Paul Ryan is a Big Fat Liar

              Paul Ryan, himself  a recipient of Social Security survivor's benefits, is apparently either ashamed of it, or the most mean spirited and hypocritical  man in the US Congress. Another option is that he's simply a liar, whoring himself to the God of privatization and profit. Of course. like in Oz, the face behind the curtain  is something else, in our case Big Pharma.  

        The recent draft proposal of the latest scam to repeal the Affordable Care Act rolled out by Ryan  is loaded  with venality and subservience to private interests at the expense of those members of the working public who most need affordable health care.

        In an incredible leap of illogic,  the proposal ballyhoos "Increased ability to contribute to health care savings accounts." Wow! So these minimum wage, or thereabouts, workers who actually have no savings because their earnings don't reach that far, will be allowed to put money they don't have and won't have into accounts they can't afford? And where will that money come from? Rent? Food expenses? Gasoline?  To top off the incredible smoke and mirrors of this alleged "good deal" reflect on  just how little of any major medical emergency will actually be covered by most uninsured person's health savings accounts if any.  

       Here's an example based on reality, not Paul Ryan bullshit. The "average" hospital stay in the US is 5 days. It's 4.6 days actually, but I'm rounding  up and I'll tell you why later. In Maryland, that translates to $11,840 dollars. which brings up several corollary questions.

        Can someone who is uninsured even have a medical savings account? No. Just no. Unaffordable, period, as discussed above.  Who pays the bill (the entire bill)? We do.Now the "rounding up" thing. Factually, those whose medical care of last resort is to show up at the Emergency Room "in extremis" tend to be far worse off and require significantly longer hospitalization than the average admittee, another reason for regular preventive doctor visits, which these folks won't be able to afford if the ACA dies.

        Secondarily, how affordable are healthcare spending accounts for the "average," whatever that  might be, family? In the current marketplace, according to the Kaiser Family Foundation, while premium costs are rising slightly slower than in years past, deductibles  are skyrocketing, which means that healthcare costs are actually increasing even more than premiums as a result. Many workers now have deductibles in excess of $1000. The average American family now spends out of pocket  monthly, for an individual family policy about $750 monthly, and these are 2015 numbers.  For many, if not most, families this doesn't leave a hell of a lot for a medical spending account! For employer sponsored plans, the family monthly cost is lower, but deductibles are high and going higher as employers pass out of control drug costs on to their workforce.    

        Additionally, in a "tough break, next case" proposal, State Medicare spending would be capped per beneficiary. Need that bypass operation? "Sorry, you've used your Medicaid up, guess you're gonna die." How very Ron Paul of the Congress, no? Some will remember the Paul rally where when the question arose re: health care for the poor, audience members screamed "Let 'em die!"

        In a another bewildering  provision,  those who don't get coverage at work would get a "$2,000  to $4,000 tax credit." Truth told, most people in this situation don't pay very much in taxes anyway, but who's counting? I guess the explanation goes like this "Remember that tax refund you're waiting for? well, good news, you'll be getting $240 more (average marginal rate times $2000). Too bad your drugs are at cost, since you're uninsured.  So your "Hep C" treatment with Harvoni will cost $94,000 (but look at the bright side, you'll get $240 more in tax refund, so all you need is another $93,760! Funny how that all worked out, huh?"  

       And finally, the subsidies for those unable to afford the entire cost of the healthcare will vanish.  Wait before you smile. Understand  this: we will still pay for these persons' healthcare, only now it will be for an amputation and hospital stay costing tens of thousands instead of the cost of routine doctor visits and reasonably cheap diabetes maintenance. Likewise,  women who cannot afford Ob-gyn visits will present at an ER in pre-eclampsia, and we'll all foot the bill for extended hospital care. Ask any Nurse you know who's ever worked NICU or OB.   

        The Emergency Medical Treatment and Active Labor Act (EMTALA) which is one of just a scant handful of Reagan era humane pieces of legislation, mandates such care, but if individual Medicaid is capped, these expenses will be dumped on the hospital, and again we will all pay!

       You really want to decrease health care expenditures, Mr. Ryan? Then repeal the 2006 law forbidding Medicare /Medicaid from negotiating drug costs. Tell Big Pharma no! As of now, the fastest rising cost in the whole panoply of medical expenses is the cost of medications. As of last year Medicare/Medicaid spent about  $220 billion on medications at the manufacturer's retail asking price. This far outstrips what insurance companies pay, which is estimated to be about 50% or less of "list  price." Applying  that "guesstimate" to Medicare/Medicaid means that we all are subsidizing the 20% net profits of the top ten Big Pharma companies by about  $110 billion annually. This is costing every human in America $353.69 annually which we shouldn't pay.

       Why does the above matter? In simplest terms, if the "no negotiating drug prices" loophole were closed, the least optimistic estimated savings to Medicare/Medicaid would amount to about $9,200  annually  for every single insured person under the ACA, and since about half or more don't get any premium subsidy, it's actually double that.

       So tell me yet again, Speaker Ryan, why you need to gut the  Affordable Care Act. Admit it, it's the name thing isn't it? Look around at your colleagues, like Louie Gohmert (embarrassing ain't he?) who are refusing to hold town hall meetings because they are afraid of their constituents' displeasure with your attempts to demolish the ACA. Or perhaps ask Tom Cotton who got filleted and deboned in public over exactly this issue.