more than tripled for 4.1% in 1900 to over 13% in 2010, and the number increased from 3.1 million to 40.3 million…” Continuing in the Course section: Increased Longevity: “…Thanks to medical technology and better health care, people are living longer after retiring. A child born in 2010 can expect to live 78.3 years, about 30 years longer than a child born in 1900…“
The National Conference of State Legislatures (NCSL) 9/20/17 issued a ‘Health Insurance: Premiums and Increases’ report that stated, “…Annual premiums reached $18,764 for 2017, up 3% from 2015 for an average family coverage with workers on average paying $5,714 towards the cost of their coverage. For those Americans who are fully-covered, these cost realities affect employers… plus the ‘pocket-book impact’ on ordinary families. Yet for those buying insurance on an exchange or private market plan for 2017, the average increase before SUBSIDIES was a shocking 25 percent…”
According to the Bureau of Labor Statistics (September 2017), “Employer costs for employee compensation averaged $35.28 per hour worked in June 2017… Wages and salaries averaged $25.10 per hour worked and accounted for 68.3% of these costs, while benefits averaged $11.18 and accounted for the remaining 31.7%…” BLS June 2017 release stated, “Employer costs per hour worked for employee… (for) health care… INSURANCE (was) $2.95.”
[40 hr.w. x 4.3 weeks = 172 hr.] x $2.95 Employer Cost = $507.40 per month
According to the Heritage Foundation (‘Federal Spending by the Numbers 2012), “In the past 20 years, federal outlays have grown 71% faster than inflation. The average American household’s share of spending is $29,691…”about $5,000 per household more than 2008. Heritage adds, “federal entitlements are driving this spending growth, having increased from less than half of the total federal outlays just 20 years ago to nearly 62 percent in 2012.” In their 2014 report, the Foundation stated, “Obamacare …alone will add $1.8 trillion in federal spending by 2024.”
By July 2017, many major Insurers had pulled out of the Marketplace in at least one state. They included United Healthcare, Humana, Aetna, and Anthem and Cigna (which are still considering a merger as of October 2017). According to the Kaiser Foundation in 2018 – 1,433 counties will have ‘one or no insurer’ for Obamacare’s Marketplace. This noted that that equaled about 45% of all (3007) U.S. Counties. They have reported that half of the counties in Texas only have Blue Cross – who asked for a 56% increase in marketplace premiums for 2017.
Cornell University published for the Congressional Research Service (‘CRS Report for Congress’ 9-17-2007) U.S. Health Care Spending: Comparison with Other OECD Countries. It revealed that “the United States spent $6,102 per capita on health care in 2004 – more than double the OECD average ($2,552).” They showed that ‘Health care spending as a percentage of GDP’ was 15.3%.
In the 182 page Budget of the U.S. Government Fiscal Year 2017, the Office of Management and Budget revealed that by 2018 the Debt held by the public would be $15.3 trillion. They projected an increase of $6 trillion in deficits from 2017 to 2026, thus projecting at least a National Debt of $26 trillion in 2026 – all other things constant (and they rarely are).
OMB revealed the following Outlays for 2017: Defense $601B, Social Security $967B, Medicare $602B, Medicaid $377B, Net interest $304B. They projected for 2021 the following Outlays: Defense $695B, Social Security $1.2T, Medicare $781B, Medicaid $469B, Net interest $609B. Thus, an increase in Total outlays from $4.1T in 2017 (Receipts 3.5T) to $5.1T in 2021 (Receipts $4.2T). Note a $1 trillion increase in spending in 4 years with only a $100 billion increase in receipts – and this will be effected by the change in reduced taxes.
Now the America middle class taxpaying family lies in dire straits, we their children caught in the flow of massive and increasing National Debt and interest, with increasing household cost – namely healthcare; with the mountains of war and defense spending on one side and the Social programs on the other side. And many will run their course into an average of hundreds of thousands in Long Term Care cost including $200,000 in nursing home costs.
Perhaps for most, the Federal Government will subsidize most or all of the cost. But how can this be if there are not receipts to cover it – and at some point – countries will stop purchasing our Debt instruments? How will we endure and maintain our standard of living? If the National Debt and Debt Ceilings are meaningless and if the Federal Reserve can continue to Fund/Loan trillions of dollars at no consequence than let them pay for all Healthcare costs; but if America can’t continue this way – a balanced budget must be reached and healthcare cost controlled.
Before review current laws, congressional replacement plans, and a modest proposal; the following section will offer a brief timeline of Government Healthcare in the United States.
Timeline on U.S. Healthcare & Government Programs (7 pages)
1600s to mid-1800s: Healthcare and Medicine was a ‘family affair;’ with ‘home remedies,’ ‘traditional medicine and cures,’ and few doctors to care for ‘the general welfare’ of the people.
1636: Plymouth Colony passed a law to aid disabled soldiers.
1636: Harvard College (Massachusetts Colony) was established and in 1638 received America’s first printing press. Harvard Medical School would not be established until 1782.
1660: London’s Royal Society founded.
1665: Philosophical Transactions was the first English Science Journal (London, England).
Early 1700s: Cotton Mather, a Puritan Minister and prolific writer, moves the idea of inoculations for small pox (learned of from a slave). His father, Rev. Increase Mather, was the 7th president of Harvard (1685-1701).
1722: New Orleans (French territory; later Louisiana) opened a military infirmary which evolved into Charity or Royal Hospital (1734) – later reopened in connection to the 1834 Medical College of Louisiana – revived after Civil War by Tulane School of Medicine (1885).
1736: Friendly Society for Mutual Insurance of Houses against Fire was founded [bankrupted in 1740 by the Great Fire in Charles Towne (Charleston, S.C.)].
1751: Pennsylvania Hospital was co-founded by Benjamin Franklin and Dr. Thomas Bond.
1765: The University of Pennsylvania (1740) established the first medical college.
1766: The Medical Society of New Jersey was formed (the oldest in the U.S.).
1775: The Army Medical Service (U.S. Army Medical Department) was established for America’s Continental Army as Army Hospital.
1776: Continental Congress provided pensions for disabled soldiers; and in 1789 the First U.S. Congress did likewise.
1792: First marine insurance company founded in Philadelphia as Insurance Company of North America (merged in CIGNA in 1982).
1797: The Medical Repository was America’s first medical journal (New York).
1809: First monograph on heart disease written by John Warren, co-founder of Harvard Medical School and Massachusetts General Hospital (1821).
1811: The first domiciliary and medical facility for Veterans was founded in Philadelphia.
1812: In Boston, Warren (and James Jackson) started The New England Journal of Medicine and Surgery and the Collateral Branches of Science.
1845: New York Life (‘America’s largest mutual life insurance company’) was founded as the Nautilus Insurance Company.
1846: At the Boston Hospital, Dentist William Morton and Dr. John Warren performed the first major operation with ether anesthesia in 1846.
1847: Nathan Smith founded the American Medical Association (AMA) in New York; and in 1848 began annually publishing Transactions of the American Medical Association.
1849: Elizabeth Blackwell graduated from Geneva Medical College in New York.
1850: Franklin Health Assurance Company issued the first Accident policy – for 15 cents it paid up to $200 for injury due to railway or steamboat and up to $400 for total disability.
1864: Travelers Insurance began selling Accidental Life Insurance; by 1899, 47 insurers had issued 463,000 policies.
1883: AMA began their weekly Journal of the American Medical Association.
1889: Johns Hopkins University (1876) established a School of Nursing in 1889 and J.H. School of Medicine in 1893. JHUSOM required medical students have a 4-year degree for admission.
1899: Aetna Life Insurance and Travelers Insurance began offering Disability policies.
1902: Following Germany’s (1884) workers compensation model, Maryland passed first accident compensation law (declared unconstitutional in 1904 by their state supreme court).
1905: The AMA established a Council to set standards for drug manufacturing. That same year the American Association for Labor Legislation (AALL) was founded in Wisconsin.
1905: The Socialist Party of America (1897-1946) was calling for ‘compulsory’ or ‘socialized’ healthcare.
1906: The AALL began to campaign for ‘compulsory health insurance.’ They had models based on programs in England and Germany. The AALL would continue to campaign for compulsory healthcare for years. Their 1915 Review of Labor Legislation article stated: “To create a minimum below which no human being can fall is the most elementary duty of the democratic state.”
1910: Medical Education in United States and Canada: A Report to The Carnegie Foundation… by A. Flexner. The 364 page report told of the history of medical education in America and addressed ‘the Proper Basis of Medical Education,’ ‘the Course of Study’ for various medical fields, State Medical Boards, and ‘Medical Schools’ in the various states. Flexner wrote, “The medical profession is a social organ, created not for the purpose of gratifying the inclinations or preferences of certain individuals, but as a means of promoting health, physical vigor, happiness – and the economic independence and efficiency immediately connected with these factors…” The reported that their were 91 ‘coeducational Medical Schools’ in 1909 with 752 ‘women students.’
1910: Montgomery Ward & Co. contracted with London Guarantee and Accident in New York for the ‘Nation’s first GROUP HEALTH INSURANCE policy;’ it paid weekly benefits up to ½ the employee’s weekly salary if injured or due to illness. It paid the employee directly.
1911: Wisconsin established a workmen’s compensation system, followed by 9 states that year.
1912: Theodore Roosevelt’s Progressive Party campaigned for health insurance for industry.
1914: The AMA began to support the AALL proposal for compulsory Health Insurance. It was still opposed by the American Federation of Labor (founded 1886).
1917: According to www.va.gov ‘history:’ “As the U.S. entered World War I in 1917, Congress established a new system of Veterans benefits, including programs for disability compensation, insurance for service personnel and Veterans… The first consolidation of federal Veterans programs took place August 9, 1921, when Congress combined all WWI Veterans programs to create the Veterans Bureau (Department of Veterans Affairs).” 4.7 million Americans fought in World War I. (Expenditures for veterans increased 62% from 1924 to 1932.
1917: California Social Insurance Commission was formed to “report upon the various systems of social insurance …in different countries …cost of medical aid …present facilities… the present extent of voluntary health insurance in California through fraternal orders, trade unions and commercial insurance companies.” The Report of Social Insurance Commission stated, “There has been a decided change in the attitude of American students of economic and sociological problems towards social insurance methods, so that instead of the general opposition of ten years ago the Commission finds among them at present an almost unanimous support of the compulsory social insurance method of coping with the problem of destitution in this country… Health insurance is the particular branch of social insurance which can and should be developed next in this country…”
1921-1925: Metropolitan Life began selling individual health insurance in 1921
1925: Committee on the Cost of Medical Care (CCMC) was established and issued their final report in 1932 – Medical Care for the American People. The majority of the Committee in 1932 recommended National Health Insurance either voluntary or compulsory through taxation. The Editor (Fishbein) of the Journal of the American Medical Association called the CCMC’s work an ‘incitement to revolution… socialist… communist.’
1929: Baylor Hospital (Texas Baptist Memorial – 1903) offered a $6 per year (or 50¢ per month) prepaid hospital insurance plan – designed by Vice-President Kimball – to help school teachers at Baylor University and the University Hospital in Dallas to cover the cost of a 21-day hospital stay (75% of Dallas teachers quickly enrolled). This same year the first HMO began in Los Angeles for the Department of Water and Power with the Ross-Loos Clinic.
1920s-1930s: Health Care costs were rising; yet at this time, doctors were paid by a system called “fee-for-service.”
1934: President F. D. Roosevelt (1933-1945) appointed the Committee on Economic Security to addressed old-age, unemployment issues; and health insurance and medical care. A matching state funds approached was suggested to the president.
1935: Social Security Act of 1935: according to www.ssa.gov, “Legislative History… An act to provide for the general welfare by establishing a system of Federal old-age benefits, and by enabling the several States to make more adequate provision for aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of their unemployment compensation laws; to establish a Social Security Board; to raise revenue; and for other purposes… For the purpose of enabling each State to furnish financial assistance, as far as practicable under the conditions in such State, to aged needy individuals, there is hereby authorized to be appropriated for the fiscal year ended June 30, 1936, the sum of $49,750,000, and there is hereby authorized to be appropriated for each fiscal year thereafter a sum sufficient to carry out the purposes of this title…”
1936: Using Kimball’s Baylor plan, the Chicago Plan for Hospital Care was formed and their first policy was effective in January 1937. They incorporated as Hospital Service Corporation and gained 36,000 members in their first 6 months. In 1939 they adopted the Blue Cross symbol; and in 1947 the Blue Shield symbol. Blue Cross for hospital services and Blue Shield represented plans with physician services (operating separately until 1975). In 1975 the Blue Cross and Blue Shield plans merged under the Health Care Service Corporation. Independent licensed BCBS associations followed in various states.
1938: Federal Minimum Wage – set at 25 cents.
Late 1930s-1945-: According to Kaiser Permanente, “Kaiser… evolved from Industrial Health Care programs for construction, shipyard and steel mill workers for the Kaiser Industrial companies during the late 1930s and 1940s. It was opened to the public enrollment in July 1945.” The Kaiser plan was a HMO type.
1942: Congress passed the Stabilization Act directing the president to issue an order to stablilize prices, wages and salaries. President FDR issued Executive Order 9250 establishing the Office of Economic Stabilization.
1940-1950: According to the Bureau of Labor Statistics, “By 1940, the population of the United States was 132 million with only 12 million – a little less than 10% – covered by some form of health insurance.” At that time, Blue Cross/Blue Shield held half that market for individuals. By 1950 “one-half of the U.S. population had some form of health care insurance” and National Health Care expenditures passed 4.5% of GNP.
1942-43: FDR created the National War Labor Board in 42’ and in 43’ the NWLB called for better benefits to soldiers, and equal pay for women and ‘colored laborers.’
1945: President Truman asked Congress for ‘Universal’ National Health Insurance saying, ““Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.” The AMA denounced Truman’s plan, which some Congressmen called a ‘Communist’ plan or plot.
1945: Senators Wagner, Murray and Dingell (first died in committee 1943 during WWII) proposal according to Aug. 1945, vol. 53; Canadian Medical Association Journal, “… The Journal of the American Medical Association of June 30 publishes a letter from U.S. Senator Robert Wagner… relative to the proposed Wagner-Murray-Dingell bill, which would expand the SOCIAL SECURITY ACT to include a vast program of Medical Care and Hospitalization Insurance…”
1946: Hill-Burton Act: When soldiers came home from World War II they found in 1945 that over 40% of the nation’s counties had no hospitals. Senators Burton and Hill (whose father was the first surgeon to suture a human heart) had proposed progressive changes for Healthcare, and in 1945 Truman was on board, announcing the need for comprehensive medical insurance tied to Society Security. In order to get the bill through, Hill added a provision allowing a ‘separate but equal’ clause for segregation (lasted until 1963). The Act introduced state and local shared-matching funds with Federal ‘seed money’ and a biblical ‘joint tithing’ concept. The Act provided medical services for free or reduced charges based on income. By 1968 the Federal Government financed 9,200 new medical facilities under this Act.
1949: Liberty Mutual Insurance Co. issued a Major Medical Insurance policy to supplement basic medical expenses related to facility care and physician care.
1950s: Unions had negotiated for better health insurance and benefits in nearly every major industry, including with U.S. Steel, GM and AT&T.
1951-1967: Two years after the introduction of Major Medical Health Insurance over 100,000 individuals were covered. By 1960 it reached 32 million and 156 million by 1986. According to the Social Security Administration (Bulletin Feb. 1969), by 1967 “between 75% and 87% of the civilian population under age 65 (depending on the source of data) had some form of health insurance coverage of hospital expense;” and about 66% had coverage related to physician visits. They reported 82% of the civilian population with hospital plans: 73 million in group policies, 37M with individual policies, 67M with Blue Cross plans.
1966: Medicare began its coverage with all qualifying persons age 65 and older automatically covered under Part A. More than 19 million enrolled.
1972: Social Security Amendments of 1972 extended Medicare for individuals under 65 with long-term disabilities that qualified.
1977: The Department of Health, Education and Welfare created the Health Care Financing Administration (HCF). In 1977 over 4.4 million Americans worked in health-related fields.
1980: The Social Security Disability Act of 1980 led to the creation of ‘Medigap’ plans to supplement traditional Medicare. 1982: AMA – ‘net income of practitioners was $99,500.’
1971-1991: Health care costs increased 399% versus 235% for the CPI and 70% higher CPI item. Enrollment in HMOs increased form 2 million in 1970 to over 37 million in 1991.
1970 to 1990: In 20 years the Health Care costs increased nearly 400%.
1980 to 1989: National spending for physician services rose rapidly $63.1 billion to $117.6 B.
1981 to 1991: Percent of employees participating in Medical care plans decreased from 97 to 83, as required employee average monthly contribution for family coverage increased from less than $28 to $97 (Monthly Labor Review; March 1994). Average monthly wage: $1,750 (1990).
1985: COBRA (Consolidated Omnibus Budget Reconciliation Act) became law. It allows insureds to temporarily keep health coverage after their employment ends. Coverage lasts up to 18-36 months (based on qualifying event) and costs up to 102% of the monthly premium charged to the Employer. Required only by employers with 20 or more employees.
1993: President Clinton’s Health Care Task Force (600+ experts chaired by HRC) produced the complex 1340+page proposal for the Health Security Act or Clinton Plan. The New York Times (October 28, 1993) stated, “After nine months of brainstorming and politicking, President Clinton delivered to Congress today a 240,000-word proposal for universal health insurance. It represents the most complex, detailed legislative blueprint devised by any President.” It sought $1,500 annual individual out-of-pocket limits and $3,000 for families. It spoke of “a single-payer system… established by state(s)” with ‘mandatory enrollments;’ except for those “optional enrollment of Medicare-eligible individuals (H.R. 3600 – 103rd Congress).”
1996: The Health Insurance Portability and Accountability Act (HIPAA) was enacted. Most significantly it dealt with “preexisting condition exclusions,” and “the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs.”
1998: The www.Medicare.gov webpage was launched.
2010: The Patient Protection and Affordable Care Act was signed by Obama in March. Many provisions were phased in over 5 years. The Act increased the age of dependent coverage on parent’s plans to 26. It extended Preexisting Condition coverage and added mandated employer costs and penalties to individuals and employers for no coverage. It dramatically increased the number of Americans on Medicare and Medicaid and the about of government subsidies for Americans. Obamacare prohibited lifetime limits and required coverage of certain ‘essential health benefits.’ It created a Marketplace exchange and due to premium increases saw the reduction in both insurance agent commissions for individual policies (down to $0 in many cases) and insurers on the exchange.
United States Healthcare System & Obamacare (2 pages)
The percentage of US Population with Private Health Insurance peaked in the mid-1970s at about 83%, and then began to fall to 76% in 1985. The rise in coverage came when health insurance was not considered a wage to the employer and not subject to tax. The fall was mainly due to significant increases in the Health Insurance premiums, which still outpace inflation, CPI and the ability for the average family to pay without a substantial change in lifestyle to their children’s education, activities, diets and location of residence. Nevertheless, in the 1980s and 1990s, selective contracting with managed care kelp price competition in the markets; and Medicaid and Medicare were dramatically expanded. Yet, the poorly managed Healthcare System has resulted in mandatory high cost high deductible plans or fines.
The 2015 International Profiles of Health Care Systems by the London School of Economics and Political Science (Jan. 2016) examined ‘Health Care System Indicators for 17 Countries’ and found that in 2013 the United States paid $9,086 per capita on Health Care spending. This was the highest compared to the low of China at $636; the median France at $4,361; and the next high of Switzerland at $6,325. The United Kingdom was at $3,364; Canada at $4,569; Germany at $4,920; Japan at $3,713 and Sweden at $5,153. The Percentage (%) of GDP spent on Health Care was as follows: Canada 10.7; China 5.4; France 11.6; Germany 11.2; Japan 10.2; Sweden 11.5; Switzerland 11.1; UK 8.8; US 17.1. The Report offers numerous details and explanations on 18 different countries. Additionally, the Report showed that the United States had the worst rate of amenable morality (deaths under age 75 that could be avoided by optimal quality care).
The World Factbook estimated ‘Life Expectancy at Birth’ in 2016 for the above mentioned countries as follows: Canada 81.9; China 75.5; France 81.8; Germany 80.7; Japan 85; Sweden 82.1; Switzerland 82.6; UK 80.7; US 79.8. With the exception of China, the United States has the lowest life expectancy of the group and pays the highest by for healthcare based on percentage of GDP and per capita cost.
This shows a combination of three factors: the U.S. HealthCare System is inefficient compared to the other compared developed nations; the health lifestyles (diet, exercise, obesity, tobacco use, violence, etc.) vary and are significant; and governments and people view the systems (care, responsibility, wages, taxes, etc.) in different manners. It is interesting that Japan spends less than half per capita and has more than twice the ‘average annual number of physician visits per capita’ and 5.2 years more in life expectancy.
In 2013, Japan had 18.5% of adult population as daily smokers versus the US 13.7%; yet, they only had a 3.7% obesity prevalence versus the US at 35.3% – which was significantly higher than all over listed countries – with the next being New Zealand at 30.6; then Australia at 28.3% and the median being Singapore at 10.8% obesity and a life expectancy of 85. Thus, of all factors – Obesity (BMI > 30) appears to be the most serious.
The 2015 Profile stated, “The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources as well as wide gaps in insured rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults age 65 and older and people with disabilities, and works in partnership with state governments to administer both Medicaid and the Children’s Health Insurance Program, a conglomeration of federal–state programs for certain low-income populations. Private insurance is regulated mostly at the state level. In 2014, state- and federally administered health insurance marketplaces were established to provide additional access to private insurance coverage, with income-based premium subsidies for low- and middle-income people. In addition, states were given the option of participating in a federally subsidized expansion of Medicaid eligibility. Who is covered and how is insurance financed? In 2014, about 66 percent of U.S. residents received health insurance coverage from private voluntary health insurance (VHI): 55.4 percent received employer-provided insurance, and 14.6 percent acquired coverage directly.1 Public programs covered roughly 36.5 percent of residents: Medicare covered 16 percent, Medicaid 19.5 percent, and military health care insurance 4.5 percent (U.S. Census Bureau, 2014).”
The full text (974 pages) of the Affordable Care Act (Obamacare) is available at www.healthcare.gov or: https://www.hhs.gov/sites/default/files/ppacacon.pdf
Under the Marketplace there are four different coverage options: HMOs & EPOs, PPOs, High Deductible Health Plans and Catastrophic Health Insurance Plans. Plans also vary by percent coverage (60-90) of certain benefits up to a maximum stop-loss or out of pocket. The policies are guarantee issue and renewable with variations based only on age, rating area, family composition and tobacco use. Other coverage can fall under Employer plans, Medicare, Medicaid and CHIP. In 2016, those without coverage will pay a fee of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income.
PROJECTIONS FOR HEALTHCARE
According to the Centers for Medicare & Medicaid Services’ National Health Expenditure Projections 2016-2025, “Health spending is projected to grow at an average rate of 5.6% per year, and 4.7% per year on a per capita basis…. (Thus) 1.2% points faster than Gross Domestic Product (GDP) per year over the 2016-2025 period; as a result, the health share of GDP is expected to rise from 17.8% in 2015 to 19.9% by 2025… Health spending growth by federal and state and local governments is projected to outpace growth by private businesses, households and other private payers…”
In 2016 our nation spent $3.4 trillion on health care; and that cost is projected to grow to $5.5 trillion by 2025. Health Care, with increased Medicaid spending will continue to drive the National Debt up. The Congressional Budget Office (Jan. 2017) projected that repealing the Affordable Care Act would initially cause 18 million people to become without coverage; and then as many as 32 million in 2026. Yet, it also projected increased cost, but that will come harder if nothing is done. Prices continue to be a major factor in healthcare costs and even if the trend was single-digit increases, it would not be sustainable.
But this is not the case; in December 2016 the U.S. Department of Health and Human Services stated that premiums were projected to increase an average of 22%. HHS Secretary Sylvia Burwell then warned that Insurers were ‘continuing to adapt;’ yet, we have seen that many simply have pulled out of the individual market and Obamacare’s Marketplace.
Moreover, the Kaiser Family Foundation has warned that U.S. Healthcare spending will continue to rise substantially. Millions of Americans do not take the coverage and await the penalties, which have increased in 2016. Additionally, the Foundation for Government Accountability (theFGA.org) reported that 24 states have enrolled 110% more adults than expected through ObamaCare’s Medicaid Expansion.
FGA said, ‘state spending on Medicaid increased 71% in the last 10 years, making it one of the largest growing line items in state budgets…” In their Nov. 16, 2016 ObamaCare Expansion Enrollment is Shattering Projections report, they added, “This enrollment explosion will soon unleash a fiscal crisis. Unlike the federal government, states cannot print their own money and, starting in January 2017, states’ share of Medicaid expansion costs will increase to 5 percent. Assuming the federal government keeps its funding promises …state costs will gradually rise to 10 percent by 2020.” FGA concluded, “ObamaCare’s perverse funding formula for able-bodied adults… and expansion’s enrollment explosion, combined with higher-than expected costs for able-bodied adults, will spell disaster for ObamaCare expansion states, taking limited taxpayer resources away from the truly needy and other core priorities, including education, public safety, and infrastructure.”
FACTORS DIRECTLY RELATED to the CURRENT HEALTHCARE CRISIS
The HealthCare Crisis is not such because people are frail and resources scarce. The United States is a blessed nation with an abundance of self-sustaining resources unlike most of the countries in the world. America’s life expectancy allows for decades of senior retirement. Now, to show the point, imagine that America had an affordable postsecondary (colleges, etc.) education and graduated the numbers of doctors, nurses, etc. to meet growing demands. And imagine that the care was very affordable to all working Americans; and that Long-term Care had little cost to the State and Federal government and so on. This scenario shows us that the predominant problem lies directly in the finances – the COST of HEALTHCARE – and not the ability of those who provide care.
Thus, the question becomes what drives the cost of HealthCare? Now we get into complexities that cause most Congress persons to stick to only a few talking points, lest they reveal their ignorance. Even seeking and exploring these factors consumes much of the time of staff for Congress, and employees at the Congressional Research Service. This section will strive to approach these things. But, even if we find our answers, then we must deal with ethics, economics, philosophy and a number of disciplines to debate as to who is to make sacrifices, and who is worthy for what benefits, and which departments and items must be slashed, and how shall the future be administered and monitored.
And another thing, there were times in history when leaders have said: “Ask not what your country can do for you – ask what you can do for your country (JFK 1961 – Democrat);” “We must dare to be great; and we must realize that greatness is the fruit of toil and sacrifice and high courage (TR 1898 – Republican).” Also, if you were a sincere Jew (Exodus 22:24), or Muslim (Surah Ali Imran 3:130), would you not protest against excessive interest? And if you claim to be a Christian, then would you “Carry each other’s burdens, and fulfill the law of Christ (Galatians 6:2)?” And perhaps one more: “If anyone (who is able-bodied) does not provide for their own… they have denied the faith… (and) no widow should be enrolled unless she is at least sixty years old… (1 Timothy 5:9)
In 1945, after more than 400,000 American soldiers gave their lives to make a free Europe and free world, Americans at home greatly sacrificed paying a minimum of 23% income taxes and up to 94% on earnings over $200,000 (of course the wealthy still had 25% on Capital gains). During the war many lived on rations. And just two or three generations ago most of our ancestors lived modestly and medical practitioners made a good but reasonable income.
But greed and corruption have made the term capitalism taste bitter in the mouths of most of our youth. Religious or non-religious, young adult still have a sense of justice, and frustrations over their inherited National Debt and competitive difficult professional job markets.
In order to understand the FACTORS related to Health Cost we must look at those involved (more specific than saying – EVERYONE); for the sake of time reduced to 10 classes:
- Congress: The Representatives of the People must act for the People and not for the Lobbyists (Big Pharma, Fortune 500, etc.). www.opensecrets.org revealed that Lobbying contributions on Health in 2016 was over $1 BILLION for the years 2015 and 2016; and over $ 5 BILLION in the last 10 years. The leading categories include the Pharmaceutical, Hospital and Nursing Home Industries. Congress has to ability to make law and thus both the largest responsibility and blame for the Healthcare Crisis. There has to come a time when the average American taxpayer comes before Wall Street profits or at the cost of subsidizing masses of abled-body poor people.
- The Family: Here lies a great issue at many levels. The traditional family structure has significantly changed in America. Whatever a family may be, they must be more responsible for their own – be it their children or parents, grandchildren or grandparents, step-relations or guardianships. It is not enough for the rich or poor to cry that situations are not fair; did the average male Malawian in 2009 have many options when their life expectancy was 47? And nearly 3 out of four people (71%) in the world live on less than $10 a day. Food, shelter and education have been provided for every American; but it is not a Constitutional right for a single unemployed mother of 2 to receive $40,000+ per year (Sec. 8 housing, SNAP, WIC, SSI, CHIP, Medicaid, public education, college grants). We need compassion and to reevaluate shared responsibilities. Also, obesity and certain conditions could be better addressed at home.
- Health Insurers: As for as Health Insurance agents, their commissions have been slashed down about 70% in the last 4 or 5 years; United Healthcare when leaving a state’s exchange offered agents $0; Blue-Cross $144; others $100 and thus, many have left the business that don’t have mass enrollment connections (as some work at hospitals during open enrollment). As for Insurers, according to the Heritage Foundation, in 2014 “the likely lost about $3.2 billion overall selling individual QHPs.” They are not leaving the Marketplace in masses because of profits. And according to ModernHealthcare.com, “Health Insurers lost less money on individual plans in 2016 than they did the year before, but those losses still totaled billions of dollars. Insurers selling plans in the individual insurance market on and off the exchanges lost between 7% and 9% of premiums, compared with 10.1% in 2015… according to McKinsey and Co. …In aggregate, insurers lost between $5.5 billion and $7.5 billion in 2016, compared with $7.2 billion in 2015.” Another way of saying that is Insurers lost more than $16 billion in the last three years of Obamacare. They noted the ‘not-for-profit Blues plans… landed between 4% and -7%’ in 2016; “but for national insurers, such as Anthem and Aetna, margins worsened from -7% to between -9% and -12%… UnitedHealth, Aetna, Anthem, and Humana have either scaled back… or exited the individual market completely… Medicaid insurers’ margins… -1% to -6%.”
- Healthcare Occupations: Doctors and Highly Paid Fields: The Bureau of Labor Statistics (BLS) said in 2014 that 2.4 million new health related jobs would be added from 2014 to 2024. By December 2016, the BLS reported that 15.8 million people were in the Healthcare Industry which represented almost 13% of the approximate 122 million people in the Civilian Labor Force. Moreover, of these 1 in 9 persons, at least 4 of 5 are being compensated with taxpayer dollars. This is important because now it is not simply a matter of economics and capitalism; it is a matter of income directly related to social laws and at the cost to your fellow citizens.
Thus, it becomes fair and responsible for representatives of the taxpaying citizens to ask are certain people, groups or occupations being unjustly enriched and why? Are there undue burdens that are affecting society as a whole? Then as we search for truth, if we take a biopsy of the problem, we will find a malignant mass in the nation’s lymphatic system. We find corruption at the highest levels, government officials with corporate lobbyists; we find lawyers not just making unfair laws, but suing the medical professionals beyond the point of what is equitable. We find citizens oblivious, uncaring and or feeling justified in multi-million dollar law suits regardless to the cost of their neighbor. We see certain sorcerers (pharmakeia) mixing potions and enchanting half of society with their expensive elixirs. Moreover, they work with others that carry professional titles, and designate disorders and depressions such that they can bill of high fees to the governments and taxpayers. And these are only some of the players.
Nevertheless, when one citizen makes over 5 times that of another citizen and benefits directly from the laborers of the other five than wisdom and justice demands a hearing. Any executive or doctor (Dentist, top?% of nurses or therapists, pharmacists, physicians and top assistants, podiatrists) must both be protected for common mistakes (other than gross negligence and willful crimes) and give more back to their fellow citizens in some manner to reduce cost.
|Comparison of Wages in U.S. Dollars (y = per year)|
|Year||Minimum Wage||Average Worker (y)||Average Physician (y)|
|Notes: based on 2015 dollars: Minimum Wage 1960 – $7.98; 1980 – $ 8.89; 2010 – $ 7.07
Average Worker – SSA’s Average Indexed Monthly Earnings. AMA sources used for table.
Median Household Income in 1960 was $5,620 and in 2016 was $59,039.
Medscape Physician Compensation Report 2017 showed Specialist at $316K and Primary Care 217K
BLS: Physicians 2016 mean wage: $99 per hour + overtime; LPNs: Mean hourly wage $21.56.
This does not reflect Credit Reports, ability to leverage wealth, or signing bonuses.
- Hospitals, Facilities and other Healthcare employees: Again because the industry is enriched because of an inelastic demand and taxpayer subsidy or supported system; than representatives must – and citizens have the right to – ask for the records and facts and search to make a better system. Of course, lower paid workers and the ‘middle class’ can only bare a certain burden; but we must look at the salaries of those executives being paid through Medicare and Medicaid contracts, as well as allowing profits to hospitals, and see if there are unjustified expenses.
- The Federal Reserve and banks: The Fed will make about $190 billion in profits 2016 and 2017. They hold more than $4.5 trillion in assets (including $2.5T in U.S. Treasuries and $1.8T in Mortgage-backed Sec.) The FDIC in 2016 insured deposits of $6.8 trillion about 10,000 institutions (mostly commercial banks). Central banks should receive in 0% to 1% dividend on that portion of Debt Instruments held in trust by or for the Social Security Administration and other such Federal entities. The member banks dividends should be indexed to the like of 10-year T bills and let them make their profits through their other loans. Which the Federal Reserve Annual Report which said their 839 “state member banks reported profits of $21.8 billion for 2015, up 15.3%.”
Most of these banks CEO’s make excessive salaries; such as the combined compensations for the top 5 for 2015 and 2016 was more than $150 million (for 5 people and their families – while charging up to 36% on their large portion of U.S. household’s more than $1 trillion in credit-card debit). If CONGRESS wants to help the HealthCare Crisis for both low and middle wage employees, than REFORM the laws on excessive usury – and place a maximum on allowable INTEREST by ANY Legal Institution (including Pay Day loans and Pawn Shops) to that of 10 times that of their best credit card offered or 10 times the U.S. 10-Year Treasury Note, to a maximum of 25% – which is still sinful. No one is forcing these institutions to give money to high risk citizens. Also, enough of the ‘prequalified’ usage; either guarantee ‘qualification’ to a minimum level as required in a few responsible states; or say phrase it is an ‘offer to qualify.’
- Colleges, Universities, VoTech, Student loans, credits, grants and Occupational placement: If student loans is a primarily and reasonable argument for increased salaries to highly paid employees receiving 75+% of their Healthcare related incomes, than there must be a better way of finding compromises in cost cutting. If taxpayers ask for a decrease in highly paid salaries to reduce climbing cost and debt, than it is fair for highly paid employees to ask for grants and future income credits on a debatable portion of their current tuitions and future incomes. Perhaps something to the effect of GI Bill tuition payments for future service by RNs, etc. and Doctors, with future income credit credits on a portion of future income – both scaled and capped. Additionally, America needs a better job placement system for students and low income citizens – perhaps using some type of apprentice program or trial internships into charity healthcare systems, as well as credits for private employers.
- Government Contracts: Government Contracts – whether Defense, HealthCare, Education or Infrastructure related – must be examined. Most contracts are reasonable compared to ‘operating costs.’ However, when operating cost is reviewed and excessive CEO, executive and highly paid employees’ compensations are found to be unjustly enriched at the cost of taxpayers governmental dollars, than it is fair to ask for reform and monitoring in that area.
When a net subsidy from the federal government of $700+ BILLION of taxpayer’s 2017 dollars (many with very high deductibles and premiums for healthcare) is giving to the Health Industry from Health Insurance Coverage of citizens; when Federal Debt held by the Public is in the trillions and reaching 150% of GDP in 30 years; when the Defense budget is $600+ BILLION per year and future veteran cost climbing; when infrastructure spending could surpass $1 TRILLION over the exit four years; wisdom and justice demands an examination to find cuts, corruption and abuses.
The Pharmaceutical Industry makes massive revenues from government contracts and benefits. Since PDUFA was passed in 1992, Pharma Companies have paid approximately $8 billion to the FDA in fees. That may seem like a lot until you see that Big Pharma had $1 trillion in global revenue just in 2016 alone – and half of the revenue went to the U.S. and Canada. Moreover, in 2015, their profit margin estimated by Forbes for the Healthcare Technology industry was 21%. And a vast portion of U.S. revenue came from Medicare and Medicaid.
- Federal and State Government employees: In 1960, of 180 million American’s, about 1.8 million were federal employees, not counting uniformed military personnel and postal workers. In 2017, with a population of 325 million, there are about 2 million federal bureaucrats; but the number of state and local government employees has tripled to more than 18 million due to federal funding. Including federal, state and local government employees the BLS show over 21.5 million versus less than 13 million in the private manufacturing sector.
Now, 20 million Federal, State and Local employees only pay enough taxes to support the current employment compensation (including Healthcare and Disability Benefits) plus the future pension obligations [i.e. (current income) x (% = # of years x 2)] of about 15%to 20%of their 20 million – approximately 3.5 million. Therefore, about 16.5 million only have jobs because of taxes received from other citizens – whose benefits (namely future pensions) are nothing like those in the government. For example, a public teacher versus a private teacher; or even in the case of the typical worker – guaranteed and defined benefit pensions of a percent of salary have been replaced by a much lower 401k plan. And mainly only high paid executives, owners, and key employees received nonqualified deferred compensation plans. At any rate, when state and local governments view their budgets, they don’t have the luxury of a Federal Reserve Credit Card – and except for rare times – neither should the Federal Government.
- Lawyers and Legislation: When the time comes that the vast portion of attorneys can no longer follow justice in settlements (or 33%-40% fee commissions); and when those settlements directly affect the citizens and society they prosper from, than it is time for Congress to act. State Constitutions have been amended; and state and federal laws often change. America has changed significantly since the days of state constitutions when legislature’s from before 1790 to after 1900 wrote in law “it is the right as well as duty of all men in society… to worship the Supreme Being, the great Creator and Preserver of the Universe…;” and when they advanced “religion and morality” and freedom for “every denomination of Christians.”
Of course laws discriminate against certain classes and set guidelines and restrictions for society. Laws discriminate against murderers and rapists, and even kind hearted citizens that that desire to do 120 mph on the Interstate. They discriminate against the poor and the rich, against races and foreigners.
Reforms and discussions are needed in many areas, for example: Tort reform; Exemption from Worker Compensation for small employers (10 or less); Medical Malpractice reform; Discrimination Reform (U.S. 2017: white 61%, black 12%, Hispanic 18%, Asian 6%, other 3%; and now 17% of newlywed marriages are interracial); Tobacco – cigarette phase out; Estate Taxes increases for the super-rich (increase gifting, but when 1 family wealth equals that of 1,000,000 others – something is crazy wrong – especially because it was done but tax breaks and often government contracts or subsidies and credits; either way – society calls now for justice); Class Action suit reform (if lawyer should not be compensated 1,000 times that any plaintiff – if the plaintiffs/victims/recipients only get a $10 check in the lowest paid class – than the attorneys such not receive more than $10,000. The point is when lawyers make millions on class action suits while the class makes $100 or less each, than the very recipients and taxpayers will pay for the settlement in future increased cost and only the attorneys come out ahead.
Congress, Judges and attorneys all need to be fair about the value of a human life. When slavery was legal, the courts assign a value to them as property (about $5,000 to $10,000 per young adult male slave in 2017 dollars). Of course we are beyond those days, but today laws use people. When it seems right to lawyers and legislatures, they assign value to a vital being – for example, a wrongful death lawsuits plus criminal charges due to the death of an unborn child by drunk driver; but when it seems right to those same law makers, the same mother who benefited from a wrongful death suit, could have in a drunken or sober state aborted the unborn child with little monetary and no criminal consequence. What is the monetary value of a person? Total Global Wealth ($250 trillion) ÷ 7.5 billion people = $33,000 a person. (US: $85T ÷ 325M = $261K; but median US wealth per adult in 2016 was $45,000) Of course, age, occupation, future loss, and other damages should be viewed. The point is when you give excessively to one, society often pays the cost.
ESTIMATED FEDERAL REVENUES AND SPENDING
2017: Revenue $3.4 T – Outlays $4 T = Deficit $600B
(CBO reported 2017 Fiscal Year Deficit already $520B & expect $120B more)
Fiscal Year 2017 CBO real numbers first 9 months: Rev. $2.5T – Outlays $3T
SOLUTIONS to the HEALTHCARE CRISIS (21 pages)
The only solution to the Healthcare crisis is the same for the National Debt Crisis, the reverse the trend in government spending outlays being more than receipts. It is a difficult as telling an addict to simply quit. Once Congress or the human body is addicted, it is difficult to reverse. But it can be done. And what is needed is a holistic approach of addressing all the variables involved rather than amending the budget and laws piecemeal.
- The 2018 fiscal year (October 2017-September 2018) United States Budget Estimate: Total Receipts $3.65T minus $4.1T in outlays or expenditures ≈ $450 billion Deficit. Of the spending, $2.54 trillion is Mandatory, $1.25 trillion is Discretionary, and $315 billion is Debt Interest. The goal in Healthcare Crisis must be joined with the goal of Reducing National Debt. Congress and pass presidential administrations got us into this House of Debt, so we must pay it off like a middle class home owner that is high in debt and low in credit and a 40-year period (some mortgages in Europe and Asia go to 50 to 100 years).
Let’s look at some history; in order to pay the national debt in Andrew Jackson’s time, it took massive cuts, increased import tariffs (a type of TAX), removed tens of thousands of Indians from their lands which were sold to the public (with about 70 treaties), crushed the banking system, had masses of immigrants that contributed to the economy (did not take from it), and General Jackson stayed out of expensive wars. Note: the British promised the Indians the land west of the Appalachians Mountains; then about 60 years later Jackson and Congress promised the Indians land west of the Mississippi River. Anyway, the Jackson method cannot work today, except the lesson in massive spending cuts and tax increases.
Now, what about other Presidents, what was reasonably possible? From George Washington (1789) through Jackson (1836) reductions in the National Debt occurred in at least 32 of the 48 years. From 1837 to 1937, including several war periods, administrations cut the National Debit 40 times. Since 1931 (the Depression into WWII spending, Debt held in check only by high taxes) the National Debt has only been cut 4 times and held below a 2% increase 14 times. Thus, in about the first 150 years, Congress held to attempting a balance budget with cuts to the National Debt 72 times – nearly every other year. In the last 75 years, Congress totally changed its philosophy – in the greatest part due to unlimited Debt ceilings through the Federal Reserve.
Nevertheless, based on history it appears a 4% cut is about the best hoped for and only every other year (in the past with increases in between). THEREFORE, heading towards a balanced budget 2020 and cutting the national debt of $22 Trillion from there would mean cutting $550 Billion a year for the next 40 years; $440 Billion over 50 years; and $275 Billion a year using the 80 year Debt free by 2100 (22nd Century) Plan. So yeah the 22nd Century Plan: that would mean a net difference in the current budget of: the $440B deficit + $275B = $715 Billion.
THUS: we would have to adjust the current $3.65T Receipts and $4.1T Expenditures by not $440B, but $715 Billion. So throwing darts at the board method, let’s say our throws landed on Increased Receipts by 2/5 and Decrease (Cut) spending (Programs) by 3/5 of the $715 B. That would mean we need to increase 2018 Receipts by $286 Billion (through taxes, stealing, spoils of war, selling some of our people or assets, or whatever Congress dreams up); and it would mean Congress would have to cut Spending by $429 Billion dollars. That’s the goal and oh yeah, addressing the cancerous Healthcare Crisis – all at the same time.
- The Tax Receipts: No way that reducing taxes on the top 10% leads to decreased National Debt – 60 years of history shows this. Moreover, the Pensions & Investments Research Center calculates the Senate’s 2018 tax cut proposal increases Debt by $1.5 trillion. The Walmart Family is worth about $100 Billion or worth the Median Wealth of 45 million adults throughout the world. Anyone bloody way, there is an argument that Sam’s clubs increase obesity and Healthcare costs were they go; but what matters here is that our future American Youth should not have to carry all the Debt burden while the past generation allowed the making through lowered taxes of 100 billionaires and thousands of very wealthy multi-millionaires.
The bottom line: if you want to stimulate the economic by increasing jobs and charitable donations, than high INCOME TAXES on amounts above $2 million to 50% and above $10 million to 60% (including Capital Gains and Dividends) will do it – because they will want to support charities and give jobs to their friends and relatives before paying the government. This is much lower than after WWI and WWII and we are still in America’s longest war. It will also increase revenues between $70B and $100B as population increases. Additionally, for the income amounts (and capital gains and dividends) over $200,000 (Married Jointly) and over $150,000 (single) the tax needs to move to 45% and this with increases in population will generate about $20B to $50 Billion more revenue.
In 2017, only about 1 in 50 Estates will pay ESTATE TAXES due to the $5.49 million per person exclusion. For many of the wealthy, they pass money to heirs with loopholes like step-up provisions and trusts which some estimate how been used to avoid $110 Billion in Estate Taxes since 2000. The largest portions of estates are unrealized capital gains that have never been taxed – thus, with leverage, lawyers and loopholes the rich get richer. One of the main purposes of Estate Taxes when created in 1916, was not to affect the average family or even above average family; but to retrieve wealth that otherwise would go untaxed.
ESTATE TAXES: instead of 11 brackets with lifetime exclusions; keep gifting the same per year, change the first 10 brackets to 1 bracket: 0% up to $2million (single)/$3M (MJ); 5% on $2M/$3M to $5M/$6M; all returns over $6M 25% to $50M; 30% to $100M; 40% to 1Billion; and 50% above that (no loopholes, deductions for funeral, executor, legal fees, state taxes – including estate, house/land to $2M, 1 x $100,000 gifting to maximum of 10 receivers): $20B to $50B new $.
So we are short about $80 billion or so; on the right path and increases in population will take care of it; then when the curve is at the right point, taxes can be reduced – assuming we are not in a war or that people are living 100 years and half live through government funds.
- Cutting Expenditures by $429 Billion starting 2020 (after dumping a trillion into infrastructure 2018 and 2019). According to the House Budget Committee (HBC) in 2012, there were 92 Anti-Poverty Programs – most duplicative of others. Moreover, we have spent ¾ of the entire National Debt ($20 Trillion) or according to the HBC in 2016, “$15 trillion since President Johnson declared a War on Poverty… we may have lessened material hardship, but we are not helping Americans build lives of self-sufficiency.”
Some argue we have created a welfare state, well many needed and still need it; nevertheless, the facts show since 1997, the Labor Force participation rate has returned down to the 1978 63% rate – and that a significant percentage of those are able-bodied citizens ages 20 to 60. The HBC in 2016 said the 2026 National Debt would exceed $29 trillion and HBC/CBO showed $40 trillion before 2040.
You ever visit a Section 8 Housing facility? Signing up and waiting as for the lotto is common practice. In Louisiana there are over 100 housing authorities offering Section 8 Housing Choice Vouchers. According to their website Baton Rouge manages 174 active Housing Choice Vouchers. They reported for 2016 “the average voucher household contains 3 persons and has a household income of $14,192 per year; 71% were headed by a person 25 to 49 years old… 65% of households included children… 96% of all voucher households were headed by minorities… 95% …being Black and 1% being Hispanic… the average monthly tenant contribution… in 2016 was $328 and the average monthly HUD expenditure per voucher holder was $716. The average utility allowance …is $135.” New Orleans’ waiting list online was “closed.”
So what is the point in this data? Primarily the point is that Section 8 Housing has become a lotto system that aids a small percentage of the population that would fall in the same category. It is not a fair system to those waiting or those paying for it. Secondly, perhaps 15% of those on Section 8 in Louisiana, according to various locations, where disabled or over age 65; and thus, receiving other government funds. Thirdly, what would they have to do without Section 8? The answer is the same thing as the other not on it: live with a friend, relative, spouse, partner, get married, go to school, get another job, in a charity home, nursing home, assisted living, etc. etc.
According to the Center on Budget and Policy Priorities (March 2017), “the federal government spent $190 billion in 2015 to help Americans buy or rent homes, but little of that spending went to families who struggle the most…” Of course they also showed that Household’s with income over $200,000 get $6,076 in ‘annual federal housing spending,’ but after saying it is in ‘mortgage interest and property tax deductions,’ they omit that the government is not actually giving them anything – but rather reducing there increased tax burden. They showed Households with incomes below $20,000 receiving $1,529 a year in ‘federal housing spending.’
Trillions have been spent, and the coffers are calling for a return. People are free in America, if they are not happy with the great benefits, they can go to Mexico and live on concrete floors. Just got back from a poor town outside Juarez, Mexico in July 2017; and a father came up to us and said will you pray for my 20 year old son, last month he cut his legs off in an accident at work. As we stood outside their small wooden home with no grass, we asked, ‘will the government give him assistant?’ He said because his son worked for a government-owned company they would give him an allowance enough for food and a few dollars more.
In the Peru orphanage friends built (25 children) near the Amazon, most of the children have been given by the single mothers who can’t afford to feed them and give them a room with only children in it; and many of the mothers do whatever to bring in income and survive. So if our government says, sorry can only give you $30,000 in benefits, rather than $40,000 (poor single mother w/2 children – typically born out of marriage – as half the births to minorities in Louisiana or 90+% on Section 8); then, sincerely God bless you, but your problems are both common to humanity and most likely willfully initiated by yourself.
It is time for the Housing Act of 1937 (Section 8, rental housing) to be reformed. All the Disabled and Elderly need to be handled solely by the SSA (Medicaid) and other offices. According to NYCHA, New York has the largest Section 8 program with 90,000 vouchers. And most of the sign up occurs online or by phone. Many offices in all 50 states need to be cut for both efficiency and cost reduction. Like many insurance agents and others have lost their jobs to online marketing, the government needs to do the same to their agencies.
The U.S. Department of Housing and Urban Development (HUD) has informed “more than 200 public housing agencies (PHAs) in 23 metropolitan areas across the country …that HUD is delaying the mandatory implementation of Small Area Fair Markets Rent 2 years.” President Trump’s 2018 Budget “continues to provide rental assistance for 4.5 million households…”
Since HUD budget for 2017 is nearly $49 billion in gross discretionary funding and $11.3 billion in new mandatory spending over 10 years. Priority needs to be given to the homeless. Obama increased HUD funding $1B before leaving office (like charging a credit card above its limits). The 567 Native American tribes would like more than a $50 million increase, maybe 1% of the land west of the Mississippi – but it ain’t going to happen. Cut 5% in 2019 – reaching 6% in 2020 across the board on all new and renewing rental contracts. Cut 5% of the vouchers by 2020 until below a balanced budget. CUTS: between $3B and $5Billion.
- Department of State, Foreign Military Financing: This part of the 2017 budget was reduced $312M from $6+Billion; yet the 2017 DOS and USAID budget was $50B and Trump is proposing 2018 DOS and USAID budget of $37.6 billion. Starting to see how HRC’s Clinton Global Initiative received over $1billion from foreign donators when she was Secretary of Treasury and Presidential Candidate, and then closed its doors in 2017. This could cut expenditures, but it is in part already factored into 2018, but it held in check we will say a $13B cut per year (2020); thus, we now only need to find about $410 billion in cuts.
- NASA: The 2017 Budget “invests in space exploration and technological advancements, providing $19 billion, including $763 million in mandatory funding in 2017, to NASA to further U.S. leadership in space and at home. The Budget supports exploration of the Solar System, including robotic missions to Mars and to the Sun, and funds the development and operation of a fleet…” For 2018, Trump’s plan would reduce the budget $561 million.
In 2011, the CBO said, an increase of “.1% in the GDP growth rate could reduce the budget deficit by as much as $310 billion cumulatively over the next decade.” Maybe in a vacuum, but what happened was the Obama Administration and Congress added $5 trillion in National Debt since that time and projections show deficits for the next few years at least. In 1958, NASA began with some millions of dollars, and as the space race continued, the budget grew – to $1.2B in 1962, 2.5B in 1963, 5B in 1965 and leveled out after we landed on the moon in 1969 the budget remained stable, even during the ICBM build up in the nuclear race with Russia (which came under Defense Spending) until the 1980s when it creep up from $5billion to $11B with steady .5% to 1% increases, and by the same reached $19 billion in 2017.
With new companies like Planetary Resources and Satellogic launching possible our best imagery satellites and marketing commercial deep space exploration, private corporations continuing the works and dreams of those that came before them. Planetary Resources is looking at using asteroids to reduce space exploration cost astronomically; saying that 16,000 near-earth asteroids are rich in resources. Satellogic raised $27 million for their world class world imaging. And when Boeing, Lockheed, Orbital, Loral, Astrium, AT&T (DirectTV), Dish and the like put satellites in space, they are put into their budgets and funded by government contracts or public user fees.
It is more effective for these companies to launch their own satellites that do it with NASA. It is much cheaper to launch from Baikonur, Kazakhstan or even French Guiana. Companies will pay a million dollars to fly a satellite to Asia, because it is cheaper than Cape Canaveral. The Government needs to get more competitive or out of the commercial satellite business. NASA will need to continue joint ventures with our countries – regardless of the difficulties – to keep cost down and the program in space. Companies like SPACECOM (Western Union/Continental Telecom) – sold to European Comp. – now Israeli owned – will continue to thrive through private enterprises and a 10% cut in NASA’s budget will not change that.
One could put a thousand satellites in space and it would not have changed the $1.2 trillion in damages from the 200+ weather disasters 1980 to 2017 (NCEI – noaa). And when Texas, Louisiana, Mississippi and Florida get billions in FEMA funds, they can’t complain if their PAE-BWXT contract or their Space Center contracts are reduced. Universities and Commercial Industries will continue Technology advancement. Now is the time for $2B in cuts, not 500M.
- Legislative and Judicial Branch: Not sure why the Sergeant at Arms & Doorkeeper of the Senate gets a budget of $137 million a year + inflation; but their ‘Salaries, Officers and Employees’ get increased funding from $173M in 2014 to $190M in 2017, while taxpayers will bear the cost. Now, is a time for difficult cuts and better organization! Of course the Capital and Supreme Court offices and positions are vital and important, but their combined approximate $12 billion budgets need to also make a little sacrifice along with anyone else. Again the average non-government lawyer or professional does not get such pension and health benefits. Nevertheless, a 5% cut can be found. So now we only need to look for $407B more.
- FEDERAL PRISON SYSTEM Reform: The Federal Prison System gets $7.5 billion in 2017 for about 43,000 positions and 20,900 correction officers. According to Prison Policy Initiative (PPI), in 2016, there were about 2.3 million people in 1,719 state prisons, 102 federal prisons, 901 juvenile correctional facilities, 3,163 local jails and 76 Indian Country jails; plus military prisons, immigration detention centers. PPI reported that in the local jails are about 630,000 persons, 187,000 convicted and 443,000.
About this point – the taxpayer – part of your brain should be asking at least 2 questions. How much are we paying and how many are in for traffic bench warrants and first possession marijuana and like schedule I drugs? By the way, the government gives out free schedule II Methadone at their clinics (to deal with cocaine addicts, etc.), but locks another up for marijuana (which does lead to several societal problems – but we should not add to them.) The answers are: Well in New York City an inmate could rake in over $150,000 in annual revenue – well not for them – but maybe it would be cheaper to give them a house on Guam). Anyway, the average taxpayer cost in 40 states according to the Vera Institute of Justice was $31,286 in 2012; so that means about $3k a month now.
Well let’s compare, the average college/university dorm room is larger than the average cell; and according to the College Board, even with a 28% increase over the last decade, a 3-meal-a-day plan averages $3,989 (<$11 a day); and the average room cost about $10,000 in 2014-2015; thus, about $14,000 per college student for room and board versus $36,000 for an intimate. Administration and food service cost should be about the same (cheaper in large prisons – because the server makes <$1 a day), so what does a guard cost? Let say one $60K guard (all benefits) per 10 intimates (they are in a controlled setting). So 10 college students boxed up in their walls and eating university food cost = $140,000 a year + a guard = $200K; and 10 intimates with a guard cost = $420,000. There is the cost of healthcare per intimate – but they are not exactly on the Obamacare Gold plan – but if they were – we would still be paying $25% to much.
For New Orleans, the statistic of 1 in 15 black men are in jail or prison has been used; regardless Louisiana has been call the world’s prison capital because it has the highest incarceration rate in the US and 13 times that of China and 20 times Germany’s rate. Primarily because many of the facilities are ‘for-profit (ran by sheriffs or companies);’ but cheaper than that of other states – from which some transfer people.
It is time for serious reform from locking up users at age 20 to educating them and putting them to work at age 17. Moreover, the federal laws need to change – no ‘for profit’ jails or prisons; and no federal funding for first time marijuana possessions under 3 oz. – and if they would legalize (as much as we hate the taught) 1oz. – it would save the courts time and taxpayers billions. Convert a future convict to an asset, from a potential liability.
Additionally, State Prisons have about 1.3 million prisoners and almost 200,000 in federal prisons. In times, where all Americans must play some part in paying off the National Debt and providing cheaper HealthCare – the Federal Bureau of Prisons and the DOJ as a whole will have to find their cuts – a lot of cuts from the proposed $27.7 billion 2017 to $22 billion in 2020. Furthermore, these changes will free up state dollars to replace cuts they will see in Medicare and Medicaid. Down to about $400 billion more cuts needed to correct this 70 year old mess.
- Energy and Environment: Environmental Protection Agency (EPa): EPA is already seeing a $257M in 2017 for their Clean Water… State Loan Funds; yet, they still had received $32B in the last 4 years. They report that the President’s 2018 budget “provides $5.65 billion to support the agency’s work to protect human health and the environment. When EPA was founded in 1970, the hazard waste issue was still looming. The Love Canal (N.Y.) lawsuits were still in the news, and other hazardous sites were a serious issue. And in 1980, EPA’s Superfund program was created to clean up the nation’s worst sites. Now EPA monitors and fines corporations. If the reduction from $8+ Billion a year (during Obama) to $5.65B under Trump is true – then maybe we should not ask EPA to find more – but we can hope for a goal of $1B less by 2020. Most corporations with $4.7B a year in revenue can do quite a bit.
The Office of Environmental Management 2018 Budget request is $6.5 billion. Radioactive Tank waste and nuclear materials are serious stuff, but could likely handle and clean up for less than $9 billion a year. As a whole the DOE budget is $32.5 billion (of which $30.2 is discretionary). It also seems like $13B a year to maintain nuclear stockpiles without testing is a lot (that’s more than North Korea’s entire Defense budget with testing). Also, $5.7 billion in research is a great deal, with corporations profit from the testing and get reduced taxes – let them test tax-free (100% write off to the company as an expense).
Yes, there is a place for these line items; but again cuts have to be made here and everywhere. Additionally, $1.8 billion for the Defense Nuclear Nonproliferation used to secure or eliminate nuclear and radiological materials worldwide should be meet with shared UN or international funds. The budget needs to be reduced (except for the portion that pays Special Forces and the CIA to ‘eliminate’ senseless dictators building up ‘nuclear and radiological materials’ regardless of UN resolutions).
As to the 8,000 or 9,000 stored nuclear warheads spread-out in various locations, most are disarmed and at least partially dismantled or awaiting dismantlement; however, according to the guys in the rubber suits with the gloves and full-body cover, maintaining warheads is expensive because – well – they have the ability to corrode and change configurations which could be volatile later. Thus, they have to be kept – typically in sealed airtight containers – and still only have a shelf-life of 20 – 30 years; which means the cold war ones from even Reagan’s time have likely been dismantled or maybe refurbished for discounted sale. Also, we keep some in at least 6 other countries.
Nevertheless, it is time to incinerate some of the costs (and maybe some of dismantled stuff – out in the pacific away from everyone; please). Also, the average $112,300 salary at the DOE, plus benefits, for the more than 13,700 employees must be adjusted – along with those similar in every Department. American taxpayers cannot pay for tens of thousands of government employee’ pensions and excess salaries, and then can’t even afford care for their own parents. Find 5% to 10% cuts, or let the employees pay for at least 50% of the true Healthcare cost and 75% of their own pensions. Energy and Environment – $3.5 – $5B in cuts: leaves $395 Billion.
- Education: We do not need to dig up quotes to know that Education is vital to the present and future of every nation. Education programs have the potential to curve future prison populations and increase future tax revenue and make life easier for our great country. More grants are need, along with accountability and appropriate performances by both the student and administrator. Grants and credits for needed professions – such as primary care doctors or school technical support; as well as for plumbers and electricians, etc. Corporate credits and grants for apprentice programs with high-risk teens could help.
Also, non-grant student loans, whether Unsubsidized or PLUS loans (7%), whether undergraduate (4.45%) or post-graduate (5.3%), should no more than the 10 Year Treasury Notes (2.3%) plus .05% rake on undergraduates; + 1% on post-graduates; and + 2% on PLUS loans. $1.4 trillion in student loan debt off the per-head count of mainly 18 to 20+ year old is not a good message to the next generation of needed professionals. But, if the system thinks it is fair, the let children receive degrees for passing certification tests – if a 17 year old can win Microsoft’s Excel competition or a 20 year old living in a basement can stop a global virus and hack into most corporations at will – then maybe they should get degrees in shorter time if we are going to profit off of their 4-years of tertiary schooling.
Now, if the average teacher receives $60,000 in current compensation, plus a defined benefit plan (and most of the summer off – yes, but 12 hours days during the school-year); and if full-professors make $120,000+ current and future benefits; and more so if the NCAA allows $5+ million salaries to head coaches (without capping salaries half that and making them scaled by school population) then, the average taxpaying citizen can say – you must sacrifice a little.
Now if the government truly wanted to change education and help the middle class and drain the swap of lobbyists – then giving vouchers per child for public or private schools would not only be more competitive for pricing (as they assume in Healthcare reform), it would put School Choice back in the hands of parents, guardians and local representatives; rather than loud lobbyists and those seeking to keep the own interest or promote their own agendas – Christian, non-Christian, Non-religious, Secular, or whatever. It will head that direction one day; but in the meantime baby steps – charter programs – successes and failures – graded A to F public schools, etc.
NEVERTHELESS: Trump is right that “we must enrich the mind and the souls of every American child…” however, we must also balance the budget and pay off a little National Debt every year for the next 100 years (assuming we have 100 years). Depart. of Educ. spending has increased from $17.1B in 1989 to $68.3B in 2017 (FY 2018 Budget Summary). They can and must find 5% to 10% cuts until we reach a balanced budget.
- TRANSPORTATION: With $380 billion dollars in cuts to find; we come to the DOT. Population increasing, Instates, roads, bridges, airports, buses, trains, and infrastructure needing to be addressed; this will be no easier than any of the others. But, remember – the recommendation was to start between 2018 and 2020; and before that call the Federal Reserve up and tell them to dump another trillion in the bank account (for non-Defense/non-Healthcare spending) – no kidding; what the heck; let’s do this right – take a trillion and get things right – secure the roads, borders, get the drugs and serious cartels out of America, do workfare and any program to change the minority prison and unemployment problem – but that is a trillion with 0% interest tied to it and make the Feds or SSA hold it at that rate with no commissions – they can do their part to ‘make America great again.’
So, back to transportation and their numerous administrations for land, sea and air: the Fiscal Year 2018 Budget for these good citizens was $98 billion for 2017; and Trump’s proposed 2018 is said to cut the DOT’s discretionary budget 13% to $16.2B. Mandatory, discretionary, whatever – Congress; you get receipts and have expenses – call them whatever you want, but cut them and rise revenue until you not only find your balance – but start paying off your promises and debt. DOT can do like others with very large budgets, find 5% in cuts overall after a 2018.
Dump in $100B spread between all the above; and maybe used to hire college grads, internships for undergrads, and work programs for jail paroles – tied to GED programs or whatever seems right to help America; but in 2019 it is time to get Fiscally responsible. With the above cuts, than we are down to about $360B needed [(adjusting for increases in population and in taxpayers and better citizens over the next decade] – that and there ain’t much chance of Congress raising taxes + cutting outlays to $715B in any of the next 10 years.
- Interest on Debt: Adm. Mullen, a former Joint Chiefs of Staff Chairman said, “the most significant threat to our national security is our debt.” President Madison called ‘public debt …a public curse.’ President Washington, said “Avoid occasions of expense… and avoid likewise the accumulation of debt not only by shunning occasions of expense but by vigorous exertions to discharge the debts, not throwing upon posterity the burden which we ourselves ought to bear.” And Benjamin Franklin said, “when you run in debt; you give another power over your liberty.” Thomas Paine explained how National Debt is directly related to increased taxes, saying, “The burden of the national debt consists not in its being so many millions, or so many hundred millions, but in the quantity of taxes collected every year to pay the interest.”
There are verses in books considered sacred by the Jews, Christians and Muslims that speak against either changing one’s kin or countrymen interest (usury) or excessive interest. One says, ‘you are hurting your own people by charging interest when they borrow money (Nehemiah 5:7);’ and when Jesus (who the Quran speaks of; and who the Jewish Josephus said, ‘He was the Messiah);’ drove the ‘money changers’ out of the Temple – not only were they defiling the Temple and the commands of God, but they were raking, stealing or taking an excess and unethical portion from the Treasury. And whether you are religious or not, there is a sense of justice and common sense. And millions of Americans understand how frustrating and unreasonable it is, when put in that position in life – when one does not have an unlimited lifetime flexible payment personal Federal Reserve Card – that they must pay 25% to 100% interest on credit cards, pay-day loans, (when getting pass the deceitful ‘pre-approved’) personal loans with 6% up-front origination fees, pawn shop rates and the like. The cries of many of them reach the heavens (certainly bypassing Congress who most (correctly) surmise couldn’t care less, because they feel and know they are being taken advantage of at some of their most vulnerable times and their leaders do not rescue them – when it is legally and ethically within their powers.
Among other things (like providing society with a valuable, patriotic and needed service), secondly it is the business of banks and financial institutions to make profits. But Americans are nearly $13 trillion ($12,850,000,000,000.00) in Debt; and it is one of the HIGHEST DUTIES of Congress to PROTECT THE GENERAL WELFARE of its citizens – by war or peace – against things seen and unseen – against fraud, corruption and abuse – and if necessary – as warned many presidents and politicians before this Congress – against Central Banks.
A Debt obligation – is not only a commitment – but a liability. And liabilities not backed by assets (such as the Gold Standard – although the nation has become richer off of it – because of our pass technology, global positioning, and military victories and power) become burdens that cannot be carried easily or at all.
The Interest Expense on the National Debt Outstanding (October 2017: > $20.3 Trillion and GDP, and in 2013 led to a downgrading in the U.S. credit rating) is $276 billion for FY 2017. In 1985, the CBO said, “Interest outlays are the fastest-growing major component of Government spending…” up $21 billion, from $90 billion in the fiscal year 1983 to $111 billion in 1984. The INTEREST ON DEBT in the last 10 years alone has been more than $2.1 Trillion. And to give you an idea off where this Trillion Dollar Train is heading; in 1977 Net Interest was $29.9B; and in 1987 – 30 years ago it was $138.6 Billion.
1977 Budget: $356B Receipts – $409B Outlays = $ 54 billion deficit or 15% above Receipts, and the Debt Net Interest of $30B was 7.3% of outlays and 16% of Receipts; with National Defense of 24% of outlays and ‘Human Resources (Education, Health, Medicare, Soc. Sec., Income Sec.)’ being 54% (10.5% of GDP); with $698B in National Debt.
2017 Budget: $3.6T in Receipts – $4.1T in Outlays = $503 billion deficit or 14% above Receipts, and the Debt Interest of $304B was 7.3% of outlays and 8.5% of Receipts; with National Defense of 15% of outlays and ‘Human Resources (Education, Health, Medicare, Soc. Sec., Income Sec.)’ being 72% (15.4% of GDP); with $20.3+ Trillion in National Debt.
In 40 years we saw about 10 times the Receipts, Outlays and Net Interest as 1977; but 29 times the National Debt. In 2017, public debt (held by individuals, private banks and insurance companies, the Federal Reserve Banks, and foreign central banks) was $14.8 trillion, and the CBO estimated Interest in Budget Spending for FY 2020 is $428B and $528B for FY 2022 with $23.6 Trillion in National Debt. Additionally, as interest rates on Government Notes fall, the public will decrease its willingness to help finance a Deficit. Yet, to check inflation and pay off Debt, the yields must remain very low – towards 0.
Part of the Interest on the National Debt goes to banks and the Federal Reserve. Although, since its creation in 1913 the Fed has been brought under the wings of the government; it is still a group of private Central Banks – it is owned by its member banks and their stockholders (i.e. initial objections to Rockefeller and Morgan having unfair power and profit). President Jackson fought against the Banks making profits off of the government; and President Kennedy sought in Executive Order 1110 to issue Silver Certificates and move towards being backed by precious metals. Now, almost none of the Fed’s Money Supply is backed by Gold ($11B) and they can electronically create money – almost at will.
Moreover, since 1913, and some still, banks received a guaranteed 6% on their Reserve Deposits. The Fed ↑M2, then lends $ to member banks, who loans it at much higher %rates to citizens and receives %6 as it gives the same $ back to Feds to loan Congress Deficit Dollars and make billions in Interest on it. Little has changed from its creation. Just as the Federal Reserve loaned Billions to Congress (then backed by Gold held by Central Banks) for World War I and Income Taxes were reenacted to pay for it. In the past 46 years, the Feds have increased the Money Supply (M2) from $650 Billion in 1971 (when the Gold Standard was dropped) to $13.7 trillion in 2017. And, note that is nearly equal to the Public Debt.
What was done with the money? It was used to fund Human Resources programs, all the while the Feds made profits on interest by increasing spending. The Feds do return 96+% of profits, but the Central Banks and their member Banks still make billions in interest and dividends through increased Debt; and unlike the past – it is done electronically without the cost of storage, securing or being limited by Gold.
If there was not an increase of $10 trillion dollars in M2, than there would not have been in vast Welfare System of Human Resources going to non-taxpayers (right or wrong – just economics). If there was not Government-Taxpayer dollars flowing like Niagara Falls – on behalf of the non-taxpayer citizens – then Insurers, Medical Professionals, even Walmart and Microsoft, etc., would not have receive anywhere near their profits and HEALTHCARE Premiums would not have risen out of control (there would have been no money to pay for a third or more of them, or money to buy $100 tennis shoes, $250,000 houses, etc.). The point is not should we help the poor and stimulate the economy – of course; the point is at what cost and how?
Regardless, it is time for Congress and the Federal Reserve to tie and cap bank dividends to 10-Year Notes at a much lower rate. ALSO, ALL funds held from Federal and State Government Agencies by member banks of the Fed should not make more than .25% in corresponding dividends. First, they are not storing Gold. Second, that will well cover there patriotic tax-deductible administrating salaries. Third, if that does not seem fair to them, there are a few insurers with better financial ratings that the Government which will work a very low fee arrangement for a portion of the TRILLIONS of dollars to go in Variable Annuities with a principal protection rider; and give free handling in their Money Markets.
- Veterans Affairs & Veterans Administration: 2018 Budget: $186.5 Billion. American is a free and respected nation because of its Military. Most of the 193 nations in the United Nations have new Constitutions and have had their land and or governments taken or changed since WWII. The question is not do we have an obligation to our veterans; it is again only a matter of economics and ethics as to what is appropriate, fair and affordable. About 20 years ago if you would have walked through the VA hospitals you would have heard many of the Vets saying, people in here a dying left and right – and then many would add – you know from Agent Orange (chemical warfare during the Vietnam War/Conflict).
Veterans have earned the right to at least the same quality Healthcare as other Americans and their Pension promises. And their dependents and beneficiaries deserve those arrangements contracted for; however, Veteran Affairs must continue to strive for better efficiency and equitable contracts with both Insurers and employees. Lastly, Congress and the VA must consider that Defense spending and actions directly affect VA spending and citizen’s taxes.
- Department of Defense: More than half of Discretionary Spending and a quarter of Total Spending (adding Military, VA and related Debt Interest, Health Cost and Retirement) go towards the Defense Outlays. In the less 40 years America has spent $14 trillion on National Defense (not including VA, SS, etc.); with interest = the entire $20 trillion National Debt. The DOD says Trump’s 2018 Budget Proposal request is $639 billion. Only Obama surpassed that with 4 of his 8 years; yet National Defense as a % of outlays was larger by the Bushes, Clinton, and definitely by all before Reagan since 1941, with a high of 89.5% in 1945.
According to Atomic Audit: The Costs and Consequences of U.S. Nuclear Weapons Since 1940 (1998), since 1945 (end of WWII) the U.S. has manufactured and deployed “more than 70,000 warheads” at a cost of $5.8 trillion (in 1996 dollars); then followed by a trillion in Debt Interest payments on the Deficit Spending, storage, maintenance, etc.; only to pay to dismantle most of them for billions of dollars. In 2000, the U.S. had about 12,000 warheads, and now according to Ploughshares.org there are less than 15,000 nuclear weapons in the world with the Russia and America both having about 7,000. This was in great part due to the Treaty on the Non-Proliferation of Nuclear Weapons (1970).
The Doomsday Clock is at ‘two and a half minutes to Midnight (Bulletin of the Atomic Scientists)’ and the Scientists tell us we have 4000 warheads – enough with Russia-China (& other Shanghai Cooperation Organization members) and a few maniacs (currently hands on clock pointing to DPRK & IRI) “to kill a fourth of the earth with warheads, famine and pestilence that follows (Rev. 6:8).”
MOREOVER, the fact that we overproduced 8,000 unused warheads shows the lobbyists power and Congress and Defenses’ (at least past) inefficiencies and poor forecasting – at the cost to taxpayers and burden to future Americans. If we are going to go to war, set a goal and get it done. 2001-2017: In Iraq, America and others killed more than 360,000 Iraqis (4,500 US died) of which about 300,000 were civilians; and in Afghanistan about 90,000 Muslims have died between both sides. Some costs of the wars are the cost related to millions of orphans and future reconstruction; as well as the creation of ISIS in camp Bucca; where in 2004 Al-Baghdadi was allowed as a religious cleric was allowed go to the different areas to minister.
Cost of the Middle East wars are nearing $5 trillion (2001-2017 + future related costs) or about $11 million a person killed. There are times for Special Forces to take targets out; and times for Naval present, Air supremacy, thousands of boots on the ground and Total War. But, if the goal was to kill 100,000 Iraqi soldiers and 100,000 Iraqi civilians that may or may not have been justified; then maybe we should have hired independent defense contractors (Blackwater, the mafia or poor unemployed Africans, Asians or Central Americans). Myriads will be willing to risk their lives for a million dollars a person with no medical, disability or retirement. The point is not are standing armies better prepared and armed; it is that deficit spending trillions for war beyond the spending of 15 other major countries combined has to stop.
But if we must build 2 Virginia Class Submarines, does it have to cost $5.5 billion; and likewise with a $2 billion B-21? And when these DOD contracts are making corporations rich, do we need $13.2 billion in Science and Technology (unless it is for college grants). About 20 companies got the bulk of the last trillion in defense contracts. According to SIPRI, world military spending in 2016 was $1.69 trillion; and 7 out of the 10 top arms-producing and military services companies were from America and most of their revenue comes from the DOD. Adding the VA & Homeland Security, the Militarized Budget > $730B.
The top 50 U.S. corporations benefiting from DOD contracts (i.e. Lockheed $.3.6B profit 2015; Boeing, BAE, Raytheon, Northrop, GD, UT, L-3, etc.) made over $100 billion in profits over the last decade or less. They can reduce cost more – yes, it will take a little from the S&P all-time highs; but currently less than 1 in 3 millennials have S&P stocks and good jobs; and they – with Generation Z and Generation DT (debt & tribulation) – will be carrying the weight of the National Debt. Use the military to control some of the $500 billion in drug trafficking and give them the seized properties and cash; work in soldiers with police rallies (like some other nations do); find solutions; but cut Defense spending 10% in 2019 and on until a balanced budget.
- Department of Labor; IRS, etc.: DOL needs to reform Worker Compensation laws with exemptions for small employers (10 or less, with proof of individual or group health insurance) – this will stimulate the economy (and keep a lot of small construction crews legal); the IRS will see reform in 2018; and these and other unmentioned Departments need to take Trump’s campaign words and have supervisors look for places that can be cut.
- Social Security, Unemployment & Labor: With $300 billion in cuts to go, we reach the largest funded department – the Social Security Administration with 60,000 employees with and 1,230 field offices. There are about 19,500 cities, towns and villages in the U.S. (about 99.5% of them with cellphones and internet) of which about 16,500 have population under 10,000 and another 1,500 over 25,000 leaving about 1,480 with populations over 25,000. Many of the 726 cities with 25,000 to 50,000 are very near the other large cities.
With hundreds of thousands of jobs being affected in the private sector by internet competition, and with $20.3T in National Debt, until we reach a balance budget, in like manner of Sears, Kmart, Kohl’s, Walmart and scores of others (many who have filed bankruptcy) the SSA needs to cut between 10% and 230 offices by 2020. Maybe get some of the Tech-geniuses through university competitions with grant prizes to come up with cost effective solutions to joining offices together and still meet the needs of the public while cutting overhead like private companies with massive debt loads. The new Online Social Security Matters is a good start.
DHEW (1954) and SSI (1973): For more than 180 years of U.S. history since 1789, unfortunate poor Americans 65 or older, blind or disabled; lived without supplemental (non-Social Security) income. In 2017, eligible individuals received $735 and couples $1,103 and essential persons receive $368. $38.5B is requested for 2018. According to the SSA, August 2017, there were 2.75 million beneficiaries receiving both Social Security and SSI of the total 66.7 million receiving one or the other; and 5.5 million only received SSI. Perhaps some of the ones receiving both can be reviewed; and perhaps like pro-bono attorneys; medical professionals (primarily care physicians, nurses, etc.) could do a few hours of pro-bono a month to offset SSI mental cost.
- Federal (and State) Government Pension Plans: Less than 29 million of about 115 million people (or about 25%) in the private industry are covered by pension plans. There are basically two: Defined Benefit and Defined Contributions. Defined Benefit plans are much more costly, as they promise employees retirement based on a specific formula: typically some combination of (income earnings) x [(# of years) x (benefit factor: 2%)] + inflation rider. Thus: $50,000 x (25 years x 2%) = $25,000; in many programs the benefit factor increases to 2.5% or 3% with retirement after age 55 or 60 and or with 25 or 30 years of service: thus for age 55 retiree: $50,000 x (25 x 3%) = $37,500. Now, 401ks are the most popular of type of Defined Contributions plan.
The BLS reported that the “average costs to employers per employee hour worked for providing access to defined benefit plans” increased from $2.73 in 2008 to $4.48 in 2015 for ‘all goods-producing industries’ and from $1.79 in 2008 to $3 in 2015 for ‘all service-providing industries.’ And of course BLS stated “employees covered by unions tend to have greater access to employee benefits… 72% of union workers had defined benefit plans in March 2015, compared with 13% of nonunion workers…”
Only about 7% of America’s approximate 115 million private industry employees are in a union. And about 7% of America’s population (22.3 million) or 14% of the Labor Force works in a government job. For the vast majority of Americans and the middle class, most have either no defined plan or defined contribution plans, such as 401Ks, which usually have no future cost to employers after retirement. And government employees outnumber manufacturing employees almost by 2 to 1 (22.3M to 12.3M).
“The Pension Benefit Guaranty Corporation protects the retirement incomes of nearly 40 million American workers in nearly 24,000 private-sector defined benefit pension plans… (through) ERISA and… insurance premiums from employers… (www.pbgc.gov).” For the last 16 years PBGC has had a negative Net Position; thus their Liabilities are greater than their Assets (by an average of about $20 billion a year for the last decade). According to 2016 Annual Statement, “PBGC is responsible for benefit payments to more than 1.5 million people in over 4,800 failed single-employer and multiemployer plans.”
That is a ton of failed plans; and guess what my fellow federal employed American; if it was not for the Federal Reserve piggy-bank/credit card and TRILLIONS in increased Debt Ceilings, then many of you would not only have ‘failed plans’ but NSF accounts. Nevertheless, PBGC reveals more in the Annual Report: “PBGC’s combined net position decreased by $3,064 million, increasing the Corporation’s combined deficit to $79,413 million as of September 30, 2016, a record loss, from $76,349 million as of September 30, 2015.”
There are three important questions here: Can future taxpayers support and carry the burden of government Defined Benefit Plans especially as people are living longer? Do CSRS, FERS, etc. pensions meet a balanced budget without deficit spending? Is it just for roughly 86% of the taxpayers with non-defined benefit plans to support the other 14% with much better retirement plans back by Failing Corporate plans, high corporate insurance premiums (subsided through tax laws and tax payers and the consumer market), Congressional Deficit Spending at the cost to future taxpayers? If any of these questions are mostly likely not; then reform is needed – and billions of dollars of debt and interest will be save each year. The alternative in 10 or 20 years, will be slashing government employee positions by double-digit percentages; freezing inflation benefits; and changing formulas.
- HHS: FDA: The Food and Drug Administration protect public health through scientific examination of food, drug and certain chemical or cosmetics. Since 1992, the FDA charges fees for many of its review activities on products from medical devices to drugs. 2017 ‘New Drug Application (w/Clinical Data)’ was lowered from $2.37M in 2016 to $2M and about half that without Clinical Data. Fees for Devices and Animal Drugs are much lower. FDA’s 2018 Budget asks for a 10% increase from 2017 to $5.1 billion. They also stated they will ‘recalibrate… user fees’ to get $1.3 billion over 2017.
U.S. prescription drug spending doubled between 1995 and 2000, reaching $122 billion, according to a 2003 report by the National Institute for Health Policy. Generic Drug laws have helped but Big Pharma significantly profits from Medicare and Medicaid; and of course even more from private plans.
About 1998, four U.S. Tobacco Companies agreed to settlements over more than $200 billion. By 2000, Americans were very aware that chemicals in tobacco cause cancer, kills and drives up Healthcare Cost. Since that time FDA moved towards a tax and AD campaign compromise with the Tobacco Industry. Telling the youth, tobacco will kill you; but because of lobbyists and tax revenues, we allow fools and addicts to continue its use.
Less than .01% of people die from quitting cold turkey or switching to vapor or a patch; but 100% of life insurance & health insurance premiums increase due to cigarette smoking, quality of life drops, life expectancy is about 10 years less than for nonsmokers, cigarettes cost many $300 a month, and ‘more than 480,000 deaths annually.’
Smoking is one of the few factors allowed to affect Obamacare and individual and group Healthcare cost. It is not just to require taxpayers to subside increased costs of Americans on Medicaid and other plans due to the non-taxpayer’s lifestyle of smoking. Twenty-five (25) years ago the Surgeon General reported in 1992 that “the estimated average lifetime medical costs for a smoker exceed those for a nonsmoker by more than $6,000 (NE Journal of Medicine 1997).”
In 2014, Reuters reported the smoking cost to be “8.7% of all healthcare spending or $170 billion a year.” The same report reminded readers that “50 years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease… (CDC).” FDA and Congress, in order to promote the ‘general welfare’ and lower general HealthCare Cost, and to help stop addiction (nicotine said to be as or more addictive than cocaine); needs a Cigarette (traditional smoke tobacco) Phase-out Plan beginning 2020 to stop the production and importation of cigarettes. With about $250 Billion in cuts still needed; this would save tens of billions a year in current premiums and future cost.
- HHS: CMS; Medicare: The U.S. Government Accountability Office states on its 2017 ‘Fiscal Outlook & The Debt,’ ‘Fiscal Health,’ that “long-term fiscal projections show the federal government is on an unsustainable path.” The CMS (Centers for Medicare & Medicaid Services) National Health Expenditures for Health Care spending “sponsored by federal, state and local governments was projected (at) …$1.5 trillion in 2016.” Moreover, CMS reports, “the government-sponsored share of health spending is projected to increase and account for 47 percent of national health expenditures by 2025 (up from 46 percent in 2015), driven by continued growth in enrollment in Medicare due to baby-boomers and ongoing subsidies paid on behalf of lower-income Marketplace plan enrollees.”
Medicare is available to Americans 65 and older; or to those that have been disabled under SSDI for more than 24 months. Medicare has an automatic Part A (hospital insurance); and a Part B (medical insurance) which requires choice enrollment. Many Insurers sell Medicare supplement insurance (or Medigap) plans which cover gaps like deductibles and coinsurance cost. There are 10 Medicare Supplement Plans; for cost and coverage, Medicare Supplement Plan F has been one of the most sold because only plans F and G cover excess doctor charges. Medicare Advantage, Medicaid and LTC are not Medicare Supplement Insurances. Additionally, there is a Medicare Prescription Drug Plan (Part D).
|Federal Insurance Program||State and Federal Assistance Program|
|Funded by Payroll Tax, premiums, gen. rev.||Funded based on FMAP (Fed. Med. Asst. %)|
|People ≥ 65 or disabled 24 months||Subsidy for low-income people of every age|
|Must pay deductibles & coinsurance||Pays little or no part|
|Person paid 40 quarters (10 years) into Social Security System or disabled while paying.||Child or adult; not based on employment; only income test relative to Fed. Poverty Level.|
|Non-working Spouse eligible at 65||Based on 133% FPL|
|Does not pay for Long-Term Custodial Care||Does pay for Long-Term Custodial Care|
|Very limited Dental and Vision||Includes Dental and Vision|
|Enrollment: 1966– 19M; 1990– 34M; 2016-56M||Enrollment: 1966– 4M; 1990– 23.5M; 2017-73M|
|% of Population: 2017 – 14%||% of Population: 2017 – 20%|
|Total Spending: 2015 – $646 Billion||Total Spending: 2015 – $ 545 Billion|
|Payments are indexed at ≈80% of Private Ins.||Payments are indexed at ≈60% of Private Ins.|
|% of Primary Care adult acceptance: 93%||% of Primary Care adult acceptance: 67%|
|% of Pediatrician acceptance: 95+%||% of Pediatrician acceptance: 84%|
Possibly the most discriminated classes in the U.S. is the Healthcare Premium Payer. The typology of the payer is not only a main variable for administrative healthcare databases; but it should be a conversation from Healthcare Reform. The Healthcare System discriminated against about 80% of the population in that it by law uses fee-indexed schedules requiring Healthcare personal and facilities to accept up to about 33% less for Medicaid and about 20% less for Medicare than for Private Insurance.
American’s Healthcare System is separated into several enormous groups, as we as other groups and associations. These groups include those under Medicare, Medicaid, the VA, private HMOs, PPOs, POSs, GPPOs, MCOs, HRSAs, Union and Sharing Agreements, Self-Pay, Charity, Defaults, and Associations. Thus, those small and medium businesses or millions of middle class individuals with Private Health Insurance who are taxpayers – not only subsidize the poor Medicaid class and support the Medicare Class with taxes; but also by paying as much as 33% more in medical fee-for-services (FFS) in the Charge Description Master (CDM). Likewise, Insurers, Facilities and Physicians are by law are forced to manage profits and losses based on a discriminating System.
An example of this can be seen examining the MPFS (Medicare Physician Fee Schedule). For most codes related to services, Medicare pays 80% of the amount listed and the beneficiary is responsible for 20%. Then, assistants at a surgery may receive 16% of the MPFS rate and nurse specialists 85%. For the typical middle class taxpayer, they are subject co-pays, co-insurances, high deductibles and even paying the amount above ‘reasonable and customary’ charges.
The System and its discrimination in Fees Schedules for different people for the same exact surgery or service, whether Medicare Fee-for-Service or Medicaid Fee-for-Service, needs to be questioned. If the system is doomed to be ‘unsustainable;’ then it does not appear just to place more burden on Medicare beneficiaries who with their employers paid for retirement/old-age care, pay deductibles and co-insurances, and face potential additional Long-term Care cost in the tens and hundreds thousands of dollars per person. Likewise, it also does not seem reasonable to continue to increase cost and low benefits on the stressed middle class.
|Year||Uninsured (no health plan)||Medicaid Population|
|# of Americans in millions / % of Nation’s Population; *ACA became law 2010|
|1990||34.7 M / 13.9 %||23.5 M /9.4 %|
|2000||38.7 M / 14 %||34.5 M / 12 %|
|2010*||48.6 M / 16 %||52 M / 17%|
|2016||28 M / 8.6 %||71.5 M / 20%|
In 2000, the Census Bureau stated, “The uninsured poor comprised 23.8% of all uninsured people. Medicaid was the most widespread type of health insurance among the poor.” Another way of saying this was 76.2% of the uninsured in 2000 were not classified as poor; but most either could not afford the premium or were not eligible for Medicaid or Medicare. Congress must understand with life expectancy increasing and thus more Americans on Social Security and Medicare for longer periods of time; taxpayers cannot support current budget spending, government employees Defined Benefit plans and Insurance Benefits; as well as the current Medicaid population – even before addressing the issue of paying down the National Debt.
19: HHS; Medicaid: Due the Affordable Care Act (Obamacare which passed the Senate 219-212 March 2010), and seeking to have no uninsured American’s, Medicaid enrollment doubled between 2001 and 2016. Since the 3rd quarter of 2013 before the Exchanges opened for January 2014 enrollment until 3rd quarter 2017, Medicaid enrollment has increase 24%. Moreover, the actual cost per enrollee is much higher than government estimates; and enrollment surpassed both the uninsured population and Medicare enrollment. Note: 65% of people in Nursing Homes are und Medicaid at a cost of approximately $65,000 to $80,000 annually (2017).
According to the Congressional Budget Office (March 2016), “In 2016, subsidies for people under age 65 will total more than $600 billion… from 2017 through 2026, the number of people with coverage is expected to grow from 246 million to 253 million… the number of uninsured people is also expected to rise, from 26 million to 28 million… for the entire 2017-2026 period, the projected net subsidy is $8.9 trillion… federal spending for Medicaid and CHIP benefits provided to people under age 65 (excluding those who reside in a nursing home or other institution) is projected to amount to $3.8 trillion – or 43% of the total net subsidy. That amount includes $1 trillion in subsidies for people whom the ACA made eligible for Medicaid… For the 2016-2025 period, CBO and JCT’s projection of the net cost of the ACA’s insurance coverage provisions is now $136 billion higher than their March 2015 estimate…” CBO estimates that an average of 62 million noninstitutionalized people… will be covered by Medicaid in 2016…”
At this point, even if Medicaid cut spending by 10%, we would still need more than $200 billion to reach balanced budget and pay off the National Debt before the 22nd Century. Medicaid, has to be cut; but to fixing the Healthcare Crisis must involve a holistic change in taxing and government spending. And again, stopping the production of cigarettes alone would be the largest factor in reducing premium cost and health insurance spending. The Affordable Care Act did establish Medical Loss Ratios at 80%-85%; thus, requiring Insurances to use at least 80% of collected premiums towards actual care; the other to administration, overhead and profits. This was a needed change.
There are several plans in Congress such as the “American Health Care Act of 2017,” which passed the House 217 to 213, yet in 13 roll calls has not passed the Senate. The AHCA is anticipated to reduce Federal expenditures by over $328 billion primarily because of lower Medicaid spending and repealing the 2020 expansion. However, it eliminates Obamacare penalties retroactively to 2015; then add back higher up to 30% penalties beginning 2019 for not buying health coverage. It also brings us backwards towards the ‘preexisting condition’ problem again. The AHCA would establish Cost-sharing Reduction subsidies (CSRs)
Many other things to look at; but this was a 40-hour pro-bono article. A few other suggestions below and a couple of repeated ones.
- ADDITIONAL SOLUTIONS to HEALTHCARE:
TOTAL CREDIT PROGRAM – Limit total Credited Non-taxed Government (non-Medicare/non-Social Security) Benefits per individual and family (example: single mother with 2 children maximum $3,000 per month – in combined: Housing & Utilities assistance, Medicaid premiums, Food assistance, Private Education Vouchers, Public school cost or grants, SSI, etc.).
Work toward universal Healthcare Fee Schedules that are not significantly different for private and government policies.
Put stop-losses on charges above “reasonable and customary.”
Require Job searching for able bodied Medicaid recipients under age 60 – as done for Unemployment benefits.
Require a work-fare program for continuation of extended benefits.
Require nonprofit hospitals to play on a level field with the 18% for Profits hospitals – or refund excess gains from preferential tax treatment (60% of hospitals are Nonprofit).
Require nonprofit or charity hospital administrators and staff to receive benefits/salary ≤ for profit hospitals and to refund excess profits; also should test their % of Medicaid/free service.
Change classes of Nursing Homes, whereas Medicaid pays 15% to 30% less than Private Insurance (this is already similar to required ≈33% discounts in hospitals, etc.).
Use Relocation programs where cost is lowered by moving persons to less expense locations; example from highly population high cost cities to less dense or rural locations (Arizona cost or 10% less than California; Florida is 40% less than Connecticut’s average).
By law cease cigarette manufacturing in the United States (we don’t sale heroin to the public).
Allow 5% reduction and 5% increases in premiums base on 3 classes: preferred, standard, obese weight classes (based on an agreed universal standard insurance underwriting).
Change unlimited coverage for Alcohol and Drug Abuse for Subsidized plans; place a maximum on plans (no more $10,000 to $20,000 30-day programs charged to government). Require a minimum service for average reasonable and customary charges (Addiction Centers).
Allow Insurance plans to offer 2 or 3 classes of coverage; including limited $20,000 benefit.
Require 1 Chronic Disease screen at low co-pay at age 50 to 55 for preventable diseases.
Limit Medical Malpractice Settlements (such as to $1 million per individual; plus up to 25% attorney fees) against combined group: facilities, staffs and physicians (exception for willful, Extreme Gross Negligence, Willfully Criminal actions).
Monitor and fine fraudulent billing and reduce ‘unnecessary tests’ by medical providers.
Allow more functions for nurse practitioners and other professionals.
Reduce significantly above average Specialists charges.
Reduce separation of payments billing.
Add a 2 cent tax on gasoline and 10 cent monthly tax per cellphone line to subsidize State Medicaid programs (this will distribute cost over lower and middle classes more equally; and likely Cellphones will cause brain tumors with U.S. > EU GHz. levels).