Thursday, November 25, 2010

Giving Thanks

Everyone Carries his own burden, but there are many who still bend over to give a helping hand;
To all helpers, we give thanks;

There are those who feed from the trough of politics, and each tries to catch others unaware of the tariffs;
To all taxpayers, they give thanks;

S/He who talks much about foolish things also crave much;
To all who give them audience, we give thanks;

For those who bear the burden of taxation and tariffs;
Let them know that the weight of governance rests on their shoulders and the state is forever thankful.
To these, let us be grateful.

Wednesday, November 24, 2010

Medical Loss Ratio and the Promise of Republicans to kill the Affordable Health Care Reform Law

The new health care reform law failed to receive the blessing of Republicans at its passage. If the issue of the medical loss ratio is now being debated, it is probably in hindsight for the Republicans who abstained from contributing any vote after the initial open floor congressional debate. The denial of commitment of the Republicans to the law is well known. The enormous potential payoff of the law for consumers is what is being challenged, if Republicans are able to repeal the law. History has shown that it takes more than verbal bravado to derail a good and well-intentioned law. Lawmakers who voted to pass the Health Care Reform Law and who are still in congress owe themselves the latitude to continue to stand tall for their beliefs. Democrats owe the nation an obligation to twat any effort of the Republicans to repeal or upstage well-intentioned provisions in the law.

Beginning in January 2011, insurance companies will be required to spend 80 to 85 percent of their premiums on health services and on activities aimed at improving the quality of care of individuals’ health. There are some questions regarding whether Health Insurance companies will exploit the ‘green washing’ loophole by counting marketing cost and ill-defined wellness programs as part of the 80-85% threshold of spending on medical care. Such debates are probably in line considering that insurance companies often attempt to exploit weaknesses in laws to their financial advantage. Health Insurance companies must expect to be challenged, if they delve into the gray area of 'MLR Shifting'; this is one loophole in the Affordable Health Care Law that needs to be filled. As written, the law expects any insurance company to spend premium amount of what they take in to improve the quality of health care. The blog today addresses the implication of Republicans’ repeal of the law in the context of the Medical Loss Ratio Provision of the Affordable Health Care Reform Law of 2010.

If Republicans are able to overturn the Health Reform Law of 2010, the public would not only be denied the commitment of a greater percentage of their premium in their personal care, a huge number of Americans will return to the status where they are prevented from getting more value for their health insurance spending. The premiums of medical subscribers may not decrease and yet insurance company will continue to deny justifiable claims just because the Republicans want to remain: “Mr. and Mrs. NO!” There is no more disservice that Republican can do to American Health Care System than to repeal the health care reform law. Health Insurance companies will continue to reclassify frivolous administrative expense as health care expenses and increase their fly-by-night magic to frustrate any investigation into their books with respect to fraud along the line of administrative costs in health care premiums.

To a large extent, insurance companies are not interested in Republicans repealing the law as many of them have spent millions in implementing part of the law that has gone into effect. Some have even created glossy handbooks informing customers of how they are going to implement some provisions of the law. What the insurance companies are interested in, are how to exploit loopholes in the law to their financial benefit. Contrarily, what consumers are interested in are acceptable health insurance business practices regarding the implementation of the provisions of the law, not the Republican's bandwagon of repealing the law. The law is here to stay, what we want is the rule of the road for acceptable insurance companies behavior regarding the implementation of the law. Consumers are essentially tired of double billing that continues to erode the ratio spent on patients' care relative to the premiums doled out to health insurance companies.

The provisions of the Medical Loss Ratio is designed to encourage health insurance companies to use existing premium outlay and capabilities to meet health care needs of patients who suffer recidivism in health care quality. Through various schemes of administrative costs management, insurance companies often divert higher ratio of premiums into administrative overhead; money that should have gone into improving quality of care for patients.

Before the passing of the Affordable Health Care Reform Law, doctors and patients complained about the abuse by insurance companies of patient's premiums without anyone listening to them. A higher than usual ratio of patients' premiums were allotted by Insurance companies to administrative costs, some of them very dubiously. Premiums continued to escalate without patients benefiting from the added costs. The higher premiums that insurance companies continued to charge hardly led to improvement in care for patients, instead they fattened the pockets of the insurance companies as they continued to deny genuine claim. The new health care reform law puts a break to this abuse and asks the insurance companies to justify the medical loss ratio distribution. This essentially is one of the best provisions in American Health Care Reform Law that Republicans want to revert, when they threaten to repeal the health care reform law.

The Medical Loss Ratio provision provides the foundation for discussion with health insurance companies on how they develop the sliding scale for administrative as against actual health care delivery costs from patient premiums. The provision calls for insurance executives to examine the following questions: 1) how much of patients' premiums is actually going into their care; 2) Where are insurance companies exceeding targets, and where are they falling short of expectations; 3) What are the main drivers of the rising administrative costs in health care and what are insurance companies doing to pull back the ever increasing ratio of premiums going into administrative costs; 4) what are the current and future critical challenges to quality of health care delivery as insurance companies and health delivery agencies attempt to meet the provisions of the new law; 5) what are the most critical concerns that doctors and specialists have regarding how they are being paid and how the health care needs of their patients are being met; 6) What should be insurance companies' short-term and long term Strategies in developing humane business goals that address the concerns of patients and their doctors regarding the care they deserve and offer; and 7)what has been the obstacles to achieving health insurance business goals as they attempt to manage a healthy medical loss ratio consequent to provisions of the Affordable Health Care Reform Law of 2010. Whether insurance companies are using a four box or another tool to remain pragmatic and responsive to the needs of the law is better left for time to tell. What consumers are looking forward to is an opportunity for the insurance companies to self-police their operations before the law courts are invited in for a more objective assessments of their efforts.

The effort to repeal the Affordable Health Care Reform Law of 2010 threatens not only the stability of the American Health Care System, but also, insurance companies' ability or arrangement to implement the current provisions of the law that has gone into effect. The insistent cries from Republicans that the US government has taken over the health care system is not only a disservice to the public, it is tantamount to a crocodile cry, specifically designed to derail and confuse insurance companies that are currently grappling with the issue of managing the provisions of the medical loss ratio dynamics. Imagine for a moment that Republicans are able to repeal the law, what would consumers who have questioned the huge ratio of their premiums that insurance companies have repeatedly diverted to administrative costs, benefit from this Republican's Shenanigan?

How would Republicans convince the public that their effort is being made in good faith, especially when some of the insurance companies' frivolous schemes and programs classified as administrative costs have been determined as frivolous and downright ridiculous by consumers and the courts? Would Republicans like to be on record for being the stumbling block before the quality of health care that Americans receive in hospitals? A repeal of the law will demonstrate once again what one of the congressman from Florida, Alan Grayson (D), once said in the heat of the debate over the health care reform bill, the Republicans Health Care Plan is: Don‘t get sick, and if you do get sick, die quickly!

Thursday, November 18, 2010

Congressional Hearing on Climate Change: Do we now have to negotiate with Republican majority come January?

The argument against climate change is hardly convincing: Republicans want us to believe that it makes little difference and are working hard to bring before congress men who will take up their position or do their dirty job. As congress goes into hearing this week, there are evidence that information to be shared with committees will only bolster the argument that there is nothing like climate change; and, if there is, the cost to change direction is too high at this time for the nation. Talks of the health of the economy being impacted by solutions to correct climate change influences are disconcerting as some well known politicians are advancing the argument: do no harm in a period of economic slump!

Climate change is real and there is preponderance of scientific evidence to prove that, even though there is this acrimony regarding tainted data from University of East Anglia, England. Ocean seafarer will inform you of the dwindling marine fisheries and other ocean resources due to changes in Ocean current, a problem that can only occur from changes in currents and climatic imbalance or inconsistencies. The changes in the climate have impacted marine biodiversity, species of animals and plants that were easily harvested in the past; the fishes and shrimps are no longer here. Until recent decades, it was still possible to harvest huge tonnage of seafood at depths that are not as high as what fishermen have to contend with nowadays. Given the complicated issue of environmental pollution from oil spill and its probable impact on the ocean currents, it is still possible to convince many people in the marine business, that the movement of offshore waters and current is due largely to the problem of climate change. Justifying every nit-picky argument from skeptics of climate change may not be entirely possible, but it is safe to say that from what mariners and seafarers are experiencing at sea, it is not just the same as in the past; and, hardly can you convince these marine gofers that other reasons may be adduced to the new experience. Mariners know the sea and understand the climate and how it can impact their operations and exploits!

No one should under estimate the challenges that climate change is already creating and will continue to create in the future on the balance of sea, ocean, land, air and ozone layer stability. The uniqueness of the Arctic Circle and ocean floor currents have shown some convincing evidence that the challenge that climate change may create will be more costly, if we do nothing. We cannot wait for the doomsday before reacting. Mariners and gofers want something done, even if the public are still dragging their feet. Take it this way: if indeed there is no need for alarm, or to worry about the impact of climate change, and the nation still puts in place some corrective measures, we have very little to lose. Now, if we disregard the scientific evidence showing there is cost to bear for doing nothing about climate change, and we actually refuse to do something, then there is probably hell to be paid.

Since Republicans are now in the majority, we understand where the direction of the debate over climate change is heading. The Republicans maintain an askance attitude towards the argument of evidence of climate change. Leading scientists in the field of climatology have indicated that there is evidence there is climate change and the nation needs to address this concern. Some scientists are apprehensive of giving in to the argument that climate change is generally not good for the economy, the environment and weather. The latter group argues that nature takes its course to make corrections during imbalances and data collected over the years indicate that there are some corrective measures that set in whenever there is an imbalance in the whole world climate. The problem with that argument though, is that, in the absence of mans effort to chart its future, nature will automatically take control, and accommodate the zillions of industrial and chemical pollution that is being pumped into the air through human activities. Sadly enough, the advanced economies of the world, contribute more to the ozone layer pollution than the developing countries. Thus, to refrain from taking action is tantamount to accepting failure or that man cannot correct for his errors or mistakes.

When it comes to designing public policies to correct for the problems of climate change, there is clear disconnect between what Republicans profess and what they actually do. While a few of them are open to conviction that there are real problems with climate change, many are rigid, totally against any effort to correct for probable problems that climate change may wroth on the people and the economy. The rigidity of not accepting that there is need to work on corrective measure(s)to address climate change effect has prevented any movement in public policy to explore the “what ifs” dimension in the argument of climate change. If still apprehensive, take it from a mariner, the global ocean space is changing, ocean resources aren’t where they used to be and we aren’t waiting for no politician to tell us what experience has shown to be true!

How can those of us convinced that there is need to address the problem of climate change at this time, rather than wait any longer? How can Democrats in congress advance argument un-behalf of convicted climate change gurus? The integrity of scientists presenting data in support of climate change is hardly in doubt; what is in doubt, is the conviction of Republicans who are skeptical about the whole idea of climate change and would rather gloss over its impending problems. The task this morning is how, do we negotiate with Republicans in congress, assuming negotiations are appropriate to afford for inching steps in congress to put in place public policies that will begin to address problems that many scientists agree is a potential nightmare for the nation’s weather and economy and probably, the world.

The first and the most obvious question for the congressional hearings this week on climate change is whether there is a need to address the potential impact of climate change on the nation's economy; and, if it is appropriate to start looking at workable solutions during an economic slump? Scientists want us to set aside our political affiliations or nuances and take decisive steps to address the potential problems of climate change and the difficulty it may create, even for the economy as we speak. Mariners want congress to take steps to critically evaluate what is being said. The distinction between what is supposedly to be true and what is beholden to Republican majority are not the same. If it appears that the current argument that climate change is now on us and it is impacting many things around us, including the ocean current, weather systems and other known issues at sea, it appears rational that something has to be done to implement corrective measures, else the doubts will precipitates into fears surrounding what climate change can wroth on our seafood source. The difference between political ideology and the reality around us may be difficult to decipher, but men and women at sea, see things that inhabitant of land try to rationalize away!

Rather than debating climate change on the basis of ideology and political affiliation or the fear of what corrective actions may have on the slow economy, why don’t we let thinkers and scientists lead us in the right path on what obviously many politicians are ignorant about. After all, it is science and scientific thinkers that have brought our nation this far and will do in the future. There have been very few politicians that are scientists; and vice versa. Moreover, many scientists shy away from politics because they often see things, including the issue of climate change, objectively from what concrete data is telling them. Many scientists and the public at large are frustrated from the ideological argument from politicians that we must not do anything now regarding climate change. No one is contending that our economy is still in the dumps; however, solution to climate change from the heavy pollution and destruction of the environment, including untenable ideological fights by Republicans are generally not in the interest of the nation.

Thus as congress debate the issue of climate change this week, may representation not be ideologically inspired! Please let those scientists who understand what they are saying lead the nation in finding solution to climate change. The multifaceted argument that climate change is hardly an issue when our economy is tethering is radically inspired. Let the real world data, experiences from seafarers and demonstrated changes at sea that many mariners can attest to, help the politicians see the light. Although politicians tend to portray themselves as knowing what is good for the public in public policy formation, with respect to climate change mariners are saying: something ain’t right at sea and we know our waters are warmer than in the past; and, we want our representatives to do something about it!

Wednesday, November 10, 2010

Unmasking the lies in Republican's Promise to repeal the health care reform law?

Republicans are in the majority in congress come January 2011 and are determined to repeal the Affordable Health Care Reform Law of 2010. The tea party faction of the Republicans party has played a critical role in allowing Republicans to gain more representatives in the house of congress. In 1994, a similar wave of unconscious determination to shift the power structure from Democrats to Republicans took place. If I can recall, it was a similar mid-term congressional election results in favor of Republicans that embolden the party stalwarts to foster their crescendo of the contract with America.

After a short romance with victory, the Republican majority found out that it was easier said than done, when it comes to legislating with purported mandate. New congressmen eventually find out that, all the assumption about how Washington works and how best to wield power, get tempered by the reality of the arrangement in congressional committees and the influence of lobbyists. So, while the Tea party is a darling of the Republican Party, their new membership can hardly confer the right to make or shake the status quo the way they envisaged during election, except those long-time Republicans, who have been in the house, allow them. What does this actually mean? This blog today will attempt to shed some light on the true arrangement of power politics in American congress.

Newcomer Republicans in the House come 2011, who are promising to repeal the Affordable Health Care Reform Law, will eventually realize that lobbyists and government officials, including the senior Republican lawmakers who are beholding to a thousand and one interest groups, are not always distinct population. Today’s unseated centrist Republicans and Blue dog Democrats are tomorrow’s lobbyists. The revolving door-transformation of government officials and dethroned lawmakers into lobbyists and lobbyists into government officials and future lawmakers, make it practically impossible to repeal many laws once passed, including the Health Care Reform law. Here is a recipe of what the bravado of the new Republican lawmakers, especially those tea party favorites, have stacked against them as documented by Marion NestlĂ©’s 2003 award winning book on food politics:

In 1968, for example, at least 23 former senators and 90 former representatives had registered as lobbyist for private organizations. More recently, among congressional representatives defeated in 1992 election, 40% became lobbyists. So did their staff; from 1988 to 1993, 42% of Senate committee staff directors and 34% of those on the House side became lobbyists. By 1998, 128 former members of Congress were listed as lobbyist – 12% of all senators and representatives who had left office since 1970 (pp. 99-100)

What does this observation mean? Well, if you are in doubt, lobbyists and former congressional staffers and lawmakers fashion bills that are passed into laws. Before a bill appears before a congressional committee, lobbyists and former lawmakers have sliced and diced it and by the time it gets to the desk of the President, nearly all and sundry would have had some input. This is why the initial laws in all instances are a hodge-podge of ideas and recommendations that has to be amended or straightened out by supplementary amendments. Hardly are theses laws repealed; and when they are, not usually in the totality that the old timing Republicans have been pronouncing and encouraging the new tea party rank and file to believe. Guaranteeing the repeal of the health care reform law is an illusion, one that no new lawmaker must romanticized with, unless he or she wants to be disappointed.

The Revolving door issue has practically crippled the process of lawmaking in American Congress. I can mention a litany of names, past and present in today’s politics that have benefitted from the revolving door syndrome and who will vehemently tell you, it is just impossible to eradicate. The lobbyist groups, think tanks and Non-profit organizations in Washington DC determine which laws are made, signed into law, amended or repealed; not the new tea party faction republican lawmaker that is dreaming to bring about change to congress! When new lawmakers go to Washington promising to make a change, they are either frustrated out or discouraged from making a difference by the existing parameters of exchange of expertise between industry representatives and tax-payers’ financed public officials.

The dilemma posed by the revolving door issue has often made that change sought by new lawmakers impractical. Lobbyists exert so much influence over public policies and legislation and make it difficult for the people’s representatives to triumph in the first few years they go to congress. It often takes more than three terms of return to congress before new lawmakers can rise in rank to be able to have some influence on laws passed, or bills in the pipe line for amendment. Republicans can lay groundwork for gridlock until 2012 Presidential election, hoping to defeat President Obama and then moving forward to repeal the health care law, but this is a long shot! They may use parliamentary oversight to cut money from implementing the remaining parts of the law; however, it is a gamble that can easily backfire in light of the provisions in the law: 1) creation of 20,000 Primary Health care Physicians training and jobs; 2) provisions to help low income pregnant women quit smoking; 3) raised threshold for itemized medical expense deduction of adjusted gross income from 7.5 to 10% for regular income tax purposes; 4) enhances incentives for adopting children with special needs and creates avenues for adoption assistance exclusions with adoption refundable credits in yearly tax filing through 2011; 5) require that non-profit hospitals conduct periodic community health needs assessments and adopt a written financial assistance policies; 6) creates a new two-year temporary tax-credit to encourage investments in new health care therapies for tax years beginning in 2009 and 2010; 6) eliminates the deduction for subsidy for employers that maintain prescription drug coverage for retirees who are eligible for Medicare Part D, starting in 2013; and 7) codifies the economic substance doctrine, among others. Can anyone imagine that these and more are what Republicans are clamoring to repeal?

Never mind Republican John Boehner’s promise of a common-sense health care reform that he is touting to 1) let families and businesses buy insurance across state lines; 2) all individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do; 3) give states the tools to create their innovative reforms that lower health care costs; and 4) end junk lawsuits that contribute to higher care costs by increasing the test and procedures that physicians sometimes order not because they thinks it’s good medicine, but because they are afraid of being sued. All these are gimmicks designed to play to the Tea Party state’s right bandwagon. All of these promises had been deliberated over in the past three decades and Republicans had even attempted to craft some of these provisions under a Republican majority in congress that never went anywhere or far. These promises from Boehner are the worst lies and improbable that is being sold to novices who hardly understand the wait game in American politics.

Americans cannot wait for a reformed health care system and the 2010 Affordable Health Care Law is the first step towards this goal. The Republicans want to take us back to where we were in the past that has hardly made health care delivery efficient or people centric. To defer to these lulitunes is to take the country backwards and keep our health care system in the destructive limbo it has been over the years. That is why we must, all concerned Americans, stand up for our health rights. No more promises, no more gimmicks, no more delayed service deliveries and no more Medicare fraud in favor of Republican’s financiers.

Sunday, November 7, 2010

Making the Health Care Reform Legislation Work for all of us!

When you look at the best health care legislation passed in this country in the last half a century, you're probably looking at the result of hours of hard work and debate from the two aisle of congress. Never mind the bandwagon of 'born-again' Republicans bent on undoing the Affordable Health Care Legislation of 2010. The process of developing and passing the legislation went through groundwork and feedback by both Republicans and Democrats in the past congressional sessions; even though Republicans will continue to complain they were completely shut-out in the deliberations. The fact that Republicans abstained from supporting the health care reform legislation in the current congressional session has very little to do with the quality of the provisions of the legislation.

One of the real reasons why Republicans are at war with the legislation has very little to do with the cost, although Republicans want the whole nation to believe so. If you ask me, it has to do with pure politics. This nation and past congressional sessions with Republican majority have spent triple the amount set aside for implementing the health care reform package on wars. Despite the fact that the new law is going to help raise over twenty-eight billion dollars over a ten year scoring period, a targeted revenue to help offset the overall cost of the reform package. Republicans are still not satisfied; however, in consonant and collaboration with the military industrial complex they are willing to sacrifice or kill human beings with tax payers’ money.

Republicans are hardly interested in healing the sick and underprivileged amongst us, but are very ready to send them to war without the necessary ammunition to protect life. Republicans are unwilling to subscribe to a law that asks everyone to sacrifice a little to allow many to be covered under a health care insurance package that is paid for within the huge costs cuts that have been worked into the provision. Republicans have supported supplementary funding for the continuation of two wars that have mostly benefited their sponsors and supporters financially; yet, they are unwilling to subscribe to a law that extends the employer provided health insurance coverage to adult children of taxpayers under the age of 27 or dependent children up to the age of 26.

Now here is the part that makes you wonder why on earth are Republicans so disinterested in legislation that once, their senior members, mostly drafted in sessions that Republicans were in the congressional majority? The truth is Republicans are pretty smart in not wanting to give credit where credit is due. Democrats, under a majority in both congressional chambers and White house saw it fit to work proactively in the interest of ordinary Americans, to pass the health care law. Republicans abstained from ensuring that their voices are heard in the debates leading to the passing of the law. What Republicans offered as their contribution was the usual criticisms that gave no life to the legislation nor constructively offered reasonable changes that could make it palatable to their critical interests: their political war chest contributors.

One of the common criticisms of the legislation is that it compels Americans to buy health care insurance. As creative as this criticism is, Republican forgot that there is a trade-off to bring 44 million people into the fold of the insured. If we had failed in this trade-off, this same group would have continued seeking emergency care in the already overtaxed hospital emergency rooms all over the country. Americans, who do not carry health care insurance, continue to overburden hospital emergency rooms at the expense of everyone, including Republicans who criticize the new health care reform package. Short of covering the total cost of many of these free loaders on the system, the new health care law ensures that at least many of these Americans are able to buy a health care insurance policy, even though at a subsidy, and are able to share in part of the cost of care they have sought at no cost over the years. This does not seem to be a financial give away. When you hear Republicans label the Affordable health care reform law of 2010 as 'Socialistic Medicine' or 'Obama care', they are obviously engaging in deception or mischief. Who of those millionaires populating the Republican Party has offered to pay for the care of the millions that obviously could not pay for their health care cost, but overburden hospital emergency rooms? You are probably going to hear, the American Capitalism is everyone for himself or herself and God for us all. In one short sentence: who cares?

Well, in a representative Democracy, one which America has vowed to pursue and one that this nation has committed innocent lives and trillions of dollars in spreading all over the world, there is the inalienable rights to life, liberty and the pursuit of happiness. The last word in that maitre is happiness! How can anyone be happy with a health care system with a lopsided cost and burden to the public, yet denies access to 44 million Americans who will inform you that they had no alternative, but to seek emergency room care, that by law cannot be denied due to the nature of health care as a product. Many of the past customers of the hospital emergency rooms are documented as carrying no health insurance policy at the point of demand for health care service. The new law just allows these groups of people to participate and still pay some, unlike in the past.

If there are parts of the Affordable Health care Law that are imperfect; yes, let’s work on amending or improving them to be fairer to all, but not junking the whole law. If the objective of Republicans is to repeal the law as they have announced since their newly found majority, they sure got some new things coming. In Republicans new quest to discredit Democrats and the first African American President, the Republicans want to use the unfair political arrangement, one that is heavily stacked against minorities and the underprivileged, to advance their selfish interest of overturning a legitimate law. If this new pronouncement from Republicans is allowed unchecked, then we do not have a democracy. What we have is a killing field for the poor and underprivileged and a caviar table of all assortment of care that the rich can afford without batting an eye. What a Democracy this will be!

To create a health care system that is not wasteful and discriminatory against the poor and underprivileged, we cannot abrogate the 2010 Affordable Health Care Law. We can work to improve its provisions by amending or reordering some of its mandates; but, we cannot throw the baby with the bath away and think we are doing anyone any good. Yes, Republicans have been able to improve their fortunes in terms of representation in congress through the mercy of the extreme right in our society, however; that hardly gives them the right to destroy probably the best thing that has ever happened to America's Health Care System since Medicare.

The litany of the provisions of the health care package is indisputable. The Health Care Reform Law provides coverage for many Americans in high risk professions: $11,840 for individual and $30,950 for family coverage; with Non Medicare retires in the age group of 55+ being offered a policy at a higher premium threshold. The latter group being amongst the category of America's emergency room repeat visitors, because of their vulnerability, including the inability to pay for insurance coverage and institutional racism or class-ism. If we return back to the old status quo as fanned over the airwaves by Republicans since the November election victory, we are saying these groups of high risk under-insured or uninsured are not worthy of any coverage and should be excluded. If we exclude them and these people continue not to carry health insurance, they will still continue to overwhelm our limited hospital emergency rooms.

The health care reform law provides adjustments to policy with higher premium costs based on participants’ age and or gender. When a 45 year old is covered under an employer provided policy covering major medical service in excess of say a value of $40,000, there are some tax benefits for the employer. The $40,000 family insurance coverage is subject to excise tax in the amount of $10,270.28; a threshold that is hardly overburdening to the employer or employee. The employer is able to report $10,270.28 as taxable to the insurer on the W2 form and the money is paid to the IRS. Since Republicans are first to fight against taxation and their benefactor in the last election are so 'taxed enough already' obviously, there is a room here for their bro-ha-ha! This complaint however does not prevent Americans in need of health care, flocking to the emergency rooms to seek care. In addition, this arrangement makes a mockery of all the effort Obama's Presidency has devoted its time in the past two years.

The 2010 Affordable Health Care Law demands that businesses report general transactions greater than six hundred dollars to the IRS during a year to corporate and non-corporate providers. This seems very logical as we are all attempting to go paperless; therefore the complaint that this requirement will overburden providers and business with paperwork is hardly tenable. Computer use generate less paper work and no business will deny in this age that it has not made payment online or received payment from same source likewise.

For the 'tea party' faction in the Republican party, who are so much against any more taxes, anymore government in our business, and any more regulation to allow for a level playing field for all, the reporting of employer-provided health insurance on W2 is not just acceptable; neither is the annual nondeductible fees on pharmaceutical manufactures and importers plus health insurance providers, tenable. However, none of them will ever deny that they had no clue as to what to do when the economy tanked at the latter end of Bush's Administration. For them, the delayed implementation of excise tax from 2013 to 2018 in the health care reform package, to give time for implementation and realization of cost savings, is a tongue in the chick. Hardly will they appreciate the redistribution of annual fees for pharmaceutical and drug importing firms; or the imposition of 10% on qualified indoor tanning services, being part of the necessary reform to the health care system. What these people must however realize is that we are all in this huge boat and it is leaking good people into the ocean of grief because they cannot afford to carry health care insurance; a convoluted misfortune that we will have to pay for in the long run.