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The medical bill score: How the public judges health care

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https://www.axios.com/the-medical-bill-score-2492012366.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=health-care

We track a lot of numbers in health care: how much we spend on health as a share of our economy; the number of uninsured; and the share of the federal budget allocated to health programs. What we don’t track — and a number the Congressional Budget Office cannot score — is the statistic that means the most to the American people: the share of the public having problems paying their health care bills.

Data: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015); Chart: Lazaro Gamio / Axios

The bottom line: The “medical bills score” is the single most important measure of how we are doing in health care from the public’s perspective. And ultimately, if Congress ever passes a new health care bill, it is how the public will evaluate that plan — from Graham-Cassidy to Medicare for All and everything in between.

The numbers that matter: As we found in a Kaiser Family Foundation poll in February:

  • 31% of Americans age 18-64 report they or a family member face problems paying their health care bills.
  • But that number shoots up to 57% for people who are sick.

It makes sense that people who use more care have more health care bills, but it also reveals how poorly our system performs from a consumer perspective when people who need care the most are protected the least by insurance coverage.

The impact: People are not just whining about necessary cost sharing. In a survey we did with the New York Times, we found that:

  • 70% of people with problems paying medical bills report cutting back on food, clothing and other basic necessities.
  • 59% report using up most of their savings.
  • 41% say they’ve taken an extra job to help pay for their health care.

Not surprisingly, the uninsured (41%) are more likely to have problems paying medical bills. But this is not a problem limited to the uninsured: 30% of the insured – think voters — have problems with medical bills.

The back story: The share of the public reporting problems paying their medical bills has not moved much in recent years. The Affordable Care Act has extended coverage and better financial protection to tens of millions, but it doesn’t have much of an impact on affordability beyond people covered by the Medicaid expansion and the marketplaces.

In the far larger employer-based health insurance sector, deductibles and other forms of cost sharing have been growing about five times faster than wages, and deductibles have been growing especially sharply for people who work for smaller employers. .

What to watch: Health care is a pocketbook issue for most of the public and the American people have their own scoring system. They may give this or that mostly partisan response about a health reform idea on a poll, but until they see how they’ll get help paying their health care bills, they will ultimately be disappointed by every health reform plan.

 

NEW QUESTIONS FOR LEADERSHIP TIPPING POINTS

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New Questions for Leadership Tipping Points

The opportunity and ability to step into a tipping point makes us feel responsible, powerful, and apprehensive.

Every decision both responds to and creates a tipping point.

New questions for leadership tipping points:

Ease:

The pursuit of ease makes you matter less.

Ease in small doses expands capacity, but in large doses destroys us.

  1. How might this decision challenge you in new ways?
  2. How might new challenges become personal growth points?

Please know that I’m not encouraging workaholism. However, making a difference requires getting your hands dirty.

Direction:

Every decision contributes to trajectory.

The consequence of decisions is real direction, not intended direction. You’re always heading somewhere.

  1. How does this decision reflect a “running toward” attitude, rather than running away?
  2. What are you running toward?

Long-term or short-term:

The appeal of short-term perspectives is immediate gratification, sometimes at the expense of long-term value.

Crisis requires short-term perspective. Put the fire out! But constant “crisis mode” sacrifices the future on the altar of urgency.

  1. How does making this decision reflect a long-term perspective?
  2. How does making this decision reflect a short-term perspective?

Relationships:

Life is relationships, nothing more, nothing less.

  1. What new relationships might result from making this decision?
  2. How does this decision impact current relationships?
  3. How might new relationships expand capacity and/or capability?

Service:

Tipping points include opportunities to both receive and give value.

  1. What new opportunities for service are available?
  2. How might your strengths find new expressions?

5 general questions:

  1. How does making this decision reflect a commitment to something greater?
  2. How are you expressing your best self?
  3. How are you expressing the self you hope to become?
  4. How much of this decision is motivated by fear?
  5. How much of this decision is motivated by dissatisfaction?

What questions might leaders ask when facing tipping points?

25 Inspiring Quotes From Mahatma Gandhi

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http://www.ravipratapsingh.com/2017/10/inspiring-quotes-from-mahatma-gandhi.html

Mahatma Gandhi Quotes_Ravi Pratap Singh_Learnnovators

Today, the 2nd of October, is celebrated as Gandhi Jayanti in India to mark the occasion of the birthday of Mahatma Gandhi.

Like millions of people around the globe, I too have derived tremendous inspiration from Gandhi’s life and teachings. It’s a measure of the man’s greatness and foresightedness that nearly seven decades after his death, his words are even more relevant today than they were back then. If only we pay more heed to the Mahatma’s words, the world would be a far more peaceful and compassionate place to live in.

On this special day, I thought it would be a great idea to share 25 of my most favourite Gandhi quotes with you… hope you find them as inspirational as I do!

1. “Live as if you were to die tomorrow. Learn as if you were to live forever.”

2. “The weak can never forgive. Forgiveness is the attribute of the strong.”

3. “First they ignore you, then they laugh at you, then they fight you, then you win.”

4. “The best way to find yourself is to lose yourself in the service of others.”

5. “You must be the change you wish to see in the world.”

6. “An eye for an eye only ends up making the whole world blind.”

7. “Whatever you do will be insignificant. But it is very important that you do it.”

8. “Nobody can hurt you without your permission.”

9. “Our greatness lies not so much in being able to remake the world but being able to remake ourselves.”

10. “What we are doing to the forests of the world is but a mirror refection of what we are doing to ourselves and to one another.”

11. “Strength does not come from physical capacity. It comes from an indomitable will.”

12. “In a gentle way, you can shake the world.”

13. “There is a sufficiency in the world for man’s need but not for man’s greed.”

14. “You can chain me, you can torture me, you can even destroy my body, but you will never imprison my mind.”

15. “Man becomes great exactly in the degree in which he works for the welfare of his fellow-men.”

16. “Even if you are a minority of one, the truth is the truth.”

17. “An unjust law is itself a species of violence. Arrest for its breach is more so.”

18. “The future depends on what you do today.”

19. “No culture can live if it attempts to be exclusive.”

20. “It is my conviction that nothing enduring can be built on violence.”

21. “An error does not become truth by reason of multiplied propogation, nor does truth become error because nobody sees it.”

22. “My religion is based on truth and non-violence. Truth is my God. Non-violence is the means of realising Him.

23. “In matters of conscience, the law of the majority has no place.”

24. “Non-cooperation with evil is as much a duty as is cooperation with good.”

25. “I am prepared to die, but there is no cause for which I am prepared to kill.”

And finally, one bonus quote from the great man which embodies everything he stood for…

26. “My life is my message.“

What the FY 2018 budget resolution means for ACA repeal

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http://www.fiercehealthcare.com/aca/2018-budget-resolution-republicans-aca-repeal?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTTJZNU4yTTNZV05sWm1FNSIsInQiOiJ2OXhPMHVRRk82MmRcL2llaVprUXFYSFJkbDBIS1lTcm1mRzVDSnFQQWRncUR5WmVDaFdFOGdTTkh4RWhIRTNHakR4Nm5Cd1hVYUIyZ1wveVl4ZTBpUXZqbkdYQldPTFpPazJqYlV4UGlNekw0QklMTHNwaEZtZVJGNHRXY2xVbzJPIn0=

The Senate side of the United States Capitol in Washington, D.C.

Senate Republicans’ fiscal year 2018 budget resolution suggests that they have put their goal of broadly unwinding the Affordable Care Act on the back burner—yet they could still use it to repeal key parts of the law.

The budget resolution (PDF), released by Senate Budget Committee Chairman Mike Enzi, R-Wyo., on Friday, contains reconciliation instructions that direct the Senate Finance Committee to “reduce revenues and change outlays to increase the deficit by not more than $1.5 trillion over the next 10 years.”

Since that reconciliation instruction is rather broad, the GOP could potentially use it to repeal some ACA-related taxes and other provisions that make health insurance affordable under the law, argued a post from the left-leaning Center for American Progress (CAP).

With their new budget resolution, Republicans could also still roll back other portions of the ACA, including the individual mandate, a Bloomberg article noted.

But because the budget resolution doesn’t include any instructions for the Senate Health, Education, Labor and Pensions Committee or the House Energy and Commerce Committee to craft reconciliation legislation, that may indicate that broader ACA repeal efforts are on hold, The Hill reported.

In addition to the reconciliation instructions, the budget resolution includes deficit-neutral reserve funds for legislation that would allow Congress to repeal or replace the ACA. This primarily just signals rhetorical support for rolling back the healthcare law, the CAP post noted, but that’s significant since it shows the GOP isn’t giving up on repeal.

Senate Budget Won’t Let GOP Pursue Full Obamacare Repeal

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https://www.bloomberg.com/news/articles/2017-09-29/senate-budget-allows-1-5-trillion-tax-cut-not-full-aca-repeal

Image result for Obamacare Repeal

Senate Republicans unveiled a fiscal 2018 budget resolution Friday that they intend to use to push through as much as $1.5 trillion of tax cuts in the coming months, but it won’t allow the GOP to pursue a full repeal of Obamacare.

The budget proposal would still allow Republicans to pursue a much narrower attack on the Affordable Care Act, including repealing the individual mandate to purchase coverage. The resolution also would let the GOP use the fast-track process to open up drilling in the Arctic National Wildlife Refuge.

The budget, authored by Senate Budget Chairman Mike Enzi, forecasts a balance in nine years through $5 trillion in largely unspecified spending cuts. Unlike the House budget proposed in July, Enzi’s blueprint doesn’t call for cuts to Medicaid or a partial privatization of Medicare.

“A pro-growth tax plan will move the U.S. economy forward and help to produce better jobs and bigger paychecks for every American,” Enzi, of Wyoming, said in an emailed statement.

The Senate draft is to be voted on by the Budget Committee next week, with floor votes planned later in October and a conference to resolve differences with the House after that. The House plans a floor vote on its budget plan next week.

Tax Cut

Once in place, the budget resolution would allow Republicans to bring up a tax-cut bill that would increase deficits by as much as $1.5 trillion, compared with a Congressional Budget Office baseline. Under the fast-track process, the GOP-controlled Senate could pass the proposal with no Democratic votes.

The budget sets a target for the Senate Finance to report back with its draft tax bill by Nov. 13.

“The Senate budget resolution drafted by Budget Committee Chairman Mike Enzi is a critical step to advance President Trump’s agenda to provide tax relief for the middle-class and unleash economic prosperity for all Americans,” said White House budget director Mick Mulvaney in a statement. “I urge the Senate to pass this resolution and come to a swift agreement with the House so President Trump can sign America-first tax relief into law this year.”

Senate Democratic leader Chuck Schumer of New York said the GOP plan would “blow a huge hole in the deficit and stack up debt, leading to cuts in programs that middle-class Americans rely on.”

Individual Tax Rate

President Donald Trump and Republican leaders announced a tax-cut plan Wednesday that would cut the top individual rate to 35 percent from the current 39.6 percent. It would let Congress decide whether to create a higher bracket for those at the top of the income scale. The rate on corporations would be set at 20 percent, down from the current 35 percent. Under Senate rules, any tax cuts that increase the deficit would have to expire in 10 years because the budget process can’t be used for long-term deficit increases.

The provision making it easier for Congress to allow oil and gas drilling in part of the Arctic National Wildlife Refuge was sought by Alaska Republican Dan Sullivan. Under the proposal, royalties from oil and gas production in the wildlife refuge would be raise revenue that could help offset at least $1 billion in tax cuts over a decade.

The proposal’s instructions to the Finance Committee could allow a partial repeal of Obamacare, although panel Chairman Orrin Hatch has said he will keep that separate from a tax overhaul. Republican leaders have said they won’t try again on the health-care law until fiscal 2019.

Balanced Budget

When Republicans attempted to use the 2017 budget process to repeal Obamacare earlier this year, they didn’t provide a 10-year plan for reducing the deficit.

The new Senate plan proposes a balanced budget within nine years, while leaving it to other committees to figure out how to achieve that. The proposal calls for $4.8 trillion in spending cuts over 10 years and $1.635 trillion in revenue losses, including the tax cuts. Balance by 2026 is achieved by assuming $1.2 trillion in economic growth, in part due to the tax cuts. Enzi claims to achieve a $197 billion surplus in 2027.

The Republican assumptions of robust economic benefits from the budget were called into question by a separate CBO analysis. CBO predicted that the budget would reduce economic growth in the first two years and slightly increase it in later years.

CBO estimated that annual real GDP growth in the first two years would average 1.3 percent, down from an average of 1.6 percent in CBO’s baseline. In later years, real GDP growth would be 2.0 percent, compared with 1.9 percent in the CBO baseline.

The budget, unlike the one proposed by Trump in May, would hold defense spending at the current budget cap instead of the president’s proposed $489 billion defense increase over 10 years. Non-defense discretionary appropriations — which fund domestic agencies like the Agriculture Department and National Institutes of Health — would be cut by $632 billion over 10 years compared with $1.6 trillion in Trump’s budget request.

While the Trump and House budget proposals contain a number of nonbinding policy suggestions to carry out their spending cuts, Senate Republicans — weary of policy infighting — are keeping things vague.

Medicare, Medicaid

The House budget seeks to make $203 billion in cuts in entitlements such as Medicare, Medicaid and food stamps, and it could be used to fast-track changes to the Dodd-Frank financial law. The Senate plan avoids those options.

The Senate proposal does allow adjustments to increase the defense spending caps. It also urges senators to revise the Children’s Health Insurance Program, improve management of wildfire-prevention funding, prevent private-pension bailouts and improve services to veterans.

The budget resolution doesn’t address Social Security, which will run a trillion-dollar-plus deficit in the coming 10 years. In the past, Republicans have sought to balance a “unified budget” that includes the program. This time, they are keeping it “off-budget.”

CBO says that without the Social Security accounting move, Enzi’s budget would never balance and would show a $424 billion deficit in 2027.

The nonpartisan Committee for a Responsible Federal Budget said in a statement it prefers the House budget. “We encourage the Senate to look to the House Budget Committee, which passed a budget calling for revenue-neutral tax reform and at least $200 billion of mandatory spending cuts on top of that,” it said.

Dynamic Scoring

The Senate plan renews authority for the CBO and Joint Committee on Taxation to use so-called dynamic scoring when evaluating bills — a move allowing lawmakers to assume that tax cuts will cause economic growth that would offset some of the revenue loss.

And it changes several rules to allow senators to rush a tax bill through, including abolishing the need for a CBO analysis at least 28 hours before a vote.

The Senate plan avoids other tricks, though. Enzi included provisions to keep appropriators from using phantom cuts known as “changes to mandatory programs” to offset discretionary spending increases.

The chairman also rejected pressure from some lawmakers to use a baseline number for tax revenue that would allow $450 billion in additional tax cuts. Instead, he stayed with the baseline used by the CBO.