Pages

2017-03-20

Good Laptops for About $200: Windows 10, or Chromebook

by John S. James, March 2017

We found a surprisingly good value in an 11.6-inch Windows 10 laptop for $200, and after three weeks of use we are still impressed by what we got for the money. This laptop (ASUS E200HA) travels very well, so is good for working in coffeehouses or libraries, or for out-of-town travel (for home use you might want a larger screen, which of course is less portable).

But before buying Windows you might also consider the Chromebook - designed and programmed by Google but manufactured and sold by various other companies. Chromebooks can cost even less than $200, and are much easier than Windows to set up and use.

Trumpcare in Congress: Quick Overview Now

by John S. James, March 20

This week the House of "Representatives" may vote on the major Republican effort to repeal Obamacare, replacing it with what is increasingly called Trumpcare (though President Trump doesn't want his name on his own main project). The Congressional Budget Office (the most thorough and objective analyst of the plans) predicts that 14 million people will lose healthcare in the first year, rising 24 million by 2026, compared to not changing the law.

Despite strong oppositions by doctors, medical organizations, hospitals, and many others including Trump voters, Republicans are determined to push this through. They have a majority in the House (due to heavy gerrymandering and voter suppression) - and a small majority in the Senate (due to voter suppression but not gerrymandering, since the Senate's election districts are fixed at state borders).

Most or all of the Republican replacements for Obamacare will basically end Medicaid, the Federal program of medical care for the poor, who have no other way to get acceptable healthcare in most cases (federally qualified health centers could help in some areas, but without Medicaid their funding is uncertain - as is their ability to scale up fast enough to treat 14 million more patients next year). And for the middle class, the plans will increase healthcare costs for older individuals, and also increase costs in certain geographic areas (including some that voted heavily for Trump), based on hastily devised formulas. For healthy young people who are unlikely to need much medical care, costs will often decrease, especially in certain areas. Total Federal costs will decrease by many billions of dollars - which Trump already plans to give in tax cuts, mainly to very rich individuals and corporations. (The big war budget comes from huge cuts in other programs, including the National Institutes of Health and other scientific and medical research - when the U.S. already spends about as much for its military as all countries on Earth put together.)

Some Republican plans promise to protect those with pre-existing conditions, but whether and how this will work in practice is not clear. Tax credits under some plans will help middle-class persons pay for insurance or other healthcare expenses; but this will not help much in cases of serious illness if out-of-pocket expenses greatly exceed the person's total federal taxes for the year. U.S. medical care for serious conditions often costs hundreds of thousands of dollars.

If a bill passes the House and the Senate, Trump will almost certainly sign it into law.

When these changes will happen depends on the plan that is finally adopted. Some changes, including the end of the Medicaid entitlement, will likely take place immediately. (The entitlement, which exists now and has existed since President Johnson started Medicaid in the 1960s, means that Medicaid patients have a right to certain healthcare, so they will still get treated even if the program runs out of money; Congress is ultimately responsible for finding enough funds. Without the entitlement, patients' treatment can stop when money runs out for the year.)

The  Medicaid expansion (allowing persons under 65 and with incomes up to 133% of the Federal poverty level to get healthcare through the program - at 65 they become eligible for Medicare instead) may be phased out over several years - or much faster, depending on what replacement plan if any becomes law. (Federal Poverty Level is currently $12,060 for an individual, $16,240 for a family of 2, $20,420 for a family of 3, etc.; see http://www.healthcare.gov/glossary/federal-poverty-level-FPL/  - and multiply by 133% to get eligibility for Medicaid in the 31 states who's governors have accepted the expansion. But be aware that the whole program could go away.)

And what is NOT in the Republican plans? Any serious effort to reduce the greatly inflated costs of U.S. healthcare, except by kicking many millions of people out of medical care entirely. And of course single-payer is nowhere in sight; it could eliminate all sorts of gamesmanship, and endless paperwork and paperlesswork - ending most unnecessary surgeries,  tests, and other procedures, and allowing doctors to focus on providing medical care instead of justifying and processing reimbursements.

Last Week: Trumpcare Got Even Worse

Many "conservative" Republicans don't like Trumpcare, calling it "Obamacare lite." They don't like the concessions that Ryan and Trump made to reduce political opposition - such as saying that they will not allow insurance companies to reject people with pre-existing conditions, and phasing in the end of Medicaid over several years instead of much faster.

So Ryan and Trump sweetened the bill for conservatives by allowing a work requirement for able-bodied adults. The main effect will be dropping many people from Medicaid. It is unlikely to increase employment much, for many reasons - especially lack of jobs for those without special skills and experience, and millions of mostly minority citizens being made unemployable by police records that can hardly be avoided in many U.S. cities. And to the extent that the work requirement does increase employment, it will allow employers to reduce already unlivable wages for probably millions of people.

The other change being talked about is allowing states to get Federal Medicaid support (until it goes away) as a block grant instead of per Medicaid patient - in return for more "flexibility" in how states run their programs, and decide who gets treated and who does not.

Also, almost all complex federal laws have tricky wordings that deliver gifts to insider special interests - without the public, press, or most of Congress that votes for the law knowing what is going on. Keep an eye out for these. They could possibly even include attacks on MediCARE - which is ignored in the original Trumpcare, but some of the other Republican proposals for replacing Obamacare proposed changing Medicare as well. Conservative Republicans have never been happy with the three major entitlement programs, Social Security, Medicare, or Medicaid. They picked Medicaid to attack first for strategic reasons, because it is mostly (though not entirely) for the poor and lower-paid middle class.

For More Information

We are preparing an ongoing list of published articles with reliable information at the time of publication. Be aware that the situation changes very fast, often day to day, so older articles may no longer be correct.

2017-03-07

Secret Republican healthcare bill unleashed

A good place to start in understanding the Republican proposal to "replace" Obamacare, and also ultimately destroy Medicaid, is The New York Times editorial today, http://www.nytimes.com/2017/03/07/opinion/no-wonder-the-republicans-hid-the-health-bill.html. We are reading more articles and will publish an annotated list.

Three points the press is not covering enough:

(1) The Republican leadership plan released March 6, the ACHA, American Health Care Act  (not to be confused with the AHA, Affordable Care Act, which is Obamacare) is only a starting point. It will have major changes, almost certainly for the worse.

(2) The ACHA was not designed to work as a healthcare system. Instead it was designed as a political tradeoff between different Republican factions.

(3) All the pet theories and hobbyhorse ideas put together cannot reflect the complexity of the actual healthcare and financial situations of millions of people. All sorts of consequences that no one thought about will pop up.

2017-03-04

Drug prices: Problems in funding patient advocacy groups

New York Times, March 1: 

More Than 80 Percent of Patient Groups Accept Drug Industry Funds, Study Shows

http://www.nytimes.com/2017/03/01/health/patient-groups-drug-industry-money.html

"Nearly 'nine out of every 10 are taking money,' said Dr. Ezekiel J. Emanuel, an oncologist and vice provost at the University of Pennsylvania. He is one of the authors of the study, which looked at the top 104 nonprofit patient advocacy groups that reported more than $7.5 million in annual revenues for 2014. 'I think that is not well known — I think that is a shock.'"

Comment: If we want to build social capital that can help get abusive healthcare prices under control, it's not enough to say that most patient advocacy groups are bad. I've been involved in patient advocacy for 3 decades, and it's very difficult to get other  funding. People want to do advocacy, but for a serious commitment almost everyone needs at least a stipend to live on, and minimal computer etc. expenses. (Even the original Emanual article in the New England Journal of Medicine is behind a paywall - starting at $20 for 24-hour access, and you have to register just to see that price.)

Foundations are reluctant because they don't know the medical area, many won't consider individuals or new organizations, and most require 501(c)3 status, which doesn't allow much advocacy. Governments cannot help advocacy, of course. Individual donors will need to step up and help create new organizations to handle this.

Note: ACT UP Philadelphia is an all-volunteers organization that does not accept any drug company funding. Funding is difficult, but possible because this organization has been active for 30 years. We cannot build a whole movement that way.

2017-03-01

ACT UP testimony on housing needs of people with HIV in Philadelphia

Testimony by Max Ray-Riek
Member, ACT UP Philadelphia

Philadelphia is completing its first HOPWA needs assessment in 20 years. The quantitative portion of the assessment is not complete, but the qualitative portion has been released, and points to some very important themes that will be crucial to get right if we want to fight the many epidemics threatening Philadelphia’s public health, including HIV but also homelessness, drug and alcohol addiction, and mental illness.

In order to move forward, we need to build on the needs assessment to craft a comprehensive, city-wide plan for improving the public health of Philadelphia through ending homelessness, and the HOPWA needs assessment provides some clear next steps.

Solution Step 1: We need to coordinate care and services across multiple city departments and private agencies, through a centralized housing case management service. This needs to include centralizing data and maintaining a single master wait list in which people are automatically applied to any program for which they are eligible.

Federal best practices strongly recommend the housing hub model I am describing, but Philadelphia has challenges to overcome to get there.

2017-02-23

Tuesday with Toomey protests continue - office will move March 1

http://www.phillyvoice.com/attention-protesters-toomeys-philly-office-moving/

Below are pictures we took February 21 at Toomey's current office, 17th and JFK. The crowd has not diminished from two weeks ago. The group  will meet again at this location on February 28.

The new office, at the U.S. Customs House, 200 Chestnut St, is harder for most working people to get to on their lunch break. For news of the demos and their location, see https://www.facebook.com/events/1121627961279526/, or search for TuesdayswithToomey.

Republican Senator Toomey also conducted a fake Town Hall meeting totally controlled by the organizers - a conference call announced 90 minutes before it began, according the news article above.



2017-02-19

Resistance Recess events: important

https://www.resistancerecess.com/event/resist-recess/

"The week of February 18–26 is the first recess of the 115th Congress—time specifically set aside for members of Congress to meet with constituents and get the pulse of the communities they represent.

"This is the perfect time to raise our voices. We will show up at our elected officials' events, town halls, other public appearances, and even plan our own events, if they refuse to meet with us, to make it clear to those who represent us, as well as to the media, that tolerance of Trump's hurtful agenda is unacceptable and politically toxic. ..."