Wednesday, June 28, 2017

Thanks Obama. Forbes on Medicare.

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Iran's progress against America accomplished with our dollars. Thanks Obama. (See 1 below.)

It is too early to write the history of Obama's eight years but this much should be evident:

a) His foreign policy was as weak as Carter's, maybe even weaker. The consequences, however, should prove far more dangerous.

b) His domestic policies were based on  a batch of lies and bad economics. He spread discord among the races, undercut support of various police departments, turned many government agencies against citizens, allowed deficits to explode and presided over the lowest economic recovery in recent history crippling it with unproductive/costly rules and regulations.

I am still trying to find something positive he accomplished. Any suggestions?
Steve Forbes and his staff on  Medicare. (See 2 below.)


Looking the Wrong Way on Iran

We have been looking in the wrong direction. While the West was hoping temporarily to check Iran’s nuclear aspirations, Iran was making plans to advance on the ground and in the water — and the plans are unfolding nicely. For Iran.

After the U.S. withdrew from Iraq in 2011, large swaths of Iraqi territory were easily brought under Islamic State (ISIS) control, culminating in the proclamation in 2014 of “The Caliphate” with its seat in Mosul. Having denigrated its capabilities as “the JV team,” the Obama administration was desperate to get rid of ISIS, but the Iraqi army (trained and armed at a cost of $26 billion between 2006 and 2015 with another $1.6 billion spent in 2016) was unable to handle the job, even with American air power and Kurdish fighters as allies.

The Iraqi army has since been improved, but in the Sunni heartland of Iraq, Shiite “militias” have become America’s ally in the battle for Mosul. Some militias are Iraqi Arab Shiites and some are sponsored and commanded by Persian Shiite Iran. There is no love between the two, and certainly no love between any of the Shiite militias and the U.S.-sponsored Iraqi military. But the battle has largely gone against ISIS. Militias on one side and Iraqi forces on the other are recapturing territory amid evidence of outrageous human rights abuses against Iraqi civilians by all sides. At some point soon, Iraqis (army and militias), Iranians, Shiites, Sunnis, Kurds and Americans will be eyeball-to-eyeball in Mosul. This run-in raises two questions:
  • Could Sunni Iraqi civilians prefer ISIS to Shiite militias, whether Iraqi or Iranian? If they do, Mosul may be liberated, but ISIS may still find havens from which to conduct a grinding guerrilla war.

  • How will Iraq get rid of the Iranians? Or will it? Some Iraqi Shiite militias have been loosely but legally incorporated into the Iraqi military; the Iranian ones have not. The chief of the Qods Force of Iran’s Islamic Revolutionary Guards Corps (IRGC), Qassem Soleimani, has been seen several times in Iraq, most recently near the Syrian border, an indication that Iran has bigger plans than the liberation of Mosul.
The Sunni part of Iraq actually is an essential part of the land bridge being built from Iran to the Mediterranean Sea. The “Shiite Crescent” was understood decades ago, but ignored by the West — particularly by the Obama administration in its haste to leave Iraq, which sits just to the north of Sunni Saudi Arabia. The next piece of the Crescent to the west is Syria, sitting just above Sunni Jordan.

Iran brought its forces to fight in Syria when it became clear that President Bashar Assad could not control his country with his own army and that the Russians were not interested in contributing ground troops. The Iranians, plus forces made up of Afghan and Pakistani Shiites under Iranian command, plus Hezbollah units, had been moving through the Sunni center of Syria toward the Iraq-Syria border — which they have now reached — pushing tens of thousands of Syrian civilians out of the way and encouraging others to join ISIS for revenge. Iran is so determined to wipe out Sunni resistance, however, that it was willing to fire medium-range missiles from Iran into Syria at Deir Ezor this week. That only one missile out of seven appears to have hit the target should not obscure the depth of Iran’s determination to hold onto Syria.

With Syrian airfields open to it, Iran’s Mahan Air has been flying in weapons for both its Syrian and Hezbollah allies, according to analyst Emanuele Ottolenghi who has tracked the flights for years. Without Mahan Air, Iran has to ship weapons by sea, subject to seizure by international navies — including the U.S. and Israel — enforcing the UN ban on Iranian weapons exports.

Iranian adjunct Hezbollah, now the governing power in Lebanon, represents the westernmost bit of the Crescent, just above Israel.

The Shiite Crescent covers the northwest route for Iran to the Mediterranean, but there is a second and equally compelling issue for Iran to the southwest: encircling Saudi Arabia in the water. Iran has threatened ships in the Persian Gulf and worked to destabilize Bahrain to the east of Saudi Arabia. In the heel of the Saudi boot, Iran supports the Houthi rebellion in Yemen — and with that support have come Iranian warships in the Red Sea. Iran has been deployed in the Red Sea since 2011 near the Bab el-Mandeb Straits. 

Both Saudi and American warships have been attacked in the Red Sea by Houthis firing Iranian-supplied missiles. The Iranian presence is enough to disrupt oil traffic — and the exit of Israel and Jordan through the Gulf of Aden to the Arabian Sea.

Iranian weapons brought in through Sudan and Eritrea threaten the stability of Sunni Egypt, Libya, Tunisia, Algeria and Morocco, lining the Mediterranean Sea opposite NATO’s Southern Command.

To the extent that the West — specifically the United States — thought that legitimizing the Islamic Republic in the region would mitigate its aggressiveness, the West was wrong. To the extent that the West thought a temporary halt to nuclear progress would make Iran a responsible player, the West was wrong. To the extent that the West thought $150 billion would jump-start Iran’s civilian economy, the West may have misunderstood who profits in the Iranian economy and how the money is spent.

Iran’s interests go far beyond centrifuges and heavy water. And, as it turns out, Iran’s aggressiveness had nothing to do with its pariah status — the mullahs do not seem to see Iran as a pariah, but rather as the guardian of Shiite Islam and the director of Shiite armies to defeat first Sunnis in the Middle East and then the rest of the world.

For now, they are on their way, and the United States appears to have been caught entirely off guard. If Iran is allowed to solidify its Shiite Crescent and its naval obstructionism, American allies across the Middle East and North Africa will pay a heavy price.
2)The Twin Horrors Of Medicaid: As Costs Go Up , It Harms Patients More. Can Congress Finally Fix It?

By Steve Forbes and Forbes Staff

A BIG STUMBLING BLOCK to getting a health care reform bill through the Senate (the House of Representatives passed one in May) is Medicaid. This is surprising, given that the program is probably the worst-designed health insurance system in the history of the Free World, ballooning in costs while providing clients with increasingly lousy care. Properly fixing this program would save substantial amounts of money and provide patients with better outcomes.
Medicaid was enacted in 1965 to replace and beef up state programs to help the indigent get medical care. Medicaid would make all of these efforts virtually uniform–becoming, in essence, a one-size-fits-all program. The federal government would pony up half the costs, the states the other half. But even though the states shared the tab, Washington dictated the rules. States managed the program but couldn’t make any changes without getting “waivers” from the Department of Health & Human Services. In addition to covering low-income earners, Medicaid was expanded over the years to help pay for seniors who have no assets and for long-term care for people with disabilities.
Costs immediately spun out of control. There was no fixed budget, and spending went to whatever medical bills were submitted. The only way governors could contain costs was to reduce the reimbursement rates for health care providers, which is what happened. Around one-third of physicians no longer take on new Medicaid patients. It’s no surprise that a perverse incentive took hold: Consultations were skimped on, as these were not reimbursed, but tests of all sorts–many of them medically unnecessary or even harmful–skyrocketed. Moreover, since most of any savings a state achieved would go to Uncle Sam–Washington now pays 63% of total Medicaid expenses, local governments only 37%–the spur to rein in ever rising costs and take on political heat is obviously de minimis. After all, the biggest employers in most states are hospitals, and their lobbying clout is immense.
Shockingly, reputable studies have found no difference in the health outcomes of people on Medicaid and those who have no insurance.
Nonetheless, Obamacare substantially expanded Medicaid by relaxing the eligibility rules. Under the Constitution, Washington couldn’t force the states to go along. So Obamacare offered what many governors found to be irresistible bait: The feds would pay 100% of the costs of covering these new people until 2016, phasing down to 90% by 2020 (19 states refused to bite for fear that future sharing formulas would be scaled back and they’d be left holding a heavy fiscal bag). Medicaid’s rolls expanded by 11 million, rising to a total of 75 million people. Costs soared, while the quality of medical care deteriorated, as more and more providers refused to accept Medicaid patients. More money, worse care–quite a feat, that!
House Republicans want to rein in Medicaid’s runaway costs by, among other things, gradually rolling back much of the Obamacare eligibility expansion of Medicaid funding, starting in 2020. More important, they would give states more leeway in making changes to the program. In return states would get a set amount of funding per person, which would grow by a fixed formula, instead of being open-ended, as it currently is. States could also choose to receive a block grant, that is, a chunk of money from Uncle Sam that would provide a fixed amount of Medicaid funding and remain unchanged.
Republican governors, and, no surprise, Democratic ones as well, are worried that the House bill would mean devastating cuts to beneficiaries, because its changes would slow the growth of Medicaid spending.
Their fears are overblown. It’s puzzling, to say the least, that they can defend a program that is ever more costly, increasingly ill-serves its beneficiaries and is riddled with fraud–the Government Accountability Office has found that more than 10% of the program’s payments are “improper.”
Instead, they and Republican senators should plug for a clean solution that would provide enrollees with better coverage at less cost. The House bill helps get us there. The Senate should chuck restraints and just do it–openly “incentivize” states to enact a program in which most participants would have comprehensive catastrophic coverage and generous health savings accounts (HSAs). The insurance would have high deductibles, which would make it cheap. People would use the money in their HSAs for regular medical expenses. The key is that Medicaid beneficiaries would own their accounts. It would be their money. This basic reform would go a long way toward creating a patient-oriented health care market in which we would happily experience what we always get with free markets: abundance at lower and lower costs. Medicaid is killing state budgets: 16 states are considering freezing or cutting payments to providers; 8 are mulling over tax hikes on providers.
Pollyannaish? Consider this: Medicaid spending per person is $7,500, which would work out to be a pot of $30,000 for a low-income family of four. That’s more than enough to buy an excellent high-deductible catastrophic health insurance policy, while leaving at least $10,000 for everyday expenses. Instinctively, one knows that such a family would get far more value with this HSA money than it would with the current system of patient passivity.


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