A small but vocal minority of doctors have cited the “fundamental pledge” they made to protect their patients as reason to oppose Rep. Tom Price (R-Ga.), President-elect Donald Trump’s pick to run the Department of Health and Human Services.

Price has mounting conflict of interests allegations, and has also endorsed policies that threaten the most vulnerable populations and innovations to improve health care, according to letters to the Senate signed by more than 8,000 doctors and medical students supporting the Clinician Action Network or the National Physicians Alliance.

“As we have previously expressed, we are deeply concerned about the effect Dr. Price’s policies will have on our patients and the progress made under the [Affordable Care Act],” CAN, an organization formed in the wake of Trump’s election to publicly advocate for vulnerable patients, told The Huffington Post in a statement.

These 8,000 opponents make up a small percentage of the more than 916,200 physicians in the country, but they are illustrative of a medical community that’s becoming more politically engaged ― and increasingly polarized.

“[Doctors] are becoming activists in different ways,” said Thomas D’Aunno, director of the health policy and management program at New York University’s Robert F. Wagner Graduate School of Public Service. “Physicians not only want to know about the system but they want to have more of a seat at the table in leading the changes.” 

Price vs. Obamacare

Price, a former orthopedic surgeon, is an outspoken opponent of the Affordable Care Act. Trump has made it clear that he plans to repeal the health care law as soon as possible and replace it as soon as his HHS secretary is confirmed.

“We’re going to be submitting, as soon as our secretary is approved ― almost simultaneously, shortly thereafter ― a plan,” Trump said this week during his first post-election press conference. “It’ll be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day ― could be the same hour.”

Republicans in Congress have neither agreed upon nor put forth a replacement plan, so this is likely impossible. Still, Senate Republicans pressed forward on Thursday, passing a budget resolution to strip the ACA of its funding and spending provisions. The resolution still needs to be voted on by both chambers, but doesn’t require a presidential signature.


Many of the provisions that have radically improved care ... do not exist in Tom Price’s vision for health care in America.
Manik Chhabara, co-founder of the Clinician Action Network
Reports show that the ACA has brought preventive services to 71 million Americans without cost-sharing, Manik Chhabara, an internal medicine physician and co-founder of the CAN, said Thursday during a press conference. That includes screenings for breast and colon cancer, immunizations, annual checkups and contraception.

Trump’s eagerness to replace Obamacare implies that he could be considering Price’s previous repeal proposal to be a blueprint for a new plan, Manan Trivedi, an internal medicine physician and president of the NPA, said at the press conference. 

That plan would “essentially erode the health insurance market,” he said, by eliminating Medicaid expansion, instituting regressive subsidies and getting rid of consumer protections.

“Many of the provisions that have radically improved the care that Americans have access to as part of the Affordable Care Act do not exist in Tom Price’s vision for health care in America,” Chhabra said. “And that has us extremely concerned.”

Potential harm for vulnerable groups

The letter also says physicians oppose Price because he supports privatizing Medicare. 

Phil Blando, a Trump transition spokesman speaking on behalf of Price’s team, dismissed this concern as a “Democratic talking point,” but didn’t elaborate.

However, there is evidence that Price advocates for at least some privatization of Medicare. Namely, he has supported the idea of the government giving qualifying individuals specific sums of money to pay for private health plans. Doing so would shift a big portion of the financial risk to seniors ― and critics worry that the guarantee of coverage provided by traditional Medicare wouldn’t survive in such an environment. 

The primary goal of those plans is to limit how much the government spends on health care for seniors. Critics of such plans concede that would happen, but worry the policies would leave vulnerable Americans more exposed to higher medical bills. 

“His support of the Ryan voucher plan for Medicare would be devastating to millions of American seniors,” Trivedi said.

Price’s opponents have also called out the nominee for having repeatedly fought against reproductive rights; taking policy positions against the LGBT community; endorsing legislation that would weaken gun violence protection; supporting less regulation of tobacco; opposing mental health parity laws; and being against funding for AIDS and malaria research and the Children’s Health Insurance Program. 

Growing concern over conflicts of interest* *

The NPA and other public watchdog groups have called for a congressional ethics committee to investigate allegations of serious conflicts of interests and potential ethics violations. This would be in addition to the Office of Government Ethics background check required for all Cabinet nominees.

Price traded health industry company stocks worth over $300,000 while also working to sponsor or co-sponsor dozens of pieces of legislation regarding the health industry, Trivedi said. 

“We are not certain that he broke the law, but clearly serious enough questions have been raised to warrant an inquiry,” he said. “Especially in his position as HHS secretary, we need to know that he has no other conflicts of interests.” 

Additionally, Price may have benefited from a sweetheart deal from an Australian biotech firm, Kaiser Health News reported Friday. 

A medical community divided

The American Medical Association, the country’s largest physicians group with 250,000 members, doesn’t seem as concerned as the CAN or NPA. Instead, it endorsed Price, who is a member, almost immediately. 

In a statement issued on Nov. 29, board of trustees chair Dr. Patrice Harris urged the Senate to “promptly consider and confirm Dr. Price for this important role.” She explained in a follow-up letter that Price’s physician background would provide Trump’s Cabinet with a crucial perspective. 

The endorsement surprised many physicians, especially considering the AMA supported the passage of the ACA. However, that position has shifted slightly. As CEO and executive vice president Dr. James Madara wrote in a letter to Congress earlier this month, “Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time.”

Madara also said policymakers should lay out a detailed replacement plan before altering health care coverage. 

CAN’s founding members told HuffPost in December that they were critical of the AMA’s endorsement of Price. The AMA declined to comment on the CAN-NPA joint press conference against Price.

In addition to the AMA, Price has received endorsement from the American College of Emergency Physicians, the American Hospital Association, the Association of American Medical Colleges and the American Dental Association. 

Still, the 8,000 detractors who wrote to lawmakers indicate that the medical community is becoming increasingly splintered. 

“Fifty years ago, the American Medical Association was not only the voice of the whole medical community but it was among the most powerful lobbying groups in the United States,” said Michael Sparer, chair and professor of health policy and management at Columbia University’s Mailman School of Public Health.

“As the physician community has become more fragmented, it has lost the single voice that represents it,” he added. “In part, that’s what you’re seeing right now.”

Those divisions have a political element. The New York Times reported in October that two-thirds of surgeons, anesthesiologists and urologists are registered Republicans, but the majority of infectious disease specialists, psychiatrists and pediatricians are Democrats. 

While a newly politicized medical community might be outspoken regardless of the candidate being considered for health secretary, Price is an especially polarizing choice. In addition to earning a zero rating from Planned Parenthood and co-sponsoring two anti-choice abortion bills, Price has spoken out against value-based care that would pay doctors based on the quality of their work, a measure Republicans like House Speaker Paul Ryan (R-Wis.) have consistently supported.

“His positions are actually fairly extreme,” D’Aunno said.

This reporting is brought to you by HuffPost’s health and science platform, The Scope. Like us on Facebook and Twitter and tell us your story: scopestories@huffingtonpost.com.  

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We know there’s that pesky clause in the Constitution and all, but doesn’t it seem like today would have been more appropriate for Donald Trump’s inauguration? That’s our way of saying “Happy Friday the 13th” to everyone, we should point out. Ahem.

During certain periods of the year, we have been known to overuse sports metaphors when talking about politics. But our guess is that the favorite quotes to overuse for the next four years will be those from Lewis Carroll’s Alice In Wonderland and Through The Looking Glass. We were reminded of one of these while watching the week unfold, from a Trump press conference to the confirmation hearings to the Republicans smacking into reality on their “repeal and replace with nothing” dreams for Obamacare. Here’s the quote:

Alice laughed: “There’s no use trying,” she said; “one can’t believe impossible things.” “I daresay you haven’t had much practice,” said the Queen. “When I was younger, I always did it for half an hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”

Yep, it was that kind of week. Ben Carson got off the most amusing line of the entire week, in fact. While responding to a question from Senator Elizabeth Warren about whether he’d be sending Housing and Urban Development funds straight to Donald Trump’s pocket, Carson stated unequivocally: “It would not be my intention to do anything that would benefit any American.” Well, glad you cleared that one up, Dr. Ben! Nothing like setting the bar as low as humanly possible, eh?

The other laughable statement of the week came from a little-noticed hearing for James Comey, where he was asked whether the F.B.I. has investigated reported relationships between members of the Trump campaign and Russia. Comey hilariously responded: “I would never comment on investigations, whether we have one or not, in an open forum like this. So I really can’t answer it one way or another.” Senator Angus King pointed out the absurdity of this statement, given Comey’s recent history of doing precisely that (when the target was named Hillary Clinton): “The irony of your making that statement here, I cannot avoid.” Later in the week, the F.B.I. Inspector General announced that an investigation of Comey had begun, for his naked interference in the presidential campaign. About time ― although more than a little late. If this investigation had been opened immediately after Comey gave his first press conference on Clinton’s emails last summer, then his subsequent letter to Congress might never have been written, to put it bluntly.

The Republicans in Congress have notably become Wonderland characters on their own, as they flail about trying to square the circle on their plans for Obamacare. They’re doing a great imitation of the dog that caught the car, and didn’t know what to do with it, in fact. For those who haven’t had enough impossible things to ponder before breakfast, here’s a quick rundown of the irreconcilable Republican positions:
· Obamacare is universally bad ― there is nothing good or beneficial about it.
 
· Repealing Obamacare means a “rescue mission” for the country (Paul Ryan’s term).
 
· However, Republicans have no replacement ready, meaning that returning everything to the pre-Obamacare era is what is actually on the table at the moment.
 
· Obamacare actually saves the government lots of money.
 
· Republicans are against adding anything to the deficit.
 
· But repealing Obamacare is so important that they’ll agree to ten trillion dollars added to the national debt over the next decade.
 
· Also, tens of millions of people will lose insurance if Obamacare is repealed with no replacement.
 
· Meanwhile, Republicans are assuring those people who do get Obamacare benefits that they’ll be fine under the Republican plan ― the one that doesn’t exist ― even though Obamacare doesn’t benefit anybody at all, in their opinion.
That about sums up the quandary Republicans now face. Charles Dodgson might call it being trapped in circular logic. Congressional leaders are actually now getting pushback ― from fellow Republicans ― over “repeal and replace with nothing,” for two big reasons. First, the deficit hawks can actually see how repealing Obamacare is going to blow up the budget. Second, there are actually sane Republicans who realize a whole bunch of their own constituents are going to be left to die on the streets if their insurance disappears.

At the moment, Republicans are committed to coming up with a full replacement plan ― one that, according to Donald Trump, will be cheaper and better and won’t throw anybody off their insurance ― by January 27th. So it looks like it’ll be a busy couple of weeks, folks! The Patient Protection and Affordable Care Act took about a year and a half to pass Congress, but Republicans will replace it inside of two weeks ― despite coming up with absolutely nothing for the last seven years.

Not enough impossible things to believe? Here’s a former top aide to George W. Bush, outlining what Trump has promised to do immediately upon taking office:

On the first day of his presidency, Donald Trump will face a serious governing challenge of his own creation.

He has promised a tax cut that will, by one estimate, reduce federal revenue by $7 trillion over 10 years. He has promised an infrastructure initiative that may cost an additional trillion. He has promised to rebuild the military. He has effectively promised not to make changes in Social Security and Medicare. And he has promised to move swiftly toward a balanced federal budget.

Taken together, these things can’t be taken together. Trump has made a series of pledges that can’t be reconciled. If he knew this during the campaign, he is cynical. If he is only finding out now, he is benighted. In either case, something has to give.

And that’s without even mentioning the impossible Obamacare replacement goals!

Let’s see, what else is going on? Donald Trump infamously alluded to the size of his penis during a presidential debate, so it wasn’t all that surprising that he’d address reports of hiring Russian prostitutes to... um... “shower him with gold” (shall we say), during his press conference. Buckle up, America, we’re in for a seriously wild ride for the next four years....

Trump also made news this week by his continued bromance with Vladimir Putin, which is causing noise complaints from residents of Simi Valley, California ― because Ronald Reagan is whirling so fast in his grave that neighbors now require ear plugs to block out the din.

Trump appointed his son-in-law as senior advisor, and announced a not-blind-at-all trust for his holdings, which will be run by his two sons, Tweedledee Trump and Tweedledum Trump. This virtually assures that he will be in violation of the Constitution (the “emoluments clause”) starting on Day One. What could possibly go wrong with that arrangement?

One thing worth noting is that Donald Trump is likely going to enter office with the lowest public approval rating of any president since public opinion polling began. He is barely above an average of 40 percent approval (he’s actually below 40 in several polls), when even George W. Bush (right in the midst of all the Bush v. Gore fiasco) was polling around 60 percent approval just before taking office. Most presidents experience their highest public approval ratings of their entire presidency in their first week in office, it is worth mentioning. Maybe Trump will give Dubya and Richard Nixon a run for “lowest presidential approval rating of all time,” who knows? He’d have to sink into the low 20s before that happens, but at this point it seems a real possibility.

And we have to end with a story that got almost zero attention, because Fox strove to keep it so quiet. Seems that the network had to pay out yet another sexual harassment complaint settlement, this time to a woman who accused Bill O’Reilly of improper behavior. The letter sent by her attorney laid out what she’d be accusing O’Reilly of in a lawsuit, which “included details of unwanted propositions and harassing phone calls, during some of which O’Reilly apparently was masturbating.” We leave it as an exercise for the reader to come up with your own “no-spin zone” joke.

 

We’re just going to go with the obvious this week, and hand out two *Most Impressive Democrat Of The Week* awards, to President Barack Obama and Vice President Joe Biden.

Never have we appreciated them more than in their final days in office, especially considering who is about to replace them. Barack Obama gave a very moving and poignant farewell address (much more on that in the talking points section), and he surprised Biden with a Presidential Medal of Freedom this week, which gave Biden a chance to share the spotlight at the very end.

Barack Obama achieved some goals, fell short on others, but he was a decent man and a role model to the nation throughout his presidency. Donald Trump has had more scandals since he’s been elected (some might even say “in the past week”) than the Obama administration had for their entire eight years in office. That is a record to be proud of.

And even while all the cameras are turned to the Trump circus, Obama is still making historic changes on his way out the door. Getting rid of the “wet feet, dry feet” policy towards Cuban refugees was inevitable once Obama opened Cuba back up, but Obama made sure it happened before the next administration takes office.

Cuban immigrants will still get special status in America (from the 1966 Cuban Adjustment Act), which will take an act of Congress to change. But there is now no reason that Cubans entering the country should be treated any differently than people from any other country. Obama said in his statement: “Cuban nationals who attempt to enter the United States illegally... will be subject to removal.” They will be treated “the same way we treat migrants from other countries.” That’s only fair, at this point, and it’ll be tough for Trump to overturn a policy that gives certain undocumented immigrants a free pass, one assumes.

No matter what historians think of the rest of his legacy, Barack Obama will go down in history as the president who re-opened Cuba. That’s pretty impressive right there.

For all the good that they both have done, for never embarrassing the nation, and for moving American society forward in many ways, President Obama and Vice President Biden certainly deserve their swansong *Most Impressive Democrat Of The Week* awards. They both shall be missed, that much is certain.

[Congratulate President Barack Obama and Vice President Joe Biden via the official White House contact page, to let them both know you appreciate their efforts.]

 

We certainly were pretty disappointed with the confirmation hearings, since other than notably pointed questions by Senators Elizabeth Warren and Kamala Harris, there wasn’t a lot of grilling happening from Democrats on the committees.

But instead, coincidentally enough (on Friday the 13th), this week we have a whopping thirteen winners of the *Most Disappointing Democrat Of The Week* award. We’ll list them all at the end, but the most noticeable was unquestionably Senator Cory Booker, who has obvious plans to run for president next time around.

These 13 Senate Democrats all voted against allowing the importation of prescription drugs from Canada, which would save whoppingly huge sums of money. Twelve Republicans crossed the aisle in favor of this bill, but this was offset by the 13 Democrats who voted against it. Jezebel pointed out a funny coincidence about this group:

Between 2010 and 2016, a handful of the Democratic senators who voted “nay” were amongst the top Senate recipients funded by pharmaceutical companies: Sen. [Cory] Booker received $267,338; Sen. Patty Murray (D-WA) received $254,649; Robert Casey (D-PA) received $250,730; Michael Bennet (D-CO) received $222,000.

Funny how that works, isn’t it? Their stated opposition was because the bill “didn’t do enough to assure safety,” which is laughable ― this isn’t the Third World we’re talking about, the bill only would have allowed drugs in from Canada. Also, R. J. Eskow pointed out a contradiction to this stance:

But here’s the big question: If Booker and the other Democrats are so concerned about drug safety, why did they vote for the 21st Century Cures Act? Sold as a path to innovation, the bill was actually a massive giveaway to drug companies that wanted an end-run around safety regulations.

Again, strange how that works, isn’t it? These senators vote against safety when big Pharma tells them to, and for safety when that would negatively affect Pharma’s bottom line. Curiouser and curiouser!

Here’s the complete, shameful list of which Democrats care more about drug companies than consumers: Michael Bennet (Colorado), Cory Booker (New Jersey), Maria Cantwell (Washington), Tom Carper (Delaware), Bob Casey (Pennsylvania), Chris Coons (Delaware), Joe Donnelly (Indiana), Martin Heinrich (New Mexico), Heidi Heitkamp (North Dakota), Robert Menendez (New Jersey), Patty Murray (Washington), Jon Tester (Montana), and Mark Warner (Virginia). Looks like there are a lot of drug companies in New Jersey, Delaware, and Washington, from that list. For being corporate suckups rather than fighting for the little guy, all unlucky 13 get a *Most Disappointing Democrat Of The Week* award.

[Rather than provide everyone’s individual contact information, if your senator(s) are on that list, use the main Senate contact page to get his or her email, if you’d like to let them know what you think of their actions.]

 

*Volume 421* (1/13/17)

Today’s talking points section is being pre-empted by a review (with extended excerpts) of President Obama’s farewell address. It’s rather long, but although we’ve done these “analyze the speech” sorts of columns pretty regularly, we probably won’t be doing many for the next few years. So if you’re tired of the format, this’ll be the last one for a while, we promise.

Obama’s farewell address is already being compared to George Washington’s, not for oratory prowess, but for the similarities in the warnings given. Washington expounded on what he saw as the biggest danger to the nascent democracy ― political parties (or “factions,” as Washington called them). Barack Obama’s address was a number of things ― a review of his legacy and a big thank-you to the American public, among others ― but what made it notable were the warnings from Obama on partisanship and political polarization. Obama certainly got a face full of all that, pretty much from Day One, so he’s definitely given the matter some thought.

In any case, this is going to be long enough as is, so let’s just move on to the most notable (and quotable) parts of Obama’s final big speech. You can read the whole transcript if what follows isn’t enough for you (although since it’s the White House’s official website, who knows if this link will work next week or not). No editing of the text has been done in our excerpts, except for removing all the “(Applause)” indications (which make it harder to read).

 

*President Barack Obama’s Farewell Address*

President Obama started his speech out by giving a big shout-out to the people of Chicago (which, of course, the crowd loved), and then laid out his own definition of what it means to be an American:

This is where I learned that change only happens when ordinary people get involved and they get engaged, and they come together to demand it.

After eight years as your President, I still believe that. And it’s not just my belief. It’s the beating heart of our American idea ― our bold experiment in self-government. It’s the conviction that we are all created equal, endowed by our Creator with certain unalienable rights, among them life, liberty, and the pursuit of happiness. It’s the insistence that these rights, while self-evident, have never been self-executing; that We, the People, through the instrument of our democracy, can form a more perfect union.

. . .

So that’s what we mean when we say America is exceptional ― not that our nation has been flawless from the start, but that we have shown the capacity to change and make life better for those who follow. Yes, our progress has been uneven. The work of democracy has always been hard. It’s always been contentious. Sometimes it’s been bloody. For every two steps forward, it often feels we take one step back. But the long sweep of America has been defined by forward motion, a constant widening of our founding creed to embrace all and not just some.

If I had told you eight years ago that America would reverse a great recession, reboot our auto industry, and unleash the longest stretch of job creation in our history ― if I had told you that we would open up a new chapter with the Cuban people, shut down Iran’s nuclear weapons program without firing a shot, take out the mastermind of 9/11 ― if I had told you that we would win marriage equality, and secure the right to health insurance for another 20 million of our fellow citizens ― if I had told you all that, you might have said our sights were set a little too high. But that’s what we did. That’s what you did.

You were the change. You answered people’s hopes, and because of you, by almost every measure, America is a better, stronger place than it was when we started.

Obama then moved on to warning of the dangers he saw America facing right now and in the near future (this is par for the course for presidential farewell addresses, it’s worth mentioning):

That’s what I want to focus on tonight: The state of our democracy. Understand, democracy does not require uniformity. Our founders argued. They quarreled. Eventually they compromised. They expected us to do the same. But they knew that democracy does require a basic sense of solidarity ― the idea that for all our outward differences, we’re all in this together; that we rise or fall as one.

There have been moments throughout our history that threatens that solidarity. And the beginning of this century has been one of those times. A shrinking world, growing inequality; demographic change and the specter of terrorism ― these forces haven’t just tested our security and our prosperity, but are testing our democracy, as well. And how we meet these challenges to our democracy will determine our ability to educate our kids, and create good jobs, and protect our homeland. In other words, it will determine our future.

To begin with, our democracy won’t work without a sense that everyone has economic opportunity. And the good news is that today the economy is growing again. Wages, incomes, home values, and retirement accounts are all rising again. Poverty is falling again. The wealthy are paying a fairer share of taxes even as the stock market shatters records. The unemployment rate is near a 10-year low. The uninsured rate has never, ever been lower. Health care costs are rising at the slowest rate in 50 years. And I’ve said and I mean it ― if anyone can put together a plan that is demonstrably better than the improvements we’ve made to our health care system and that covers as many people at less cost, I will publicly support it.

Because that, after all, is why we serve. Not to score points or take credit, but to make people’s lives better.

Obama then moved on to address the state of race relations in America, first pointing out, “I’ve lived long enough to know that race relations are better than they were 10, or 20, or 30 years ago, no matter what some folks say,” which is undeniably true; then he moved on to challenge Americans to do better in the future, offering up some interesting specifics:

For blacks and other minority groups, it means tying our own very real struggles for justice to the challenges that a lot of people in this country face ― not only the refugee, or the immigrant, or the rural poor, or the transgender American, but also the middle-aged white guy who, from the outside, may seem like he’s got advantages, but has seen his world upended by economic and cultural and technological change. We have to pay attention, and listen.

For white Americans, it means acknowledging that the effects of slavery and Jim Crow didn’t suddenly vanish in the ‘60s ― that when minority groups voice discontent, they’re not just engaging in reverse racism or practicing political correctness. When they wage peaceful protest, they’re not demanding special treatment but the equal treatment that our Founders promised.

For native-born Americans, it means reminding ourselves that the stereotypes about immigrants today were said, almost word for word, about the Irish, and Italians, and Poles ― who it was said we’re going to destroy the fundamental character of America. And as it turned out, America wasn’t weakened by the presence of these newcomers; these newcomers embraced this nation’s creed, and this nation was strengthened.

Obama then admitted that we all are going to have to try harder, and pivoted to a more general point about the state of our politics:

And that’s not easy to do. For too many of us, it’s become safer to retreat into our own bubbles, whether in our neighborhoods or on college campuses, or places of worship, or especially our social media feeds, surrounded by people who look like us and share the same political outlook and never challenge our assumptions. The rise of naked partisanship, and increasing economic and regional stratification, the splintering of our media into a channel for every taste ― all this makes this great sorting seem natural, even inevitable. And increasingly, we become so secure in our bubbles that we start accepting only information, whether it’s true or not, that fits our opinions, instead of basing our opinions on the evidence that is out there.

And this trend represents a third threat to our democracy. But politics is a battle of ideas. That’s how our democracy was designed. In the course of a healthy debate, we prioritize different goals, and the different means of reaching them. But without some common baseline of facts, without a willingness to admit new information, and concede that your opponent might be making a fair point, and that science and reason matter ― then we’re going to keep talking past each other, and we’ll make common ground and compromise impossible.

Obama then thanked the military, called being Commander-in-Chief “the honor of my lifetime,” and offered advice that (while not mentioning him by name) seemed directed at the next man to lead our military:

But protecting our way of life, that’s not just the job of our military. Democracy can buckle when we give in to fear. So, just as we, as citizens, must remain vigilant against external aggression, we must guard against a weakening of the values that make us who we are.

And that’s why, for the past eight years, I’ve worked to put the fight against terrorism on a firmer legal footing. That’s why we’ve ended torture, worked to close Gitmo, reformed our laws governing surveillance to protect privacy and civil liberties. That’s why I reject discrimination against Muslim Americans, who are just as patriotic as we are.

. . .

So let’s be vigilant, but not afraid. ISIL will try to kill innocent people. But they cannot defeat America unless we betray our Constitution and our principles in the fight. Rivals like Russia or China cannot match our influence around the world ― unless we give up what we stand for ― and turn ourselves into just another big country that bullies smaller neighbors.

Obama then issued a call to action to all Americans:

Our Constitution is a remarkable, beautiful gift. But it’s really just a piece of parchment. It has no power on its own. We, the people, give it power. We, the people, give it meaning. With our participation, and with the choices that we make, and the alliances that we forge. Whether or not we stand up for our freedoms. Whether or not we respect and enforce the rule of law. That’s up to us. America is no fragile thing. But the gains of our long journey to freedom are not assured.

. . .

It falls to each of us to be those anxious, jealous guardians of our democracy; to embrace the joyous task we’ve been given to continually try to improve this great nation of ours. Because for all our outward differences, we, in fact, all share the same proud title, the most important office in a democracy: Citizen. Citizen.

So, you see, that’s what our democracy demands. It needs you. Not just when there’s an election, not just when your own narrow interest is at stake, but over the full span of a lifetime. If you’re tired of arguing with strangers on the Internet, try talking with one of them in real life. If something needs fixing, then lace up your shoes and do some organizing. If you’re disappointed by your elected officials, grab a clipboard, get some signatures, and run for office yourself. Show up. Dive in. Stay at it.

Obama then gave a heartfelt thank-you to the members of his family and to Joe Biden (Michelle Obama’s praise got the biggest applause of the entire night, it’s worth pointing out), before finishing on a very high note indeed:

I am asking you to hold fast to that faith written into our founding documents; that idea whispered by slaves and abolitionists; that spirit sung by immigrants and homesteaders and those who marched for justice; that creed reaffirmed by those who planted flags from foreign battlefields to the surface of the moon; a creed at the core of every American whose story is not yet written: Yes, we can. Yes, we did. Yes, we can.

One last endearing footnote from Obama’s final speech as president: at one point, even though constitutionally impossible, the crowd broke into a chant of “Four more years! Four more years!” It’s hard, at this point, not to sympathize with that sentiment. We’ll miss you, President Obama, probably faster than any of us thought.

 

Chris Weigant blogs at:

Follow Chris on Twitter: @ChrisWeigant

Full archives of FTP columns: FridayTalkingPoints.com

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-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 46 minutes ago.

The Centers for Medicare & Medicaid Services (CMS) is extending for six months its current moratoria on the Medicare, Medicaid, and Children's Health Insurance Program (CHIP) enrollment of new nonemergency ground ambulance suppliers and home health agencies (HHAs) in selected states, effective January 27, 2017. Reported by Mondaq 18 hours ago.

WASHINGTON (AP) — If you haven’t signed up for health insurance, you may soon be getting a not-too-subtle nudge from the taxman. The IRS is sending personalized letters to millions of taxpayers who might be uninsured, reminding them that they could be on the hook for hundreds of dollars in fines under the federal health […] Reported by Seattle Times 20 hours ago.

If you haven't signed up for health insurance, you may soon be getting a not-too-subtle nudge from the taxman. Reported by Newsmax 14 hours ago.

The Republicans are desperate to destroy Social Security and Medicare. These two programs demonstrate government at its best. The federal government runs these two extremely popular programs more efficiently, universally, securely, and effectively than the private sector does with its alternatives — or indeed could, no matter how well those private sector programs were designed.

Because Social Security and Medicare are government programs that work so well, the Republican elite — with its seemingly religious belief that the private sector is always the best — hates them. So obsessed are the Republicans in their desire to eliminate these effective government programs that the very first action that House Republicans took in the new Congress was to adopt a rules package that included a new rule that amounts to a stealth attack on Social Security and Medicare.

The rules package, adopted at the start of every new Congress, sets out how the chamber will operate for the next two years. This year’s package is already infamous for provisions in the initial version that would have gutted the Office of Congressional Ethics — provisions that were ultimately dropped after a massive outcry from the American people. Unnoticed by most was an additional provision, which is one part of the Republican game plan to destroy Social Security and Medicare.

Social Security — the people’s pension — and Medicare — the first step toward universal health insurance for all — do not go through the appropriations process because, as monthly pension payments and medical insurance, they must pay what is owed, not what Congress chooses to spend. If Social Security and Medicare were subject to the whims of every Congress, they would be radically transformed. No one could count on the benefits they had earned. Presumably with that goal in mind, the new rules require the relevant committees to make “recommendations for changes to existing law for moving [unspecified} programs…from mandatory funding to discretionary appropriations, where appropriate.”

Note the vague language. Republican politicians understand how popular Social Security and Medicare are. Yet they desperately want to destroy the programs, which put the lie to their anti-government agenda by illustrating clearly that there are some tasks that government does much better then the private sector.

The solution? Cut and radically transform Social Security and Medicare, but do it in a manner that avoids political accountability. Using changes in the arcane rules of the budget to force through subsequent cuts fits that bill perfectly. By the time the American people realize what’s happening, the rules that usher in the changes are in the past, and those voting for the cuts can claim that they have no choice, for budgetary reasons.

The rule that has been adopted was telegraphed shortly after the election when Representative Tom Price, Chairman of the House Budget Committee and Donald Trump’s nominee to be Secretary of Health and Human Services, proposed changes to the budget rules, which, if enacted, would end Social Security, Medicare, and Medicaid, as we know them. (As an aside, it is horrifying to know that, if confirmed, Price will be in direct control of Medicare and Medicaid, and will be a trustee of Social Security.)Not only are today’s Republicans obsessed, they are wily. Price, Speaker Paul Ryan, and their fellow Republicans have, unfortunately, learned from President George W. Bush’s failure to convince the American people to dismantle Social Security. Unpopular as the Bush proposal was, he traveled the country to convince the American people that they should support it.

In stark contrast, today’s Republicans want to avoid political accountability by destroying Social Security and Medicare without leaving clear fingerprints. They favor arcane budget rules and fast-tracked, undemocratic procedures so that the American people don’t know what is happening. We cannot let that happen.

It is essential that an energized electorate with heightened awareness makes noise at every turn. The next four years are perilous ones for Social Security and Medicare. But if they survive the unrelenting attacks, brighter times may well lie ahead. In the last few years, we’ve seen the Democratic Party, led by visionaries including Senators Bernie Sanders and Elizabeth Warren, unite around expanding, not cutting Social Security. Meanwhile, Republican politicians and elites have continued to support cutting benefits and ultimately destroying both programs.

Historically, Social Security and Medicare have been winning issues for Democrats. They can be now, as well. In addition to expanding, not cutting Social Security, Democrats should forcefully advocate expanding, not cutting, Medicare. Furthermore, Democrats should challenge Republicans when they claim the programs are in need of “saving.”

Republican claims that they are simply seeking to save Social Security and Medicare is the same Orwellian language used during the Vietnam War, when a military officer claimed that a village had to be destroyed in order to save it. Similarly, when today’s Republicans talk of “saving” Social Security and Medicare, their plans are to destroy both programs.

And when Republicans talk about “fixing” Social Security and Medicare, Democrats should point out that Republicans are using the word “fix” the same way veterinarians do, when they talk about neutering dogs and cats. The reality is that Social Security and Medicare don’t need fixing. They can and should be expanded, but they work fine, having stood the test of time.

And, most assuredly, neither Social Security nor Medicare need saving. Indeed, both programs are solutions to a looming retirement income crisis, a broken health care system, and income and wealth inequality. Expanding them would allow them to be even better solutions to these and other challenges facing the nation.

If Democrats are successful in making the American public aware that the Republicans desire to steal their earned Social Security and Medicare benefits, Social Security and Medicare could well be a potent issue in 2018, when seniors vote in disproportionately large numbers. If, in 2018 and 2020, seniors and others vote for progressives who champion expanding, not cutting, Social Security and Medicare, we will be in a position to expand these vital programs. Moreover, we will have elected champions of the environment, civil and human rights, and so many other important causes that those who support expanding Social Security and Medicare also support.

For that to happen, Democrats must be united in their fight against all Social Security and Medicare cuts and all stealth efforts to accomplish the same result indirectly. The Democratic Party must stand clearly and forcefully in favor of expanding, not cutting, Social Security and Medicare.

If the Democratic Party can draw a clear distinction on this vital issue, it can create a powerful wedge between the Republican elites and their base. If the base catches on and realizes who truly represents their economic interests, the next four years, difficult as they are going to be, will be followed by important progress for many years to come.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 8 hours ago.

Submitted by Chris Martenson via PeakProsperity.com,



Fair warning, my family just received a 61.5% increase in our healthcare insurance premium of 2017, on top of last year’s 24.8% increase, so I am quite annoyed at the moment.  For my non-US readers, perhaps what follows will interest you as a means of understanding how and why Donald Trump came to be elected President.  I am going to be channeling some of my inner crank today.



*If you want to understand why Trump won the recent US presidential election, you can't overlook the economic data. * If you do, his victory may look mighty confusing, alarming even.  But once you understand the degree to which the average US family and the entire Gen-X and Millennial generations are being completely hosed economically, everything starts to take shape.

As most struggling Americans can tell you, real household income has gone nowhere for more than 20 years:

This multi-decade burden of "running ever faster just to stay in the same place" is what led many US voters to reject Hillary Clinton, the establishment candidate, and instead roll the dice on the iconoclast promising to upend the system.

But if Trump's plan to “make America great again” means a return to the 1980s and 1990s when median real incomes climbed smartly, he’s not going to be able to pull that rabbit out of the hat, I’m afraid.  None of the conditions in place then are with us today including cheap, abundant energy (remember, oil was $10 a barrel in 1998); not to mention that we were riding the tailwinds produced by all of the gains from the early, explosive stage of the technology and internet revolutions.

Instead, we're at a stage where the pie is no longer expanding -- it's now a zero-sum game where those with power are using their advantage to continue to increase the size of their slice at the expense of the rest of us. The US now routinely subjects its citizens to racketeering, charging excessive prices that are increasingly cumbersome to avoid. One example among thousands; a Viagra pill that costs less than $1 in India, costs over $38 in the US:

(Source)

Cell phone plans in the US are 2x to 3x more expensive (and more limited in terms of both data and speed) than any of the other countries I’ve traveled to in the past few years.  A phone bill from AT&T in Hong Kong is a single page long and clearly explains how your unlimited high speed plan ended up costing you around $30/mo. In contrast, my bill from the same company in the US runs about 30 pages, and seems intentionally opaque in helping me understand why I'm spending over $100/mo for a limited data plan with much slower speeds.

There's no good reason for this except that in the US, companies have learned they can get away with predatory tactics by “wearing down” customers with gigantic, indecipherable billing statements.

This is pure racketeering. Your phone carrier is counting on your cable company to be running the same complexity scam.  Ditto especially for all of your insurance providers whom you just know, in your heart, you'll have to battle ferociously with for what you're owed should you ever need to really use that coverage.

And it's not just corporations; the government is in on the action, too. The US tax code is now over 74,600 pages in length, and the IRS cannot even get close to answering questions accurately.  Yet the citizen is on the hook for getting everything exactly right or else incurring stiff penalties, necessitating the use of expensive CPAs -- which is still no guarantee that an auditor's subjective judgment might go against you. 

*Fun fact: during the first 26 years of its existence, the US income tax code grew by 104 pages. Over the past 30 years, it has grown by 50,000 pages.*

While our politicians to expand the tax code, as far as I know nobody from any US government agency has been at all interested in the obvious price collusion displayed in this chart:

(Source)

Believe it or not, there are two price lines on this chart (one red, one blue) from supposedly independent companies who are allegedly competing with each other -- but most clearly are not. Humalog and Novalog are both manufactures of injectable insulin.

Insulin is an absolutely vital, non-substitutable necessity for people with diabetes and these companies saw fit to collude and jack up the prices over 1000% in ten years, from $25 a vial to over $250.

Why would two separate companies maintain the exact same price for their competing products for 20 years? I don’t have any other explanation except for collusion.

In any sane, rational and caring nation this wouldn't have happened. But under Bush, and then Obama, such predatory behavior went completely uninvestigated let alone punished. 

So it's no wonder then that so many people looked at the ‘status quo’ candidacy of Hillary Clinton and said No thanks.  Many families cannot afford more years of status quo predation by the unchecked rapaciousness of US cartels -- er, corporations -- and their government protectors.

Look, we all knew that the faux recovery seen over the past seven years had to end sometime, sooner or later. A “recovery”, mind you, that never actually happened except in the fantasy press releases of the government's statistical fabricators, lovingly reproduced by unquestioning “journalists” working for corporate entities harboring deep conflicts of interest.

But the “little people” (hereby defined as those occupying the bottom 95% of the socioeconomic ladder) have long known they've been getting screwed. Sadly, it's just getting worse.

*The Obamacare Disaster*

*Obamacare (a.k.a. the Affordable Care Act) is a disaster. We always knew it was going to be. Why? Because it represents the single largest give-away to the health insurance industry in our lifetime. *

Obama and the DC politicians crafted the Affordable Care Act as a monstrously large bill. And they failed to take on the biggest source of fat in the entire system: the healthcare insurance companies themselves. Of course, these companies have very well-funded lobbyists and  pushing back against them on would have required real leadership and possibly cost some political capital.  So they were left entirely alone, with all of the massive increases in healthcare premium costs left to be borne by “somebody” other than them.

Well that “somebody” has turned out to be pretty much everybody:



*Obamacare Benchmark Premiums to Rise 25% in Sharpest Jump Yet*

Oct 24, 2017

 

*Monthly premiums for benchmark silver-level plans are going up by an average of 25 percent in the 38 states* using the federal HealthCare.gov website, the U.S. Department of Health and Human Services said in a report today.

 

*Last year**, premiums* for the second-lowest-cost silver plans *went up by 7.5 percent* on average across 37 states.

(Source)



Now what’s both fascinating and part of the electorate anger is that the same government that forced Obamacare on everyone is also the same government that swears that health care inflation is running at only 2.5% to 3.5% per year over the past few years. Here are the governments numbers:

(Source)

I find myself wondering what country (or planet?) those numbers are for. Because for those who actually pay for their health insurance, the answer for sure isn't either "America" or "Earth".

*In total, US health care premiums have fully tripled since 1999.*

But for fun, using the government’s own CPI-Med data from the table above, if healthcare premiums had tracked the government’s stated rate of inflation between 2006 and 2015 then they would be some $2500 less today than they actually are:

People are angry because they are being lied to. Or more accurately: lied to while being robbed. 

Even worse, while the rate of health care inflation is being understated at the individual premium level shown above, it's also wildly understated in the larger inflation statistic used to level-set everything from cost-of-living adjustments (COLA) to pay raises across the country.

As explained in the Fuzzy Numbers chapter of The Crash Course, even though healthcare spending is nearly 18% of GDP, for some reason healthcare comprises only 5.85% of the CPI basket:



[C]urrently *CPI-MED accounts for 5.825% of the overall CPI*. Increases in the share of medical expense paid by individuals (as opposed to their insurers), will not affect CPI levels. 

(Source)



And:



*U.S. health care spending* grew 5.8 percent in 2015, reaching $3.2 trillion or $9,990 per person.  As a share of the nation's Gross Domestic Product, health spending *accounted for* *17.8 percent.*

(Source)



Does it make any sense to record something that's nearly 18% of GDP as only 5.8% of your inflationary experience? Nope, it sure doesn’t. Unless your desire is to mask the actual rate of inflation.

In simple terms, just healthcare's share of inflation alone comes to (0.25)*(0.18) = 4.5%.  That’s more than twice the rate of the supposed total inflation we are experiencing all by itself.  Throw in rising rents, car prices, and energy and it’s far more likely that an urban consumer is experiencing total price inflation closer to 6% or more per year.

Now, if you were a government bean-counter who want to mask the impact of a rapidly-rising factor within the nation’s inflation rate, presumably to blunt the statistical damage and make things look rosier than they actually are, all you need do is weight that item less in the basket used to calculate inflation.

For example, if the vegetables making up 18% of the cost of your shopping cart have gone up in price by a whopping 25%, that’s going to leave a mark. 

But what the government does is pretend that your shopping cart only has 6% vegetables, and is increasing at a much lower annual rate -- say 3.2%. Voila! Reported price inflation for carrots and celery is now much lower: (0.06)*(0.032) = 0.12%.

Even though you're forking out 4.5% more at the grocery counter, the government is loudly telling everyone you're only seeing an increase of 0.12% 

This is infuriating, of course. 

*Here’s what this looks like in chart form. Total inflation is being sold to us as low – "too low" and "dangerously low" even. *But I’ve helpfully included where the chart would show the total rate if were only what we're seeing with health care costs:

(Source)

Imagine how much higher it would be if we added in the actual inflation observed in other costly sectors like food, housing and education. Obviously there’s something desperately wrong going on here.

This is statistical lying and weaseling of the worst sort, which of course everyone can see through because it gets harder and harder each year to balance the family budget. If you're alarmed by fake news, perhaps you should be more alarmed by fake data, something the US government has perfected and continues to perpetuate. 

All of this is deeply unfair. And -- surprise! -- people really get annoyed when they're constantly lied to. Eventually their trust goes right out the window. Is it any wonder that a profoundly status quo candidate (HRC) could not sway the voters in rural America, where these trends and insults are even more acutely felt than in urban areas? The status quo is figuratively and literally killing these people. 

As mentioned earlier, my family's health care plan premium went up over 60% in cash costs alone this year. The rate of increase is an even larger when the plans' reduced benefits and increased deductibles are factored in. The out-of-pocket amount for my family will be pretty close to $30,000 this year before any insurance actually kicks in.

*In other words, I'm subsidizing somebody.*

*Unfortunately, that somebody is probably not a lower-income person up the street who badly needs coverage, but rather someone in the C-suite at one of the major heath companies. *

Check out the 2013 compensation packages for the CEOs of the major US health insureres.  They're truly breathtaking:

Maybe 2013 was a standout year, and is an errant data point.  Maybe things moderated in 2014? 

*Nope.  Everybody apparently deserved an even more massively large payout:*

You have to wonder how much care was denied to patients in order to afford those executive salaries.  It also bears mentioning, that some of these CEOs ‘earned’ more by 10:30 a.m. on the first day of 2014 than the median household did during that entire year.

Put a different way, in order to pay out the compensation for Stephen Hemsley, the United Health CEO for 2014, nearly 4,000 families had to pay the full $16,351 amount for healthcare that year.  In what sort of world should 4,000 families have to pay close to a third of their total income to a single individual simply for the pleasure of having health insurance?

Greedy doesn’t begin to cover what’s going on here. If ever there was any sort of 'social contract' between these companies and the public, it's now utterly broken by the rewarding their upper management with tens of millions of dollars – each! – and then jacking up healthcare premiums on families simply because they can.  And now, thanks to the "Affordable" Care Act, you can now be fined for not forking over whatever insane price increases the healthcare cartel decides to dream up from their government protected boardrooms.

Bizarrely, the healthcare insurance options in many states have been vastly reduced as carriers claiming losses, while massive premium increases have been justified also on the basis of losses and reduced profits. I say "bizarrely" because you’d imagine, being a regular person, that such losses should show up in actual profit declines for the insurers.

Nope:



*Making a killing under Obamacare: The ACA gets blamed for rising premiums, while insurance companies are reaping massive profits*

Oct 28, 2016

 

While Americans continue to be hammered by rising health care costs, and while congressional lawmakers (with their taxpayer-subsidized health care) do nothing to lower the cost of pharmaceuticals and medical care, *one group is reaping a windfall in profit: health insurance companies and their investors.*

 

On Thursday, *Aetna* reported $734 million in profit on $15.8 billion in revenue for the three months that ended Sept. 30. The nation’s third-largest health insurer by revenue *handily beat Wall Street estimates for the quarter.*

 

Aetna’s earnings report came a week after *UnitedHealth* reported a 12 percent jump in revenue to $46.3 billion for the three months that ended Sept. 30 compared with the same period the previous year. The company collected $36.1 billion in insurance premiums, a sum 11 percent higher than for the year-ago quarter, while *profits increased 29 percent* to $1.98 billion.

 

A Salon analysis of regulatory filings found that the top five health insurers — UnitedHealth, Anthem, Aetna, Humana and Cigna — have doled out nearly $30 billion in stock buybacks and dividends from 2013 to 2015. (The Supreme Court ruled in favor of the Affordable Care Act in 2012.)

(Source)



Similar strong results were noted for Humana in their last earnings release.  So how can it be that all these companies are both reporting the need for massively higher premiums while also booking higher and higher profits?

Well, when you live in a country that routinely subjects its citizens to racketeering, this is exactly the sort of disconnect you have to live with. They say one thing; but you see with your own eyes, or experience with your own wallet, something completely different.

*Conclusion*

Obama’s main failing in the ACA was in not going directly after the powerful insurance industry and forcing its players to participate in the reduction of waste, and sharing in the costs. Instead, they got more than a free pass: they got millions of new enrollees with the right to ‘withdraw’ from any markets and exchanges where they felt their massive profits might take a ding. 

And withdraw they did, with 2 million people losing their coverage for 2017 due to major carriers pulling out of state exchanges. 

Just looking at the cost of healthcare alone, we can detect massive fraud and deceit being foisted on the American public today. What emerges from these many rackets is a corrosion of the social contract.  In a word, these arrangements are abusive.  

The enormous pressures we see across the globe, with the rise of what the mainstream news outlets (aka “largest purveyors of fake news”) are trying to label as ‘nationalism,’ are really in large measure simply a reaction to the economic oxygen having been sucked away from the populace of various countries and delivered into the hands of a very tiny elite.

*Yes, that elite still controls the ‘news’ and therefore the narrative; but increasingly people are waking up and deciding for themselves that ‘something is wrong’. Not unlike a person slowly becoming aware that they have somehow fallen into and been the victim of an abusive relationship.*

Let me be clear: if we do not somehow find the courage and appropriate leadership to begin righting these wrongs, this trajectory ends in tears.  And it shouldn’t be up to a government body to have to regulate proper action; the insurance companies themselves should have nobody but themselves to blame if they fail to self-regulate. 

Ditto for every major corporation that is running various rackets using a combination of predatory pricing, overly complex practices, and regulatory capture to operate as a cartel. 

*If the elites don't manage to figure out how to contain their greed, then an angry electorate is just the beginning of their troubles.  Anybody seeking to understand the political landscape really just needs to spend a little time on the eroding prosperity of the bottom 99% over the past 20 years.*

In Part 2: How To Fix The Future we lay out how a critical movement is arising at this time in history. Each of us can assume a role to play in its formation and development, and therefore its eventual success or failure. It's my personal belief that we are past the time where we can avoid major disruption, so each of us must be personally prepared as best we can for upheaval, while also working towards building a new and better narrative to live by.

Do you have the courage to participate?

Click here to read Part 2 of this report (free executive summary, enrollment required for full access)

  Reported by Zero Hedge 6 hours ago.

**

*What's happening now*

Friday 5 p.m.: Congress has taken the first steps toward partial repeal of the Affordable Care Act (ACA), better known as Obamacare.

Republicans in both the House of Representatives and the Senate passed a resolution that begins the process of repealing President Obama's signature healthcare law.

The resolution directs members of relevant committees to draft a repeal bill through the budget-reconciliation process.

With dissent among Republicans over whether or not to complete the repeal process before a replacement plan is finalized and strident Democratic resistance to any repeal of the ACA, it appears that there is a significant fight ahead over the future of American healthcare, which could lead the process down the long, winding road to Trumpcare.

*Road to Trumpcare*

President-elect Donald Trump, along with Republican leaders in Congress, says he's committed to repealing and replacing Obamacare with something "terrific." Republicans have put forth a variety of different replacement plans, but it's unclear what the final version will look like. And the path to get to the implementation of a replacement could take many forms.

Imagine it's like a board game where there are a number of ways to get to a replacement. One is fast and efficient, another winding and full of obstacles. We call it "The Road to Trumpcare," and we'll be updating the game as Congress and the new administration make their moves.

The player in our game is a hypothetical Obamacare participant. We'll call her Martha. She's a 29-year-old from Tennessee and self-employed. Martha used the federal Healthcare.gov platform to sign up for her insurance two years ago and has been reenrolling every year; she receives some tax credits for her premiums since she makes roughly $45,000 a year.

While an overwhelming majority of Americans get their health insurance from employers or a government-based program like Medicare or Medicaid, Martha is one of more than 11.5 million people who signed up for an exchange-based plan for 2017. Over 80% of these people, according to the Department of Health and Human Services, also receive subsidies for their coverage.

Martha is a bit frustrated that there are fewer choices on the platform this year, and her premiums are increasing, but she is glad to have coverage because she has Crohn's disease, which could have excluded her from coverage before ACA.

To get a better understanding of what a repeal-and-replace could mean to someone such as Martha, here are the four major scenarios for how lawmakers can address or not address the future of Obamacare.

*The Replacement Superhighway*

The fastest and least disruptive path for Republicans to follow would be to repeal Obamacare and advance a replacement bill at the same time.

The GOP could use a procedure called budget reconciliation in the Senate to strip away most of the provisions of Obamacare, specifically those that cost the government money, without the need for a single Democrat vote. Then, simultaneously, Republicans would need to go through typical lawmaking to pass a replacement bill and create some sort of new exchanges.

House Speaker Ryan and Trump both seemed to favor this option. In fact, Ryan told CNN that some of the repeal and replace measures could be "in the same bill."

According to Cynthia Cox, associate director for the Program for the Study of Health Reform and Private Insurance at the nonpartisan health think tank Kaiser Family Foundation, this would be the ideal option for patients in the event of a repeal.

"This would provide both insurers and patients a clear picture of what's going to happen fairly quickly, which would prevent disruptions to the market," said Cox. "Though, a lot of this depends on the replacement bill that the Republicans come up with."

-What does this mean for Martha?-

This would likely be the least disruptive for Martha's coverage since it would ensure that there would be no period in which the exchanges that she uses are not funded or have no federal support. For one thing, as long as Martha reenrolls in her plan during the current Obamacare-enrollment period, she will have insurance through 2017.

A quick replacement could be in place for the 2018 plan year, and depending on what the replacement is, Martha may not notice any effect on her coverage at all.

-What could go wrong?-

A lot of this hinges on the details of the Republicans' plan. Since Martha receives subsidies to help cover the costs of her plan, a number of the replacement proposals floated by the GOP could affect how much she receives. Additionally, a number of plans would institute high-risk pools, which are separate markets reserved just for people with preexisting conditions. These existed before the ACA and generally had astronomically high costs and limited utilization.

The other issue is that any change to the law may be rejected by Democrats. If Republicans want to make any larger changes outside the budget process they would need Democrats on board. If the GOP advances a bill that changes coverage in some way or rolls back parts of the ACA that do not deal with the federal budget, Democrats may block a replacement using the filibuster. Additionally, if even a few Republicans in the Senate don't like the replacement, that could sidetrack the process. If the GOP moves ahead with the repeal while Democrats object to changes to the law, it could make the road that Martha is on even more winding.

*The long and winding road*

One of the first scenarios floated by Republicans was a partial repeal of the law under what is called budget reconciliation — delaying until a later date so that Republicans can craft a full replacement bill. This would pass a law that says the ACA will be repealed in the future, somewhere between two and four years, effectively delaying the end of the ACA.

In theory, this allows GOP lawmakers to advance the political goal of repeal while giving enough time to develop a comprehensive plan for replacement. The exchanges set up by Obamacare could be intact, meaning that the more than 20 million people with ACA-based plans would still be covered, while Republicans devise a plan that would replace the ACA and keep these people covered, as numerous GOP lawmakers have promised.

Since the delay aspect could stretch the replacement process out up to four years, this would allow the GOP time to build a consensus on a replacement. It would also be politically beneficial since it would push the repeal out past the 2018 midterms or 2020 presidential election.

Republicans could avoid political fallout if the replacement plan falls short of expectations, and they could build a larger majority in the Senate to pass the bill without worrying about a filibuster.

According to Cox, while the plan sounds good, there are a few problems that could arise with this strategy.

"Depending on the parts of the law that are repealed through the reconciliation process, you could see destabilization in the individual insurance market," Cox told Business Insider.

According to Cox, without an individual mandate for people to sign up for insurance, there would be significant numbers of younger people leaving the individual market, which would lead to a pool of even older and sicker people in the exchanges.

In a worst-case scenario, this would lead to a breakdown of the individual insurance market. Businesses hate uncertainty, so it is likely that with the exchanges' futures in doubt, insurance companies would simply pull out completely. Healthy policyholders could see the writing on the wall and not renew their policies, leaving only the sickest patients in the marketplace causing, as Cox called it, "a real death spiral," repeating the turn of phrase used by Republicans to describe Obamacare's growing issues.

Also, by leaving just the sickest Americans in these exchanges, premiums for those who remain behind would be much higher than the current increases.

"If the individual mandate were to be repealed without countermeasures, it would cause very large increases in the cost of premiums," Cox said. "These increases would make what we've seen in the market so far look small."

There are, of course, ways to mitigate this. For one, Republicans could extend and enhance certain measures, called reinsurance and risk corridors, which help to provide money for insurers that take on a higher percentage of sick patients. This would help decrease the large losses some insurers are reporting and possibly inspire more companies to offer plans on the exchanges.

Many GOP lawmakers, however, have referred to these provisions as "bailouts," so that may be politically untenable.

-What does this mean for Martha?-

This plan takes her down our game's long and winding road, full of stops and starts and pitfalls along with way. As debates over the repeal continue, Martha could be stuck in a car she has no control over, stalled out and awaiting updates about her coverage. The process could take years.

Republicans, through reconciliation, would have options to pull funding for the law in a few different ways while crafting a replacement. They could simply roll back the taxes associated with the law, they could also repeal the individual mandate that all people have to buy insurance, or they could pull all funding including subsidies people like Martha get or eliminate Medicaid expansion. All these would create a different level of disruption to the market.

In the best-case scenario for Martha, the individual mandate is maintained to ensure stability of the individual market until some other plan is proposed. While Martha doesn't see her premiums or deductibles shrink, nothing goes too awry. Also, lawmakers provide enough assurances to insurers that they stay in the market, preventing a monopoly-like situation in Martha's market and higher costs.

In the worst-case scenario, these four factors go the opposite way. Insurers, facing the uncertainty of the next two to four years, decide to exit the markets leaving Martha with just one or even no choices for coverage. With only a small penalty, people healthier than Martha leave the exchanges, which leads to an even sicker group of people being covered by the exchanges and higher prices for Martha. The "death spiral" predicted by GOP lawmakers for Obamacare truly does set in and prices shoot to astronomical levels, well above projections made before the passing of the law. Concerned that allowing a lapse in her coverage could cause her to be denied coverage in a replacement because of her preexisting condition, Martha sticks with the ever more expensive coverage

*The leave-as-is loop*

A third option for ACA changes would be to simply pass a few bills that make minor but needed adjustments to the law without a full-on repeal.

Democrats may be more amenable to this option. They have long pushed for reforms to the ACA, recognizing the increasing premium costs. Some ideas floated by Democrats have been to expand premium subsidies, strengthen the penalty for not enrolling, and provide more assistance to insurers that take on a larger number of sick patients.

This would leave a majority of the framework of the law — Medicaid expansion, the exchanges, and the statutory aspect — while providing tweaks to encourage younger, healthier people to sign up and balance the market.

Politically this may be tough for Republicans since they've made ACA repeal a talking point in elections for the better part of a decade, but if there were enough face-saving concession it could placate this worry.

-What does this mean for Martha?-

Essentially, Martha would see few changes in her healthcare. The exchanges would still be intact and all the provisions protecting her care would also be in place. There may be some positive changes, new provisions could bring down various costs, or another insurer may be available in her area, but not much else.

*The repeal-without-replacement cliff*

A final, though perhaps least likely option, would be for Republicans to simply repeal the bill and not worry about replacement.

After running against the bill for so long, the GOP could just repeal it and label it a disaster, making small changes along the way but not introducing a full-scale replacement.

This seems the least likely of the options, however, since Republicans have repeatedly said that they want to ensure continuing coverage and uphold the popular parts of Obamacare. Also, the political blowback from those losing coverage would be significant.

-What does this mean for Martha?-

Martha would likely lose any type of coverage come 2018 and be back to the pre-ACA world. She could try to access health insurance through the individual health insurance market, but with a preexisting condition there is no guarantee she could get access to coverage.

She could hope that her state implements a high-risk pool, where higher risk patients can get catastrophic insurance that covers the worst-case scenarios, but these plans are incredibly expensive and few people chose to access the pools when they did exist pre-ACA.

This, in many ways, would be the worst-case scenario for Martha.

*Democratic response*

In terms of direct action, there are few choices for Democrats to block moves on the law made by Republicans.

Obviously, unless there is a change to the rules, Senate Democrats could filibuster any statutory changes to the ACA. Outside of that, it appears that they simply have to influence the Republican agenda.

Perhaps most potent for Democrats would be to use Republicans' repeal against them. Some of the highest rates of utilization for ACA plans come from heavily Republican areas, and waging a public-relations campaign to get the conservative base to push back on any changes to the bill, the Democrats may have a way to get at least some of what they want.

Politico reported that many Democrats, while vehemently opposing a repeal of the ACA, would be willing to work with Republicans to find some way to keep various part of the law in a replacement bill.

"If it makes sense, I think there'll be a lot of Democrats who would be for it," Democratic Sen. Claire McCaskill told Politico.

Whether Democrats go along with a replacement may come down to the amount of influence they can exert over the law.

*An uncertain future*

For now Martha, in our game, is hurtling down the road in her car. She doesn't like the increasing costs but wants to keep her coverage.

What turns The Road to Trumpcare takes are, for now, unknown, but more than 20 million real Americans are waiting anxiously to find out.

*SEE ALSO: The House just took another major step toward repealing Obamacare*

Join the conversation about this story »

NOW WATCH: Here’s why airlines make you put your phone on ‘Airplane Mode’ Reported by Business Insider 16 hours ago.

Alec Baldwin stepped into Donald Trump’s shoes again for “Saturday Night Live” to present his own version of the president-elect’s recent press conference and talk about inauguration entertainment, golden showers and his sons, “Beavis” and “Butthead.”

Baldwin as Trump begins in the cold open with a serious warning: “Let me answer the question that’s on everyone’s mind: Yes this is real life, this is really happening. On January 20th, I, Donald J. Trump will become the 45th president of the United States. Then two months later Mike Pence will become the 46th.”

He says he’s excited to move into the White House, and will even have a “little” pet: Paul Ryan.


Just so we're clear. #SNL pic.twitter.com/I92cqGTBIL

— Saturday Night Live (@nbcsnl) January 15, 2017

“Who is excited for my Inauguration Day?” he asks. “We have got some of the biggest performers in the world lined up. Hold on to your tits and bits, because we have got Three Doors Down, Jackie What’s-her-face from “America’s Got Talent” and the one Rockette with the least money in her savings.” He also touts “huge A-List actors coming, like Angelina Jolie, Ryan Gosling and Jennifer Lawrence ... courtesy of Madame Tussauds” waxworks.


Trump on his inauguration line-up. #SNL pic.twitter.com/5vrij0OUUd

— Saturday Night Live (@nbcsnl) January 15, 2017

He then takes questions from “reporters,” but refuses to answer any “pee pee party” questions, referring to an unsubstantiated report of a “golden shower” sex fete in Russia, saying: “It didn’t happen and It wasn’t as cool as it sounds.” But he can’t quite steer away from golden shower images as he talks about his plan to bring a “thick stream of jobs” to the country. “This country will literally be showered with jobs. Because I’m a major wiz at jobs,” he gushes.

When a reporter tells him people “could die” if he eliminates Obamacare without a replacement, leaving 20 million people without health insurance, Baldwin’s Trump answers: “Listen, sweetheart, I’m about to be president. We’re all going to die.”

He also announces that he has “turned over all my business to my two sons, Beavis and Butthead.” Gesturing to SNL cast members Mikey Day and Alex Moffat, playing Donald Jr. and Eric, Baldwin adds: “Look at those two little American psychos.” He refuses to take a question from a reporter from the “failing pile of garbage” BuzzFeed or from “over-rated fake news” CNN, though insists repeatedly: “I respect the press.” 

The last question comes from shirtless Vladimir Putin look-alike Beck Bennett (claiming to be Wolf Blitzer) who asks Trump if he’s “very very sure” Russia hacked the American presidential election, while he holds up a small video labeled “pee pee tape.”

“It was China,” Baldwin responds. “No, it was Canada. OK, It was Meryl Streep.” He wraps it up with the sendoff: “Thanks for peeing here.”

Before the Trump skewering, “SNL” re-aired a 1978 episode featuring Carrie Fisher not long after she rocked the first “Star Wars” movie as Princess Leia. She opened the show dressed as Leia. Musical guests were the Blues Brothers: Dan Aykroyd and the late great John Belushi.


Tina Fey returned to 8H* with a special message for Felicity Jones. #SNL

*as a hologram pic.twitter.com/LqqSQrSpM2

— Saturday Night Live (@nbcsnl) January 15, 2017

Saturday night’s episode was hosted by “Rogue One” actress Felicity Jones, who was joined in the opening monologue by an ersatz “hologram” of Tina Fey as Princess Leia. Fey warned Jones: “No matter how the show goes, the president of the United States will say that it’s sad and overrated,” adding: “It’s fine, no one cares.”type=type=RelatedArticlesblockTitle=Related Coverage + articlesList=5876ac67e4b05b7a465db41c,585e8358e4b0d9a594587be9,58131d80e4b064e1b4b19b4c,58036193e4b0162c043c7692,5870d860e4b099cdb0fd66ad

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 14 hours ago.

U.S. Republican Senator Rand Paul said on Sunday that the Obamacare replacement bill he plans to unveil would get rid of some of the mandates for health insurance coverage with the aim of bringing down the cost of insurance.Speaking on the CNN program State of the Union, ... Reported by Newsmax 10 hours ago.

Popular resistance to the repeal of the Affordable Care Act has begun, with the first signal that Republicans could face major political repercussions coming from the large Denver suburb of Aurora, Colorado.  

Congressman Mike Coffman, a Republican who represents the swing district there, planned a small event at a library to meet with constituents. He expected just a handful of people, but 150 individuals showed up. Most of them, according to local media reports, were present to plead with him not to go forward with an Obamacare repeal without a suitable replacement in place.  

Coffman decided to let only four people into the room at a time, yielding images on social media that looked like this:


100 wait get into @RepMikeCoffman "town hall. Only 4 citizens allowed at a time. #cd6resist pic.twitter.com/8c7Q3OQXby

— Steve Krizman (@SteveKrizman) January 14, 2017

The local NBC 9 News report on the event was brutal for Coffman from start to finish, highlighting Berthie Ruoff, a breast cancer survivor who is worried she will be unable to buy insurance without the law’s protections.

“I’m going to potentially lose my health insurance. I’ve had a pre-existing condition, I’ve had breast cancer. What is going to happen to me?” she said with tears in her eyes. 

With the help of local police, who put up caution tape near a side entrance, Coffman left the building minutes before the town hall meeting was scheduled to end. 

“We were told at one point, everyone will get their time. And then he sneaks out six minutes early,” a woman at the meeting told NBC 9.

Coffman claimed in a statement to NBC 9 that he was limited by his reservation at the library.

“Unfortunately, we only reserved the room at the Aurora Central Library for 90 minutes, which is usually plenty of time to see everyone,” he said. “For those who were unable to see the congressman today, we apologize.”

Meanwhile, Coffman appears to be resolute in his commitment to repealing the landmark law. He penned an op-ed with the three other House Republicans from Colorado insisting that “full repeal” is the only way to solve the country’s health care problems. And the American Action Network, a conservative political action committee with ties to congressional GOP leadership, has announced it will spend $1.4 million on advertisements touting the Republicans’ plan to replace Obamacare in several Republican congressional districts, including Coffman’s. 

The problem for Republicans is that their main objections to the ACA ― that deductibles and premiums are too high and networks are too narrow ― can really only be solved by a combination of reducing the growth of costs and providing further subsidies for coverage. Republicans in general have shown little willingness to spend more to help people pay for health care, but have instead argued that rolling back insurance regulations and unleashing the free market will do the trick. Without significant subsidies, though, the industry has no way of covering those with pre-existing conditions, which Republicans have promised any replacement will do.  

President-elect Donald Trump has said that a replacement could come within hours of repeal, but as of yet, no replacement exists.

Many Republicans have also promised that people with pre-existing conditions, such as Berthie Ruoff, will still be able to purchase insurance once the law is overturned. But the ACA ended the past practice of discrimination based on medical history in part by enacting the individual mandate, which ensures that the insurance companies would get new customers to offset the cost of the sicker people it would have to cover. Republicans are dead set on repealing the individual mandate, which they view as government overreach.

The pushback in Aurora suggests Republicans may be in for a world of political pain as they push forward with repeal. It recalls a few other popular uprisings against Washington, all of them triggered by congressional efforts to make big changes to health care and entitlement programs. In the summer of 2009, hundreds of thousands of people swarmed town halls in opposition to Obamacare. In 2005, the nation loudly pushed back against GOP attempts to cut or privatize Social Security, contributing to the Democratic takeover of Congress in 2006. In 1993, when President Bill Clinton tried to rewrite the rules for the health care system, the insurance industry was able to exploit popular fears of change and scuttle the effort. The failure contributed to the GOP takeover of Congress in 1994.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 11 hours ago.

Supporters of the Affordable Care Act gathered to protest the health care law’s repeal in rallies across the country on Sunday.

The demonstrations were in response to an appeal by Democratic leaders in Congress for a day of action against ACA repeal, the defunding of Planned Parenthood and other policies promoted by the incoming Donald Trump administration.

Perhaps the highest-profile gathering was a rally at Macomb County Community College in Warren, Michigan, that drew thousands of people. Sens. Chuck Schumer (D-N.Y.), Debbie Stabenow (D-Mich.), Gary Peters (D-Mich.), Bernie Sanders (I-Vt.) and several other members of Congress addressed the large crowd that had waited in long lines in below-freezing weather to attend the event. Many who have received health insurance thanks to the ACA shared their emotional stories as well.When Sanders finally took the stage after his colleagues, the roar of the audience and chants of “Bernie, Bernie Bernie” made it clear that for many in the crowd, the Vermont senator was the main attraction. Sanders’ political action nonprofit, “Our Revolution,” live-streamed the event on YouTube and Facebook.

“This is the wealthiest country in the history of the world,” Sanders said. “It is time we got our national priorities right. The United States today and I hope everybody in America understands it: We are the only major country on Earth not to guarantee health care to all people as a right!”

True to his democratic socialist form, Sanders, who won an upset victory against Hillary Clinton in the Great Lakes State presidential primary, went beyond defending the ACA.

“So our job today is to defend the Affordable Care Act. Our job tomorrow is to create a Medicare-for-all, single-payer system,” he exhorted the crowd.

There were some 70 similar rallies across the country, according to Sanders. Photos on social media show significant crowds in Portland, Maine; Richmond, Virginia; Tampa, Florida; Boston, New York City and many other metropolises.


NYC ACA rally. Couple thousand people according to attending police. Where is everyone???? pic.twitter.com/4NXUy5M2GO

— Katy Keiffer (@kcorrigank) January 15, 2017


Here taking #OurFirstStand with my fellow Tampa citizens fighting for the 1.7M Floridians insured thanks to #ACA #savehealthcare pic.twitter.com/ETEATQCJeJ

— Sofía Aluma (@sofialuma) January 15, 2017


Burlington High School auditorium is PACKED for #OurFirstStand Rally with @RightsVT @OurRevolution @ppnne & many others! #vtpoli pic.twitter.com/P5iptkhgAT

— Dustin Tanner (@dtanner2194) January 15, 2017


The cold can't stop #OurFirstStand in Syracuse, NY. pic.twitter.com/vDFOtfiaqW

— Zachary Olsavicky (@zolsavicky) January 15, 2017


YUGE crowd in Portland, Maine at the #Medicare4All rally today. Crowd is chanting "I have a Dream! Universal healthcare!" #OurFirstStand pic.twitter.com/SXKZe8d7av

— NationalNursesUnited (@NationalNurses) January 15, 2017


Huge crowd in #Boston for rally against #ACARepeal, in support of #Obamacare with @SenWarren @EdMarkey @marty_walsh #bospoli #mapoli pic.twitter.com/f47QaRtl9Y

— Joyce Linehan (@ashmont) January 15, 2017


Folks in #RVA are FIRED UP for the #SaveHealthcare rally! pic.twitter.com/XP67VKJDML

— Virginia Democrats (@vademocrats) January 15, 2017

Other grassroots efforts suggest that the prospect of the ACA being repealed is finally mobilizing Democrats and their allies to take unified, concerted action.

The progressive organizations MoveOn.org, the Working Families Party and People’s Action reported that they were holding 500 “resist Trump” meetings on Sunday.

And on Saturday, over 100 people angry about ACA repeal packed Republican Rep. Mike Coffman’s constituent meeting in Aurora, Colorado. It was a scene that resembled past politically effective moments of protest, including the raucous anti-ACA town hall meetings in the summer of 2009.

Coffman only let people speak to him in groups of four at a time, then sneaked out a side entrance earlier than the event officially ended.

*Head over here to learn about protest events scheduled for inauguration day this Friday.*

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 7 hours ago.

St. Louis-based singer-songwriter Beth Bombara explains why it was difficult for self-employed musicians like her to obtain health insurance before the Affordable Care Act. Reported by NPR 5 hours ago.

Just eight super-rich men hold the same amount of wealth as the poorest half of the world’s population, according to an analysis from the charity Oxfam released Sunday night. 

Six of these billionaires, from Forbes’ list of the world’s richest people, are American entrepreneurs: Microsoft co-founder Bill Gates, Berkshire Hathaway chairman and CEO Warren Buffett, Amazon founder and CEO Jeff Bezos, Oracle co-founder Larry Ellison, former New York Mayor Michael Bloomberg and Facebook founder and CEO Mark Zuckerberg. Rounding out the list are Carlos Slim, the Mexican tycoon, and Amancio Ortega, the Spanish founder of a retail conglomerate that includes clothing chain Zara. Together their net wealth ― assets minus debts ― amounts to $426 billion.

We cannot name the bottom half of humanity, more than 3.6 billion people, with that kind of precision, but they mostly live in the developing world.

The Oxfam statistic is one of the starkest ways to portray the disturbing rise of economic inequality, which can be a hard concept to grasp when portrayed in percentages and billion-dollar denominations. The global anti-poverty group has been tracking inequality since 2014.

Worsening inequality threatens to upend the very fabric that’s held democracies together in the post-World War II global order. In the United States, the widening gulf between the rich and everyone else helped propel Donald Trump into office. Overseas, the trend is credited with sparking Brexit, the U.K.’s vote to leave the European Union.

“Left unchecked, growing inequality threatens to pull our societies apart,” Oxfam writes in its report, citing Brexit, Trump’s campaign and “a worrying rise in racism and the widespread disillusionment with mainstream politics.”

In 2016, the richest 1 percent of the world held slightly more than half of the wealth of the entire planet, Oxfam notes. And the 1,810 billionaires on Forbes’s list ― 89 percent male ― hold $6.5 trillion, as much wealth as 70 percent of humanity.

Put another way, billions of people are fighting over crumbs from half of a pie, while the rich dig into fat slices all to themselves.

For its analysis, Oxfam used Forbes’ ranking of global billionaires and wealth data from Credit Suisse. According to the wealth data, 80 percent of the bottom half of the world’s population are adults living in Africa and India. They’re younger and more likely to be single and poorly educated. Women who are poorly educated are even more likely to have very little wealth.


Growing inequality threatens to upend the very fabric that’s held democracies together in the post-World War II global order.

A very small sliver of the bottom half live in the United States, mainly because the wealth data looks at net wealth, subtracting the amount of debt a person has from assets. That means, for example, that young adults in the U.S. who have a big mortgage and maybe a car loan and a student loan will, on paper, seem poor.

Some economics writers, Felix Salmon of Fusion most prominently, have used this point to discount Oxfam’s report. It’s a fair criticIsm, Gawain Kripke, Oxfam’s director of policy and research*,* told The Huffington Post. But it’s a footnote, not a reason to dismiss the disturbing findings of the report, Kripke said.

If you ignore debt entirely, it would take 56 of the wealthiest individuals to equal the wealth of the bottom 50 percent, according to Oxfam’s report.

“The underlying trend is the same: At the very pinnacle of the economic pyramid, rich people are getting progressively and rapidly richer, while the rest of humanity is muddling along,” Kripke said. He called the wealth of the top eight individuals “biblical.”Last year, when Oxfam did its report, it took 62 billionaires to equal the bottom half of the world. The change this year seems drastic because of improvements in the quality of the data Credit Suisse was able to get. If Oxfam had used that improved data last year, it would’ve taken just 9 billionaires to reach parity with the world’s bottom half, Kripke said. (Number nine? Charles Koch.)

Partly driving last year’s growing divide was the booming stock market, which fed even more money to wealthy folks invested in the market. The rising value of the dollar also contributed.

Trump, whose political fortune has benefited from increasing economic dissatisfaction, ranks 324 on the Forbes billionaires list ― tied with “Star Wars” creator George Lucas. The president-elect has nominated the wealthiest group in American history to his Cabinet. Combined, these future public servants hold about $12 billion, according to a recent estimate from Bloomberg.

Neither Brexit nor Trump’s policy proposals ― tax cuts, relaxed regulations, renegotiated trade deals ― are viewed as offering a solution to the growing economic disparity.

The administration’s first major policy push ― repealing the Affordable Care Act ― would take health insurance and other health protections away from millions, while giving a tax cut to the richest Americans, HuffPost’s Jonathan Cohn reported recently. 

That’s a sure way to exacerbate income inequality.  

Rising inequality causes more than a sense of moral outrage and the election of reality TV stars. There’s a wide body of research that shows inequality adversely affects the health of those at the bottom, raising the risk of cardiovascular disease, increasing suicide rates and shortening lifespans. Some attribute the rise in the death rate of white people and the heroin epidemic to inequality.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 4 hours ago.

President Barack Obama has long said that perhaps the biggest and most unexpected obstacle of his presidency was the partisan gridlock and obstructionism imposed by Republicans in Congress.

But in his final network television interview that aired Sunday on CBS’s “60 Minutes,” Obama was candid about his own shortcomings, acknowledging that while he was effective at campaigning, he was not always a good messenger for his policies.

“This is on me. Part of the job description is also shaping public opinion. And we were very effective, and I was very effective, in shaping public opinion around my campaigns,” he said. “But there were big stretches, while governing, where even though we were doing the right thing, we weren’t able to mobilize public opinion firmly enough behind us to weaken the resolve of the Republicans to stop opposing us or to cooperate with us. And there were times during my presidency where I lost the PR battle.”One of those times was the passage of the Affordable Care Act, particularly the individual mandate. Republicans seized on it, relentlessly pledging to repeal the law.

Last week, with control of both chambers of Congress and an incoming Republican president, both the Senate and the House took initial steps toward Obamacare’s repeal, which would jeopardize health insurance coverage for over 20 million Americans.

President-elect Donald Trump said Wednesday that he intends to repeal and replace the law “essentially simultaneously ... on the same day or the same week, but probably the same day, could be the same hour.” However, Republicans have continually failed to present an alternative plan, and some GOP members of Congress are wary of repealing the law without a replacement.

Obama also struggled to convey the magnitude of his economic recovery policies. As HuffPost’s Sam Stein reported last year, residents in places such as Elkhart, Indiana, which received federal funding through Obama’s stimulus package, were unaware that they had benefited from his efforts.

Time will tell if his media-savvy, image-obsessed successor will be a better salesman of his policies. So far, Trump has been adept at promoting even the smallest victories, like convincing Carrier to keep about 800 jobs at its plant in Indiana, and often gives himself credit for things that he did not do.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 3 hours ago.

[...] — just like it was for hundreds who turned out at City Hall to protest President-elect Donald Trump’s pledge to undo the health care law — it was personal. Three years ago, the 40-year-old engineer lost his job and was paying for medical insurance out of his own pocket when he learned that his son had an immune system deficiency. The 2-year-old would need a bone marrow transplant as well pricey medication, and their insurance company didn’t want to go forward with coverage. [...] under President Obama’s signature legislation, which doesn’t allow insurers to drop customers because of pre-existing conditions, his son got the requisite surgery as well as the antirejection drugs that he takes to this day, Gonzales said. Almost 2,000 people, including such notables as recent Rock and Roll Hall of Fame inductee Joan Baez, rallied Sunday afternoon in Civic Center Plaza behind the benefits of the Affordable Care Act. Headlining Sunday’s show of speakers, House minority leader Nancy Pelosi, D-San Francisco, panned her Republican counterparts for acting to take away people’s health insurance. Premiums and co-payments for many of the newly insured are rising, and subsidies to help them are testing the budgets of states and the federal government, which are having to cough up more funding to insurance companies. The process of developing an alternative policy, as Republicans have promised, is complicated by the fact that popular parts of the Affordable Care Act are paid for by its less favorable components, like special taxes and a mandate that everyone must buy insurance. Reported by SFGate 3 hours ago.

The Sunday night jab was a reference to a recent intelligence briefing that raised questions about Trump's connections to Russian President Vladimir Putin. Donald Trump aide Reince Priebus (ryns PREE'-bus) tells ABC's "This Week" that the independent watchdog "ought to be careful because that person is becoming extremely political." Vice President-elect Mike Pence says it is "deeply disappointing" that civil rights icon John Lewis would question the legitimacy of Donald Trump's White House victory. In an interview with CBS' "Face the Nation" on Sunday, Pence said he respects "the sacrifice" the Georgia congressman made, but said that he is one of many people making "baseless assertions" that the president-elect's victory was illegitimate. Vice President-elect Mike Pence says both he and Donald Trump welcome the oversight work by Congress into reports of Russian interference in the 2016 presidential election. In an interview with CBS' "Face the Nation" on Sunday, Pence said the incoming administration believes there is "no evidence of impact on voting machines," adding that "Donald Trump won the election fair and square." Vice President-elect Mike Pence is calling the timing of a conversation between Donald Trump's national security adviser and the Russian ambassador to the U.S. "strictly coincidental." In an interview with CBS's "Face the Nation," Pence says retired Gen. Michael Flynn sent a text message to the Russian ambassador wishing him a Merry Christmas and offering his condolences for a recent Russian plane crash. Speaking on "Fox News Sunday," Pence also says the Trump presidential campaign had no contacts with the Russians ahead of the election. Sen. Rand Paul says that Rep. John Lewis' record as a civil rights icon shouldn't make him immune to criticism and debate. In an interview Sunday on CNN's "State of the Union," the Kentucky Republican addressed President-elect Donald Trump's recent accusati Reported by SeattlePI.com 2 hours ago.

Reported by SeekingAlpha 17 hours ago.

Medical treatment as good as that delivered in the U.S. and Canada... but at a fraction of the price. That’s a prime benefit in the four countries that top the healthcare category of the 2017 Annual Global Retirement Index, produced by the editors of InternationalLiving.com.

Baltimore, MD (PRWEB) January 16, 2017

One of the main concerns of anyone looking to retire overseas is the quality of healthcare. Is it possible to get medical treatment as good as what’s available in the U.S. and Canada? The answer in many places is…a resounding yes. Sometimes the care, in fact, is even better than what’s on offer at home, and at a more affordable price too.

The cost and quality of medical procedures overseas helped determine the score of each of the 24 countries in the healthcare category of International Living’s 2017 Global Retirement Index.

The four countries that top the healthcare category in the 2017 Global Retirement Index all feature the availability of clean, excellent hospitals, highly trained doctors, and very affordable care.

Malaysia

Malaysia has some of the best-trained doctors in Asia--and the majority of them were trained in the U.S., Australia, or the UK. All of them speak English too, and that takes a lot of the stress away from what can be an already stressful situation.

Western accreditation is also a vital component for confidence in undergoing foreign medical treatments. Numerous hospitals in Penang and Kuala Lumpur are among Southeast Asia’s first recipients of the United States’ prestigious Joint Commission International (JCI) certification. Seen as the gold standard for healthcare service providers around the world, Malaysia has no less than eight JCI-accredited hospitals.

The most popular areas of treatment across the board in Malaysia include cosmetic surgery, dental work, and dermatology. In 2016 Malaysia was visited by more than 1 million medical tourists from around the globe, a figure that is predicted to rise in 2017.

One can understand the values on offer when you consider that a hip replacement that typically costs $39,000 in the States can be had for $5,200 in Malaysia, for example.

Costa Rica

More than 40,000 Americans travel each year to Costa Rica to seek medical and dental treatment. These “medical tourists” have discovered that this little Central American country has high-quality healthcare available at a very low cost.

One American who recently traveled to Costa Rica as a medical tourist reported a saving of $15,000 for dental implants, even after paying for airfare and accommodation.

And expats who live in Costa Rica are able to take advantage of this benefit every day of the year, paying a fraction of what they did back home for doctor’s visits, surgeries, prescriptions, and any other care they need.

There are two medical systems in Costa Rica, both of which expats have access to.

First is the Caja Costarricense de Seguro Social, known as Caja for short. This is universal healthcare, provided and managed by the government. It’s available to citizens and legal residents, including foreigners with the retiree visa, for example.

There is also an extensive private medical system in Costa Rica, with doctors, clinics, and hospitals throughout the country.

Expats often can also use insurance, either international policies or those provided by Costa Rican companies. Most private hospitals have international patient departments to help arrange financial matters.

Often expats mix and match private and public medical care. They might see a private doctor and pay cash and then have their prescription filled in the Caja pharmacy for free. Or if a procedure is taking too long to schedule at a public clinic, they might go private.

Colombia

The World Health Organization (WHO) ranks Colombia’s healthcare system as number 22 out of the 191 countries they review. That is better than Canada, which ranks 30th, and better than the U.S. too, which ranks 37th.

There are many excellent hospitals and clinics located throughout Colombia that provide both general and specialized medical services. Half of the top 43 hospitals in Latin America are in Colombia (22 out of 43). The larger cities of Bogotá, Medellín, and Bucaramanga have hospitals that have received the Joint Commission International accreditation.

Any expat not over the age of 60 with a resident cédula (national ID card) can apply for the government health insurance EPS (Entidades Promotoras de Salud). Even if you have pre-existing conditions, you can be accepted into the plan. These conditions may be excluded for a short period of time—six months or so—but then will be covered in full. To participate in the program, retirees pay a premium equal to 12% of their income. Many expats report monthly premiums in the $70 to $85 range for a couple.

Private health insurance is an option for people over the age of 60 or as a supplemental plan to EPS public coverage. Coomeva, for example, offers a private health insurance plan for people up to the age of 85. Premiums will be significantly lower than what a couple would pay in the U.S. Of course they vary depending on the carrier choose, the level of coverage, and age and health at time of application.

And here again, the cost for medical procedures is much lower than what is typical in the States. In most cases, Americans are able to save 40% on healthcare in Colombia, and in many cases, even more.

“The daughter of an expat living in Salento has come to Colombia many times for extensive dental work and Lasik eye surgery on both eyes, which cost her around $1,000, instead of the $4,000 to $5,000 she would have paid in the States,” reports Nancy Kiernan, International Living’s Colombia correspondent.

Mexico

Thousands of Americans visit Mexico each year for medical treatment and dental care. The facilities, even in medium-sized cities, are top notch. And physicians have usually received at least some training in the U.S., Canada, or Europe. If not medical school, they receive ongoing training abroad. All the latest technology, techniques, and prescription medications are available in Mexico. And having major surgery or treatment for serious medical conditions is not a problem.

Expats also enjoy access to this top medical care, of course, and overall they can expect to pay about half—or less—of U.S. prices, including prices for prescription drugs.

Legal residents have access to two systems.

The government-run system operates clinics and hospitals throughout the country and most expats say it offers good basic care at a low price—with costs running to just a few hundred dollars per year.

Many expats also use private healthcare, for which they pay cash or use insurance. It is much cheaper than the U.S. For example, a visit to the doctor is about $30 to $40. For lab testing, expect to pay about a third of the U.S. cost.

To read more about the top four countries with the world’s best healthcare, see here: "4 Countries with the Best Healthcare in the World."

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For 36 years, InternationalLiving.com has been the leading authority for anyone looking for global retirement or relocation opportunities. Through its monthly magazine and related e-letters, extensive website, podcasts, online bookstore, and events held around the world, InternationalLiving.com provides information and services to help its readers live better, travel farther, have more fun, save more money, and find better business opportunities when they expand their world beyond their own shores. InternationalLiving.com has more than 200 correspondents traveling the globe, investigating the best opportunities for travel, retirement, real estate, and investment. Reported by PRWeb 17 hours ago.

Reported by CBS News 16 hours ago.