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Obama ACA subsidies to go directly to the people through Health Savings Accounts proposed by Republican Senators Graham, Scott and Cassidy in 2017, and again in 2025, and not to Insurance companies. In a post on his social media site DJT tells Congress that the ACA subsidies given directly to people rather than money sucking insurance companies would lead to a better result of people getting their own and better coverage for less money than under Obama type subsidies sent to insurance companies.  Much of Obamacare was done under a campaign from insurance companies and other health vested interests that undermined the original objectives so that however good the original objectives the watered down, disincentivising of reducing unproductive costs, led to a hotch potch band aid result. A common sense approach with the courage to get the right result that works for the people of the Nation to get good health care similar to Japan and other nations in Europe at reasonable cost is not a goal that an advanced nation like the US should see as unreachable or beyond our efforts, skills and wisdom. Obama and Bush failed, Bush in a major error to remove the negotiating power of government Medicare agency with pharmaceutical companies that Democrats failed to push back. ...

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How ACA a company that provided bond insurance for Collaterized Debt Obligation or CDO's basically did not provide good insurance to the CDO issuers becase it did not have the financial resources necessary to do this but instead let banks and investment houses to benefit from the accounting rules in the insurance industry which allow another set of accounting rules different from GAAP (Geerally Accepted Accounting Principles). Under these rules banks and investment houses did not have to follow the mark to market rules of GAAP and could book the difference between interest payments and the insurance premium across the life of the bond (5-10 years), in the quarter they bough the insurance, what were essentially illusory profits. Merill Lynch issued a lot of these CDO's. In November 2007 ACA was forced to take $1 billion in losses for the third quarter. Standard and Poors downgraded ACA from A to CCC a month later. The downgrade forced ACA to come up with more collateral to show that it had the funds to back up its insurance. When it came short of funds Merrill Lynch, UBS, CIBC had to take big losses on these policies. This began the first big shocks on the Street at te end of 2007. Note that $43 billion in securities backed by risky corporate loans and bonds like the ones used for a lot of the buyouts have insurance from ACA. These could be the next to sour and lead to more writedowns as the economy weakens. ...

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The US Senate filibuster rule that requires 60 votes for the budget to pass is a relic of the civil rights days, today it prevents Republicans from ending the shutdown by majority vote. Republicans used it when Democrats controlled the House and Senate and Senate Majority Leader Thune does not want to drop the filibuster as it acts to ensure no hasty legislation or budget is passed without some form of overall consensus. It also means that situations such as a government shutdown can happen when the opposition party in the Senate uses it to make it demands be met. In this case Democrats Schumer and Jeffries are asking Republicans to include money for subsidies for the Obama Affordable Care Act enrollees- about 22 million people signed up for this part of the ACA to receive generous subsidies for healthcare. These subsidies are not part of the Big Beautiful Bill of DJT that passed Congress and was signed into law. Unions and airline executives are calling on Democrats to end the shutdown as it disrupts air traffic at airports, and leads to cuts in SNAP and other benefits, and to lack of pay checks for government employees. ...

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Controversy about the American Heart Association's support for Vytorin use, saying the Enhance study was too limited and patients not discontinue use of Vytorin. House Commerce committee to investigate lack of disclosure of ties of AHA to Vytorin makers. AHA receives $2 million from Merck and the joint venture that makes Vytorin. In the absence of Vytorin patients, can get Zocor in generic form for $6 for 30 days supply. Is Vytorin, if its not any better, a clever way of marketing a combination of Zocor and Zetia and touting its effectiveness over Zocor alone with a much higher price?

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Business Week's Michael Lewis has some serious questions and a message for investment bank Goldman. His questions- ACA was incompetent which is why it was chosen as CDO (collaterized debt obligation) manager. ACA was chosen by Goldman precisely because it did not know what it was doing and lost $900 million in the process. So too IKB, the dull witted German bank which lost $150 million. Goldman did not lose $100 million on the Abacus deal because Goldman was shorting the subprime market by March 2007 the time of the Abacus deal. Knowing this requires transparency of all dealings of Goldman's proprietary trading desk to understand real losses. Fab Tourre, the 27 year old Frenchman, is just a kid in this game. The real name behind this is Jonathan Egol. Who is this guy who clearly knew the subprime market was doomed in 2006 in remarks he made at the time.

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New Hampshire is known from poet Robert Frost's days to chart out its own path. It did so yesterday in typical Robert Frost ways- "Two roads diverged in a wood and I- I took the road less traveled by, And that has made all the difference." Fettterman of Pennsylvania Masto of Nevada, Shaheen of New Hampshire and King of Maine all Senators who helped get 8 Senators to vote with Republicans on ending shutdown Nov 10, 2025. Tim Kaine of Virginia was pulled in because of the 300,000 federal workers in Virginia that are his constituents for whom he felt a special responsibility and negotiated with Republicans to reverse layoffs, get back pay. This may be a key achievement of Time Kaine that is truly bipartisan. New Yorkers Schumer and Jeffries not having a federal workforce to worry about had no such responsibility and led the effort against a compromise. Masto says she saw long lines in northern Nevada for food pantry that she had not seen since Covid. Maggie Hassan joined King and Shaheen from their part of Maine-New Hampshire, and Masto was able to pull in Jacky Rosen of Nevada. All these senators are not up for reelection next year and Dick Durbin is retiring next year. As an experienced leader of Democrats Durbin might have felt that the Schumer-Jeffries demand on ACA subsidies was only going to hurt Americans who needed help, that 40 days of shutdown was accomplishing little. ...

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With a shortage of nurses and healthcare workers, some hospitals are dropping the vaccine mandate for healthcare workers. Shortages existed before the pandemic. The burnout for healthcare workers led to people dropping out. The lure of high pay has also led to nurses to travel to hot spots further crimping supply of workers. Recently workers who do not want ot get vaccinated have quit the industry or lost their jobs, some have left for facilities that do not follow the vaccine requirement. CDC estimates 30% of healthcare workers at 2000 hospitals in the US are unvaccinated as of September 2021. The Biden vaccine mandate would be effective for second shots by Jan. 4. A federal judge in Louisiana has ruled in Nov. questioning the president's authority for a vaccine mandate. Following that ruling HCA, AdventHealth, Tenet, Cleveland Clinic are among the hospital chains reversing earlier decisions for vaccine mandate. Other hospital chains in California Kaiser Permanante and in New York Northwell Health have kept the vaccine mandate. Kaiser had 98% staff vaccinated, with a similar situation at Northwell. Kaiser has 210,000 employees and Northwell 77,000. Utah Mountain also has 98% vaccinated.  Research on vaccine mandates suggests them to be effective. U Penn psychology research shows people are more likely to get encouraged to get vaccine than discouraged with a vaccine mandate not vaccinated working in healthcare in September will shrink considerably by January. ...

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Weigel of the Washington Post compares how the Affordable Care Act was passed in Congress in 2012 with the push by Speaker Ryan and the Trump administration for the American Health Care Act in 2017. Republicans he says are making the same mistake as Democrats by rushing this through Congress. There is no broad consensus on whether all Americans should be entitled to health care as in Europe and Japan for their citizens, and health care is priced in a way to make it expensive for the state to provide- until the twin problems are solved by creating a new culture in the U.S. that sees things differently, politicians will come up with their own plans based on their interests and which groups they serve.

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This story in the NYT describes how the flawed effort to pass the Republican healthcare bill or repeal the Affordable Care Act passed under president Obama failed after another effort. Many developments killed it. In the end the president lost interest, especially when he saw Republican Senator Rand Paul of Kentucky go on talk shows on the weekend before its collapse to complain about the bill. Senator Collins of Maine was exasperated by the way the bill was being rushed through Congress, and she voiced her strong opinions about this by talking to people back home in Maine and sharing her conversations with the media. The bill pushed by Senator McConnell, the Republican leader in the Senate, imposed annual caps on Medicaid spending. And did this without any discussion, shutting out committee debate, any public discussion, or formal drafting. Once this process was set in motion in this way the Republican Senators formed camps. Senator Grassley of Iowa and Jerry Moran of Kansas, normally conservative moved to the moderate side. Moran held a town hall meeting covered in the NYT, where older people voiced their concerns. Most of the patient advocacy groups, the hospital groups such as the American Hospital Association, and other medical groups also opposed it.  After Senator McCain of Arizona said he could not return following a surgery in Phoenix, Senators Lee and Moran announced their opposition. With this the bill's support crumbled including any effort to repeal the Affordable Care Act.  ...

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Congressional Budget Office analysis that shows 14 million more people uninsured in 2018 under the Republican House health care plan, this increases to 24 million by 2026.

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The Congressional Budget Office analysis of the Republican House health Care bill shows 24 million Americans would lose health insurance over 10 years. In terms of budget savings the bill saves $337 billion over 10 years. The increase in uninsured comes from the roll back of expansion of Medicaid under the House plan, the reduction of tax credits, plus the removing of income based credits replacing it with tax credits based on age. President Trump is promoting the bill saying it will reduce the premiums that have gone up since Affordable Care Act was passed and increase competition. House Speaker Ryan in promoting his plan says he is not in "some coverage beauty contest." The House Plan says Ryan, does not mandate that all be covered, but simply says coverage is in a free market giving people the option to buy insurance that they want, so that the numbers of insured would not be as many as under a mandate.

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The Washington Post survey of 1200 readers on how the Republican healthcare plan of Speaker Ryan and the House of Representatives looks to them, how it affects them in their lives. Here Somasekhar of the Post gives the stories of 5 Americans. Some see the prospect of losing their insurance under the Republican plan even as they reach an older age, others a smaller segment says the Post, whose premiums jumped under the Affordable Care Act say they faced high premiums and high deductibles. The Post says the large majority of opinions have expressed anxiety over the proposed Republican Ryan House plan for healthcare. One of them is an uninsured poor farmer, Mr. Woosley,  income about $18000 who gained benefit from expanded Medicaid under the Affordable Care Act,  one Mr. Smith, 32 years, a personal injury attorney who faces paying $10,000 if he did not take insurance and $10,000 if he took insurance because of high premiums so a wash either way deciding to do without it, one a tech worker Mrs. Powers, 62 years, income $22,000 on year and $4000 the next, from middle class during the tech boom but facing fewer opportunities and uncertain income from part time work, hit by the deep recession facing fewer opportunities as she gets older and now the prospect of losing insurance without government subsidies, one who is from the middle class who sees little benefit from the Affordable Care Act and is forgoing insurance because of the high premiums yet faces a penalty for not being insured under the ACA, another Mr. Blanchard, 52 years, is from the middle class, a computer programmer who lost his job in downsizing, earns $100,000 as a consultant self-employed, pays $767 in premium a month and relies on the Affordable Care Act which helps him gain freedom from working at a company that could downsize,  another is a middle class programmer Mr Riffle,age 44, and his wife, who does not qualify for a subsidy with a $71,000 family salary from working 4 jobs between himself and his wife- this person finds it too expensive for his salary to buy insurance $900 a month and $14,000 deductible under the Affordable Care Act. His views are worth listening to as they go to the crux of the problem- he says he may not be any better with the Republican plan. He sees the real problem as the high cost of health care in the U.S. and the only way this can be fixed is for members of Congress to be asked to use the insurance exchanges they create. If this sample is representative it shows that there are real problems with both the Affordable Care Act and the Republican plan, that the high cost of health care the problem lurking behind every plan that does not squarely address this, and till that happens and members of Congress experience what ordinary people face, this problem can never by fully solved.   Woosley, Smith, Powers, Blanchard, Riffle, and their personal experience is at the crux of what is right and wrong  with the Affordable Care Act, and also with the new Republican plan of Speaker Ryan and the House of Representatives. For every Woosley, Powers and Blanchard who benefit, there is a Smith and a Riffle who are indifferent or are affected by the high cost under Affordable Care Act and the current system of medical care with its high cost. The Affordable Care Act does not  tackle high cost, for that to happen the culture in America that makes it possible and acceptable to charge high prices must change. Another problem apart from bringing health care costs is that any solution needs to have the whole country behind it. If the notion that all people are entitled to basic health care is to stand, the whole country needs to believe it as they do in countries like France, Britain, Germany and Japan. If this has to be made a workable proposition health care has to be offered at a price that makes this possible to achieve, and that idea also needs the deep and broad sense of support from the culture in America similar to that in these other countries. Until that happens politicians in America will get elected and turned out of office in turns on issues such as health care, based on which side they take and which problems they choose not to face squarely and responsibly. ...

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This is an exceptionally humorous operating room story of Dr. Trump and Dr. McConnell by Kristof of the NYT. Sometimes humor tells the story- and Kristof does this using a story of a surgeon president Trump in the operating Room trying to address the concerns of the patient Janet, as he keeps telling her she needs a new heart with great benefits, great benefits, before she implodes or goes down failing. Flat out take the old heart out even if a replacement hasn't been found, believe me great benefits the surgeon tells her, just that the patient just isn't getting convinced as its happening to her. The analogy is with replacing a health care plan, not just the Obama plan, any plan without something to take its place. For a few days before this article by Kristof, the Republican effort to repeal the Affordable Care Act without having a replacement was presented as a good idea. Janet is like the three Republican women- Collins of Maine, Capito of West Virginia, and Murkowski of Alaska who wanted to keep the heart they had till a replacement was found, against the surgeon Trump's advice. In a way it is about politicians in the last decade who never had any discussions as they rushed through with their own agendas, as the Republican and Democratic health care plans were rushed through Congress with relatively little participation and debate to hear all viewpoints. ...

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The Congressional Budget Office analysis of the Republican healthcare plan advocated by Mr. McConnell, Senate Majority leader, is that it would add 22 million uninsured if implemented. That plan ran into opposition from Republican Senators Collins, Capito, Murkowski, Paul, and Moran, and lacked enough support in the Senate. All Democrats opposed it and with the thin majority Republicans were divided. By taking away some benefits given under the existing Affordable Care Act the plan hurt the elderly and low income people, making some Republicans listen to their constituents in home districts and not the Republican leadership. The NYT profiled two in particular who astonishingly in a sign of today's strange politics were the only ones publicly holding townhall type meetings to hear the views of people in their voting districts- Susan Collins of Maine and Jerry Moran of Kansas. Both senators were listening to rural communities and Moran stated his opposition with the words- "I am a product of rural Kansas." With it the nation takes a breather and the message goes out that it is best to listen first and then to seek middle ground, not do what both parties Democrats and Republicans did in 2009 and 2017- rush serious legislation through without support across party lines and without serious discussion.   ...