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Hope Cook: Health care's future very complicated

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Most people would agree that the Affordable Care Act or ACA is not a perfect piece of legislation. However, I believe that the risks of eliminating the benefits of Medicaid expansion, which is part of ACA, deserve more attention.

Access to healthcare is the primary intended purpose for expanding Medicaid. If low income, uninsured individuals become insured, they would no longer have to use the emergency room for their primary health care — a very expensive and inefficient delivery for basic general health care needs. Research has shown that health care delivered in a primary health care setting produces better health outcomes.

The primary benefit for anyone who has health insurance is access to primary care without incurring huge costs to themselves. It is no different for people who enroll in the expanded Medicaid program. These individuals can now go to a doctor if they are sick.

There is more opportunity for being proactive about one’s health. Fifteen percent of the total population of Colorado is now signed up for Medicaid expansion. Uninsured rates dropped from 12 percent to 9 percent. Typically, these individuals are the working poor, disabled, elderly, homeless and children.

Through expanded Medicaid, eligibility has been revised to include individuals at 138 percent of the Federal Poverty Level, which translates to $16,000 for a single adult or $24,000 for a family of four. This year, because Colorado (one of 31 states) signed up for this expansion, 100 percent of the federal dollars allocated to our state is designated to pay for healthcare for this population

The second benefit of expanded Medicaid is the increase of wellness and prevention programs. The main focus of these programs is to prevent disease and minimize costs associated with chronic disease. Areas of these programs include:

• Basic dental health that includes screening and cleaning

• Vaccinations

• Screenings for cardio vascular disease, diabetes and breast cancer

• Reproductive health including long term birth control

• Mental health counseling now includes treatment for addiction.

Other positives consequences of the Medicaid expansion program include insurance standards for basic care and requiring no exclusions for individuals with pre-existing conditions. Clients are now protected during their policy coverage period from changes to their policies by insurance companies.

Medicaid expansion is not a panacea. Premiums and the cost of care are still too high. The program hasn’t attracted enough of our younger population. Insurance companies have withdrawn from the marketplace exchanges, limiting an individual’s choice of different insurance plans.

However, a full repeal of the ACA without replacing these benefits mentioned above is a mistake. As Senator Gardner and Representative Tipton and our other elected officials begin to change this program, I hope they will differentiate between what is working, from what isn’t, and will craft a better program that retains and builds rather than repeals and starts over.

Hope Cook

Steamboat Springs

Comments

Lock McShane 1 month, 2 weeks ago

The new “TrumpCare” will never work. Healthy people will stay away, costs and premiums will increase, and the health insurance companies will leave the market due to decreasing profits, hopefully leaving us with one option, MediCare For All.

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Joe Meglen 1 month, 2 weeks ago

For the government to provide all of the benefits mentioned in this letter it must first confiscate the funds, which is done by threat of force, to pay for it, which it does while retaining a substantial handling fee for itself. Where in the Constitution (that quaint old document that enumerates the limited powers granted) is government authorized to control 16% of the economy by taking over the health care system of the United States?

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Eric Morris 1 month, 2 weeks ago

Joe, great points. Even in Canada, the socialism medicine at least has the fig leaf of being constitutional, since the provinces force it.

Speaking of federalism, Thomas DiLorenzo in "The Problem with Socialism": Hitler blamed the Jews for federalism and National Socialists wound totally eliminate states' rights altogether. Is that healthy?

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Nancy Spillane 1 month, 2 weeks ago

Ms. Cook: Thank you for your insightful letter. It holds a lot of weight with me as you are in the trenches providing health care to the Yampa Valley.

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Chris Hadlock 1 month, 2 weeks ago

Joe, that "Quaint old document" contains all the authority needed for the Federal Government to levy taxes for the general welfare of the nation. As much as you hate admitting it, that can be defined as health care no matter how much you might disagree.

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Scott Wedel 1 month, 2 weeks ago

Healthcare is a complicated situation because a substantial portion of the population cannot afford the care they need. And as a society we are not generally willing to allow people to die due to be unable to afford care. Government already pays for Medicare for those over 65 and thus ends up paying more if people has existing conditions and wait until 65 to get treated.

It is interesting that the Republican plan doesn't include anything claimed to reduce the cost of providing medical care. Their claims on reducing cost of health insurance is based upon a hope of getting more healthier people to pay for coverage that partially subsidizes others.

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Joe Meglen 1 month, 2 weeks ago

Chris, Your interpretation of the "general welfare clause" would negate the entire Constitution. If the government can do whatever it thinks best, then the Framers wasted their time when determining which powers would be granted to the federal government. James Madison, The Father of the Constitution, and one of the four primary authors, said the following about the terms “general welfare clause”: “I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.” Coauthor Thomas Jefferson explained:
“Congress has not unlimited powers to provide for the general welfare, but only those specifically enumerated.” It is 100 years of Progressive (both political parties) control of the government that makes it essential that a strict constructionist be appointed to the Supreme Court. The Constitution was written to protect the people from the government by preserving individual liberty. Your interpretation of the “general welfare clause” transfers power, and therefore your freedom, to the discretion of government. You willingly enslave yourself.

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Chris Hadlock 1 month, 2 weeks ago

Uh, did you read the Supreme Court decision about the ACA Joe? You can have any "opinion" you want. Read your history and shout it out everywhere but just like the rest of us you are bound by the actual law. In this particular case the Supreme Court ruled that the mandate was a form of tax and therefore a "Constitutional Law" no matter what you think of it.

Like you, I can only espouse my "opinion" and I am not willingly enslaving anyone or anything including myself. Providing for the common good (ie. general welfare) used to be a conservative christian belief. Your interpretation is neither.

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Lock McShane 1 month, 2 weeks ago

Joe, you state that the government has to "confiscate" tax money to pay for what it does to benefit the American citizens. Would you be happier if no one paid any taxes and the government went away so we were all on our own with no laws?

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Joe Meglen 1 month, 2 weeks ago

Chris, You have far too much faith in the State. If government functioned according to the fables taught in our civics classes you would be correct. As it has degenerated in the U.S. the last 200 + years, the real purpose of government is to allow those that control it to plunder those that don’t. The Supreme Court is corrupt or compromised, and almost certainly both. The Supreme Court rewrote the ACA legislation and called it a tax. Writing law is beyond the authority of the Court. All legislation is written by Congress which makes the Court’s rewriting of the bill unconstitutional. Enforcing the ACA is therefore done under color of law. The Founder’s grievous mistake was in establishing a federal government, that was to be strictly limited, but then gave the government the authority to police itself. When the federal government is making decisions, it invariably finds that the government has more power and the people have less. 229 years later we now have a limitless federal government which looks upon the sovereign states as vassals and the people that created it as its subjects.

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Lock McShane 1 month, 2 weeks ago

Joe, what is your solution to your perceived problem that the Federal government is too powerful and only in it for itself? Would we be better off if each state was its own country and there was no more USA?

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Joe Meglen 1 month, 2 weeks ago

Hi Lock,

Good questions.

The Founders intent was for people to be free and have the right to keep what they earn. This is the reason the Founders were strongly against, and would never entertain an income tax. A free person owns themselves. If a free person voluntarily gives up part of their life to earn an income, a free person has the right to keep the fruits of their labor. Once the government grants itself the authority to tax a person’s income you are no longer free. You become a subject of the State. The State owns you. With the 16th Amendment, the ratification of which is suspect, the Constitution was overturned.

The Constitution did allow for the federal government to collect taxes in the form of Tarriffs and as a tax on the earnings of a business. I would like the taxes to stop there which preserves individual freedom and limits the growth of government.

I would be happier with a smaller constitutional government which does not expand beyond the original and strictly limited powers enumerated in the Constitution. The function of our constitutional government is to, 1) preserve the individual natural rights memorialized in the Constitution, and 2) provide for the common defense of the States United. When the scope of government expands beyond the enumerated powers granted, by definition it is unconstitutional and therefore unlawful.

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Scott Wedel 1 month, 2 weeks ago

The general welfare clause allows federal government to offer about any program offering benefits. The Constitution describes how such programs are to be approved by Congress and administered by the executive office.

The Bill of Rights describe limitations of government powers. Not having healthcare is not a right when hospital emergency rooms have to treat people that show up with life threatening conditions.

The Commerce Clause has been interpreted to mean federal government can regulate all commerce that theoretically could be sold over state lines. It isn't even clearly established that Colorado MJ laws that define a intrastate market in which MJ is regulated from seed to sale is sufficient to not fall under the Commerce Clause.

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Joe Meglen 1 month, 2 weeks ago

Hi Lock,

It is not my perception that the federal government is too powerful. This is an undeniable fact.

Yes, we need to resurrect the State’s Rights which were unconstitutionally, and therefore illegally, crushed when the North invaded and conquered the South. The amendments to the Constitution that occurred during the Union (federal government) occupation of the South were done so at the point of a bayonet which in itself makes these amendments unconstitutional.

The government established by the Constitution was a bottom up arrangement in which the ultimate power rested with the people, which granted limited powers to their respective sovereign states, which granted even lesser powers to the federal government, which was to be nothing more than the agent or employee of the States.

The people are to be more powerful than the sovereign states, and the states are to be more powerful than the federal government. The only function of the federal government is to protect individual rights and provide for the common defense of the states.

From a libertarian perspective, and most of the Founders were libertarian, a return to a much smaller constitutional government is preferred. In terms of what is best for the individual and freedom, the form of government that preceded the Constitution, i.e., the Articles of Confederation is best.

For those that have grown up and feel comfortable with an administrative police state that regulates and controls every aspect of their lives, the status quo is prefered.

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Dan Shores 1 month, 2 weeks ago

Joe, I have to disagree. The civil war had nothing to do with states rights and states rights were not "illegally" crushed. Lincoln's primary goal and reason for going to war was to preserve the union. White southerners founded the Confederacy on the ideology of white supremacy. According to Alexander Stephens, vice president of the Confederacy: "Our new government's foundations are laid, it's cornerstone rests, upon the great truth that the Negro is not equal to the white man, that slavery-subprdination to the superior race-is his natural and normal condition". No mention here of states rights. In fact states rights did not motivate secession and as the war continued, the Confederacy began to deny states rights within the new nation. Jefferson Davis, president of the Confederacy denounced states rights as destructive to the Confederacy.

Individual freedom has it's limits. The federal government has the right to enact laws that cover all of the states. A state cannot decide for instance, that they will allow slavery, or theft, or murder. That doesn't mean that the federal government is acting as a police state and controlling every aspect of our lives. It's not a "zero sum" proposition.

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Joe Meglen 1 month, 2 weeks ago

Hi Dan,

There are multiply causes for Lincoln’s (and the Northern Industrial Interests he served) Imperial and very illegal war waged on the South. The victor writes history. What we were taught in the government’s schools is the PC version intended to portray the North’s (federal government) invasion of the South as a noble cause to preserve the union and to free the slaves. The part about freeing the slaves is a fantasy. The part about preserving the Union is accurate for the South was being plundered by the North which had captured control of Congress. The Southern States were paying 90% of the import Tariffs (protectionism for the North) which both funded most of the federal government with a substantial portion being redistributed as subsidies to the Northern Industrial Interests that put Lincoln in power. Lincoln’s only reason for wanting to preserve the Union was to ensure that the stream of taxes imposed on the South would not be interrupted. Some Southern politicians did support slavery and said that their society was based on white supremacy but so did Lincoln along with the majority of Northern politicians.

Our country was founded in secession. The founder’s put nothing in the Articles of Confederation or the Constitution preventing a state from leaving the Union. States have (or had) this right. The Union was a voluntary arrangement. The Southern States seceded for a number of reasons with Lincoln’s promise of doubling the Tariffs on the South if elected being the primary cause. The South was being bankrupted by the federal government and they thought they had no choice but to secede, which they tried to do peacefully.

Lincoln waged total war on the South including civilians. He is responsible for the slaughter of more than 750,000 Americans by latest estimates, 50,000 of which were women and slaves. The Confederacy was crushed, occupied by the North and further plundered for a decade. State’s Rights are an integral part of the founder’s vision of federalism and these were crushed, or regulated out of existence, along with individual freedom at the point of a bayonet when the Confederacy lost our second War of Independence.

Dan, you always have to follow the money.

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Eric Morris 1 month, 2 weeks ago

Joe, I am printing out your comments and will use them to supplement the education of my children (when they are old enough). They may need to cite you, if okay, on a term paper. Thank you!

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John Weibel 1 month, 2 weeks ago

The constitutional debate is great but the fundamental problem with the healthcare system is the food system. That is the root cause of most problems and without addressing it cost will continue to spiral out of control.

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Eric Morris 1 month, 2 weeks ago

John, I agree with you. Unfortunately, because of twisting the federal government beyond its limits, it unconstitutionally subsidizes the least healthful foods.

http://articles.mercola.com/sites/articles/archive/2011/08/03/the-9-foods-the-us-government-is-paying-you-to-eat.aspx

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Dan Shores 1 month, 2 weeks ago

Joe I would be interested in your source of information that the civil war was not about freeing slaves and instead about tariffs and an illegal action by he North.

Fortunately we now have the internet, so historical searches are rather easy and no longer involve hours and hours in the library. I can find no reference to tariffs even being mentioned as a reason for succession. Alexander Stephens own words describe the reason for succession, to protect white supremacy and the institution of slavery. The Confederacy opposed states rights. Southerners were worried about the westward expansion and wanted the new states to be slave states, but settlers wanted to have small rural farms instead of large plantations and didn't support slavery.

Lincoln waged war primarily to preserve the union. Abolition was a secondary goal. Lincoln was racist himself and did not believe in racial equality, few did at the time, but he was very much against slavery and believed that all men should be free.

The Confederacy was founded on the belief of white supremacy and the subordination of the negro. And conservatives wonder why we call some of them racists when they show up to Trump rallies wrapped in the stars and bars.

But this whole discussion is of topic. Here's an on topic question for you. Conservatives constantly complained about the ACA and insisted that the answer to the health insurance dilemma was selling insurance across state lines and tort reform. Does anyone know if the Trump proposal contains these elements? If not, why not?

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Joe Meglen 1 month, 2 weeks ago

Eric,

Thank you. Researching real history, including the “Civil War”, or the War of Northern Aggression from the Southern view, has been of interest to me since coming to know a well informed drill sergeant from Alabama in 1969 while stationed at Fort Ord. A clarification, “Civil War” implies that separate factions were battling over who controls the government. There was nothing Civil about the illegal invasion by the North. This was an aggressive imperial war waged by the North against the South. The South was fighting a defensive war of independence. The Southern states were being invaded by Northern protectionists who were not the slightest bit concerned about the limitations they were bound to by the Constitution.

If I am to be quoted to your children one day, let me clean up and elaborate on my prior comment a bit. The import dependent South was paying an estimated 80% of the important tariffs prior to 1860. These taxes were the major source of revenue to fund the federal government. The passing of the Morill Tariff Act by the federal government just prior to Lincoln’s election more than doubled the tariff. In his first inaugural address Lincoln promised a military invasion if these taxes were not collected. South Carolina had been one of the strongest opponents to being fleeced by the Northern protectionists which is the primary reason SC was the fist to secede. The Southern agricultural states had been turned into tax slaves for the benefit of the Northern industrial interests that Lincoln owed his loyalty to.

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Eric Morris 1 month, 2 weeks ago

https://mises.org/library/lincolns-tariff-war

The North went to war for the tariff (and union); the South went to war over slavery (and state's rights). Both tariffs and slavery are money issues. The other two are power.

Who knows about Trump's ACA? If it's done by Repugs in their Lincolnian tradition, it is about protecting their favored moneyed interests.

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Joe Meglen 1 month, 2 weeks ago

Dan,

There is the old saying; the mind is like a parachute. If it isn’t open it doesn’t work. If I supply you with a list of references validating the points in my comments will you read them?

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Scott Wedel 1 month, 2 weeks ago

The people claiming to seek open minds could just read the criticisms of their sources to learn why their viewpoints are not commonly accepted.

New York Times did a 150th anniversary of the Civil War by each week reprinting the articles of that week 150 years ago. There is simply no way reading that week by week to conclude the Civil War was fought over anything other than slavery.

Lincoln was elected as someone right for the northern states that wasn't going to let slavery expand. So yes, he was on the right side for northern states on tariffs, but the bigger issue was slavery. Many of the key events that led to war were taken by the South prior to Lincoln even taking office.

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Joe Meglen 1 month, 2 weeks ago

Scott,

With the exception of the government court historians no serious student of history claims that the North waged war on the South to free slaves. As a consequence of Lincoln’s illegal war the slaves were freed but he enslaved a nation.

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Scott Wedel 1 month, 2 weeks ago

Oh, nice shift of terms. Yes, the North went to war not to free slaves, but because the Confederacy attacked Fort Sumter. But the Confederacy was formed because Lincoln was elected (and prior to he took office so not in response to anything Lincoln did as President) and the South was so upset because an abolitionist was elected President.

And when war was started, then Northern abolitionists volunteered for the army.

As for "Lincoln's illegal war" that term speaks enough about your opinions that nothing else needs to be said.

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