SOLUTIONS to the HEALTHCARE CRISIS

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.  (These 21 pages are part of: 2018 U. S. HEALTHCARE COMPREHENSIVE SOLUTION

1. 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 (22^nd Century) Plan.    So yeah the 22^nd 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

https://www.gpo.gov/fdsys/pkg/BUDGET-2017-TAB/pdf/BUDGET-2017-TAB.pdf

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.

https://www.gpo.gov/fdsys/pkg/BUDGET-2017-BUD/pdf/BUDGET-2017-BUD.pdf

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.

12. 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.

13. 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.

14. 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.

15. 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.

https://blog.ssa.gov/new-online-security/

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.

16. 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.

17. 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.’

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm

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.

18. 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).

Medicare	Medicaid
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 3^rd quarter of 2013 before the Exchanges opened for January 2014 enrollment until 3^rd 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 22^nd 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.

20. 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).