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[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

Balancing Make-And-Buy Decisions

[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

TRICARE

Trump Could Score Politically With Medicare For All Trump Could Score Politically With Medicare For All Sen. Bernie Sanders, I-Vt., speaks during a news conference on Capitol Hill in Washington, D.C., Dec. 7, 2016, to deliver over million petition signatures demanding that President-elect Donald Trump, House Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky. (AP Photo/Manuel Balce Ceneta) Paul F. deLespinasseBy Paul F. deLespinasseMonday, 24 April 2017 03:05 PM EDTCurrent | Bio | Archive Comment|Print| A A Donald Trump campaigned promising to "repeal and replace" Obamacare. He has now discovered that insurance reform is more complicated than he realized. Congressional Republicans, happy to pass irresponsible repeals when they could count on a veto from President Obama, cannot agree on a replacement now that it will have real political consequences. Trump sensibly said that replacement and repeal should be simultaneous. Simultaneity meant that repeal would be delayed since there was no Republican consensus on a replacement. But delay was preferable to the mess a mere repeal would cause. Obamacare insured millions of additional people. Some parts are very popular, especially its ban on denying insurance to people with preexisting conditions. But insurance markets would be destroyed if this ban is retained and the most unpopular part of Obamacare, mandatory purchase of insurance, is eliminated. The obvious way to escape from this dilemma is to enact a single-payer system — an improved Medicare for all — financed by general taxation. Nobody would have to buy insurance, but everyone would be insured. People would not have to choose between incomprehensible policies with different coverage and doctor "networks." Patients would no longer "churn" between different types of insurance, each with its own network, as incomes change. People would no longer have to document their finances in order to qualify for subsidies. And it would save Americans a lot of money. Medical providers would no longer need huge staffs — now costing about $80,000 per year for every doctor — to bill dozens of insurance companies. Readers familiar with TV's Doc Martin may remember that this irascible English doctor has only one employee. Conservatives bemoan duplicated government programs and administrative bloat. But we now have separate government agencies for insuring poor people, retirees, veterans, and native Americans. We also have private bloat: back-room staffing at medical providers and huge staffs insurance companies use to figure out reasons for not covering people. The situation presents an opportunity for Donald Trump, a world-class opportunist. Imagine him explaining to supporters, often economically disadvantaged, why a system covering medical bills with only nominal co-payments, no deductibles, and no out-of-network doctors would be strongly in their interest. Or, explaining to black Americans how an improved Medicare for all would do more for minorities than any other conceivable government program. If Trump were to propose Medicare for all, Democrats in Congress would have to bite their tongues and support him. Support would also come from many of the voters, Republicans and independents, who supported him. Medicare for all would not require establishment of a new bureaucracy, since Medicare is already a going concern. Indeed, it would allow elimination of the organizations now covering the poor, veterans, and native Americans. Trump, knowing how to get national attention, would be uniquely able to explain why inevitable criticism of his proposal by the medical-pharmaceutical-insurance complex is rooted in self-interest and misleading. He could explain why the taxes to pay for Medicare for all will cost Americans with average or especially lower incomes less than they now pay, directly and indirectly, for medical care. Critics might note that Medicare for all, by making insurance more efficient, would cause immense unemployment among non-medical people currently working for doctors, hospitals, and insurance companies. But Trump could correctly reply that people will take the money previously spent to support these administrators and spend it on other things, thereby creating an equal number of new jobs in other industries. Any unemployment created by this reform would be temporary, and implementing the reform during a booming economy would mitigate even this damage. Although most congressional Republicans have opposed a single-payer system, if Trump convinces public opinion many Republicans in Congress would have to vote for it. If single-payer failed to pass, Trump could urge voters to unseat those who opposed it in 2018. Conservative public opinion may already be starting to turn around to support an improved Medicare for all. Charles Krauthammer — a trained psychiatrist as well as a nationally syndicated columnist — spoke favorably of it recently. And conservative columnist George F. Will — Princeton Ph.D. in political science — has just indicated that it is probably the best way to escape from the complex inadequacies of Obamacare. One of my own columns, published in 2009, urged conservatives to reconsider their knee-jerk hostility to a single-payer system, so perhaps I was a little ahead of the pack. If President Trump decides to endorse an improved Medicare for all, I recommend that— after previous quiet consultation — he invite Senator Bernie Sanders to the White House so the two of them could make a dramatic joint announcement. This could be political theater on a Shakespearean scale and, hopefully, one of the high points of the Trump presidency. It took red-baiter Richard Nixon to restore U.S. relations with China. Can a Republican president bring us Medicare for all?

The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All Billy Wynne MAY 11, 201710.1377/forefront.20170511.060017 ADD TO FAVORITES SHARE Editor's Note: This is the first post in an ongoing series outlining a comprehensive proposal for Medicare reform and beyond. Other posts in the series can be found here: Part 2, Part 3, and Part 4. In my last Health Affairs Blog post, I outlined a potentially bipartisan four-step plan to move past the American Health Care Act’s (AHCA’s) disastrous framework toward a more stable, less expensive health care system. For those seeking incremental, near-term solutions, I hope those recommendations provide helpful guidance. But the AHCA’s reckless drive through the US House of Representatives has taught us something about the current status of health care politics and may have opened the window to more significant, ultimately more successful, reforms. To put it mildly, the public is essentially fed up with debating how to realign the fragmented elements of our Rube Goldbergian system. Its machinations are too complex, its politics too fickle, and its rent is too damn high for the care we are getting. Where do we turn, then? More complexity? Cutting millions from coverage and shifting more costs to working families? With those options likely to be rejected, as conservative heavyweight Charles Krauthammer recently asserted, we may be heading “inexorably” toward a single-payer system. Poll after poll has in fact shown that a majority of Americans support such an approach. Most recently, an Economist/YouGov survey found that 60 percent of Americans support expanding Medicare to cover everyone, with only 23 percent opposed. If the AHCA defies odds and is enacted, this will only become exponentially truer as its impacts are felt. But, you are quick to add, there are a variety of deep-seated concerns with a single-payer approach that have kept it out of mainstream political discourse so far. That’s undoubtedly true. They include: It will necessitate massive tax increases; it will cut reimbursement for services to unsustainably low rates; it will be lower quality than the employer-sponsored coverage most Americans currently have; it will consolidate power into the hands of a small number of bureaucrats; etc., etc. My goal with this post is to demonstrate that a “unified” (punchline: It wouldn’t truly be single payer…), market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes. In fact, the parameters of such a system are all but staring us right in the face. I call it: Medicare Advantage Premium Support for All (MAPSA). While any flavor of single payer may be the last thing that comes to mind when contemplating bipartisan initiatives, just as the far left and far right share some libertarian (and other) commonalities, we may have indeed finally come full circle in this tiresome, so-far-futile debate. By combining two shots of conservative orthodoxy with one overflowing progressive one, and stirring slowly, it is not at all far-fetched to envision an endgame cocktail for our health care system that covers everyone, decreases costs, and can pass Congress. Cheers. Implementation This is another admittedly tricky element of MAPSA that warrants much further extrapolation, but, again, my goal here is only to persuade you that it is feasible. To move away from the various coverage programs currently in place, we might consider a protracted, step-wise approach. We are talking about almost 20 percent of our economy. That’s not an excuse for inaction, but it is a cause for care. Five or so years after enactment, coverage from the narrower, federally funded programs such as the Federal Employees Health Benefits Program, Veterans Health, and TRICARE, could be transitioned to the new commercially driven, federally backed, MAPSA. Three or more years later, Medicaid and individual commercial insurance market enrollees would join. Last of all would be employer-sponsored insurance, where coverage is the most stable (and privately financed). Believe me, I realize it’s easier to type this up on a computer than it is to actually pull it off. Every syllable above warrants much deeper inquiry, deconstruction, and reformulation. I said I wanted to convince you this is feasible, but I also want us to acknowledge how complicated it is. It cannot be done in one fell swoop of Bernie Sanders’ wagging finger; nor should it be casually dismissed as an economic and budgetary disaster. It doesn’t have to be either of those. Rather, I’m convinced that some thoughtful, non-ideological citizens can come together to craft a market-based, government-backed system that provides lower cost, universal coverage for consumers while protecting the livelihood and robust economic contributions of health care companies and providers. Who’s with me?

Chelsea Clinton Said Bernie Sanders Would Take Health Care From Millions But there are a few things she failed to mention. Chelsea Clinton obviously knows how to throw a political punch. Chelsea Clinton obviously knows how to throw a political punch.ASSOCIATED PRESS The Clinton campaign's assault on Bernie Sanders over health care got more intense on Tuesday. This time it wasn't presidential candidate Hillary Clinton or one of her aides delivering the attack lines. It was her daughter, Chelsea, who argued that Sanders would dismantle Medicare and Medicaid -- and "strip millions and millions and millions of people of their health insurance." Like so many statements the Clinton campaign has made about Sanders position on health care, Chelsea’s contained some true statements -- and some wildly misleading implications. For the last few weeks, Clinton has been attacking Sanders over his longtime advocacy for single-payer health care. That's a system in which everybody, or almost everybody, gets insurance directly from a government-run program. Countries like Taiwan, Sweden and Canada have single-payer. The U.S. has a version of it in Medicare, which serves the elderly and disabled. Many progressives have long dreamed of extending it to everybody else. Some even call it "Medicare for all." During his Senate career, Sanders has repeatedly introduced single-payer legislation -- most recently in 2013, when he introduced the American Health Security Act. And while Sanders has also voted for less ambitious measures, including the Affordable Care Act, he has always envisioned those initiatives as incremental steps toward a single-payer system. That has made him a hero to many liberal voters. It has also drawn the wrath of the Clinton campaign, which has attacked the scheme in two separate ways -- each making a factual claims and then leaving out critical context. Because a single-payer plan would require the government to raise literally trillions of dollars in revenue, Clinton has assailed Sanders for calling for a massive tax hike. That's true. What Clinton never mentions is that those taxes would displace existing private insurance premiums. And because Sanders' version of single-payer envisions separate state programs, Clinton and her allies have suggested that hostile state officials could thwart his plan. That's also true. But what Clinton never adds is that Sanders' scheme would also impose regulations, limiting state leeway over who to insure and what kind of coverage to supply. During a campaign appearance in New Hampshire on Tuesday, Chelsea offered a version of these arguments -- but went a little further. "Sen. Sanders wants to dismantle Obamacare, dismantle the [Children's Health Insurance Program], dismantle Medicare, and dismantle private insurance," she said, according to an account from NBC News. "I worry if we give Republicans Democratic permission to do that, we'll go back to an era -- before we had the Affordable Care Act -- that would strip millions and millions and millions of people off their health insurance." It's true that, under a scheme like the one Sanders envisions, most people would lose the insurance they have today. But that's because everybody would have the new government-provided insurance instead. And while the transition from the old system to a new one would be far more complicated than single-payer advocates like to acknowledge, the whole point of a single-payer plan is to make sure that coverage is simpler, more comprehensive and more reliable than it is today. If anything, a single-payer plan like the one Sanders envisions would result in more coverage than current arrangements would allow. The Affordable Care Act has produced a historic reduction in the number of people without coverage, but something like 9 or 10 percent of Americans remain uninsured. One reason is that the system depends upon people signing up for insurance. The Sanders bill states quite explicitly that "every individual who is a resident of the United States is entitled" to insurance, and then requires the states to enroll people automatically. Characteristically missing from Chelsea's comments was any recognition of these facts -- or acknowledgment that Sanders has a long record of arguing that people need more protection from medical bills, not less. Maybe the most generous interpretation of Chelsea's comments is that she was making a political argument: that, by calling for single-payer, Sanders undermines enthusiasm for the Affordable Care Act and makes it more vulnerable to repeal. But Sanders has been a loud, consistent critic of GOP efforts to wipe away the law. It's hard to see how that constitutes giving "permission" for repeal. Clinton campaign spokesman Josh Schwerin stood by Chelsea's comments when contacted by The Huffington Post. "It is risky to try to replace the Affordable Care Act, CHIP, Medicare, Medicaid and TRICARE with a new plan that counts on Republican governors who have already rejected Medicaid expansion to foot some of the cost of care," he said. "And it has the potential to cause disruption in health care for millions of Americans who just got covered." Clinton of all people should be sensitive to misleading attacks on health care plans. As a chief architect of the universal coverage plan former President Bill Clinton proposed in 1993, she confronted all kinds of outlandish claims. Most famously, one conservative commentator claimed falsely that this health plan would force doctors to go to jail if they refused to accept the new, government-regulated insurance. Health care was also a major issue in the 2008 Democratic primaries. At the time, Clinton supported an individual mandate, which requires that everybody get insurance or pay a fine, and then-Sen. Barack Obama did not. When Obama's campaign sent mailers to Ohio voters, warning them that Clinton would force every single person to buy health insurance, Clinton called it a tactic "right out of Karl Rove's playbook." In other words, it was something that Republicans would do to Democrats, not what Democrats should do to each other. "It is not only wrong, it is undermining core Democratic principles," she said. "Since when do Democrats attack one another on universal health care?" Clinton has long been skeptical of a single-payer plan, even though it's beloved by much of the progressive base. "I have thought about this, as you might guess, for 15 years and I never seriously considered a single-payer system," she told The New York Times in a March 2008 interview. Her argument against it was, in part, political. Selling such a plan would be hard because most Americans "become very nervous about socialized medicine," she said. "They don’t really know that Medicare is a single-payer system," she added. "They don’t really think about that." Also on HuffPost:

MEDICARE FOR ALL WOULD BE BAD FOR VETERANS. HERE’S WHY. By Concerned Veterans for America 12.03.19 Health care is at the top of voters’ priority lists, and for good reason. Many find it difficult to access timely and affordable care. For veterans especially, getting good care when and where they need it has been a struggle. However, recent reforms at the Department of Veterans Affairs have made it easier to seek care in the community and driven down wait times for those who use the VA. But Medicare for All would undo all that progress. Darin Selnick, a former senior advisor to the VA secretary, pointed out in a recent op-ed that Medicare for All would dismantle TRICARE, leaving military personnel and retirees with fewer health care options: Although Medicare for All would leave the government-run portion of the VA system intact, it would eliminate the Department of Defense’s TRICARE program, a network of private providers and military hospitals that provide health care for 9.4 million U.S military personnel, retirees, their families and some members of the reserves. … So even if the VA system remained in place, Medicare for All would still threaten the millions of veterans who have access to both the VA and TRICARE. Those who choose the latter, or a combination of both, would have fewer – or no – options under Medicare for All. Although the VA would stay somewhat intact, Medicare for All would negatively affect those who use the VA. Selnick continued: The VA has long relied on community providers to supplement the care it provides. However, since the 2014 wait list scandal, the VA has increased its use of outside health care by over 50 percent, helping reduce wait times and improve access to care. Today, about one-third of all appointments for veterans enrolled in the VA happen outside the VA system through community care. … Medicare for All would subvert these reforms by shrinking or eliminating community provider networks and restricting choices for veterans. It also would ignore the lessons learned from the VA over the past five years — that more choice, access and competition improve veterans’ health care by focusing on the needs of the veteran, not the bureaucracy. Veterans know the difficulties that come with government-run health care – limited access, long wait times and few choices. Medicare for All plans ignore these problems. Any health care proposals should look to the VA to learn not just what works best for veterans, but to understand the pitfalls of Medicare for All for all Americans. Read the rest of Darin Selnick’s op-ed in The Hill.

[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

*MHS – Military Health System

For years, efforts to provide veterans more health care outside the Department of Veterans Affairs have been described by critics as a plot to dismantle the VA medical system. While the recent improvements in delivery of veterans’ health care have proven those claims false, a real threat has emerged to care for veterans and military families.

“Medicare for All” proposals in Congress would establish a single-payer health care system run by the government. They would prohibit the sale of private health plans while ending employer-sponsored insurance coverage and private and public sector retiree health plans.

[Terri, Carrie, “The US Military Health System: Promoting Readiness And Providing Health Care,” Health Affairs vol 38, no. 8: Military Health Systems, August 2019, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00239, accessed June 19, 2023, GDS-LL]

Within the US, TRICARE is administered through contracts with two third-party administrators, referred to by the DoD as managed care support contractors.7 The contracts are multiyear competitive contracts that cover the management of enrollment processes, establishment or maintenance of provider networks, finding health care providers and making referrals, customer service functions, medical management for some beneficiary populations, and claims processing. Requirements for these contracts have changed over time, particularly with respect to the amount of medical management and risk sharing expected. Through the current contractors (Humana Military and HealthNet Federal Services), the civilian resources available to the MHS in fiscal year 2018 included approximately 604,000 individual providers (of primary, behavioral health, and specialty care), over 3,600 acute care hospitals, 833 behavioral health facilities, and over 58,000 retail pharmacies.7,8,17

In the US, around 35% of all Americans receive health insurance coverage from a government program. Most people will be familiar with Medicaid and Medicare, but there are many other types of programs for different populations, including TRICARE. This program is available to the military community, and it offers some very robust plans that rival some of the best private insurance plans. SelmanCo offers TRICARE Supplement insurance that works with TRICARE to create a rock-solid alternative to an employer's major medical plan. If employers have TRICARE-eligible employees who do not participate in their earned benefit program, it may be worthwhile to help those employees compare their options.

[Chart Omitted]

Lawmakers from both parties are putting increasing pressure on the Pentagon to fix the recruitment crisis that threatens to leave the military well short of its goals to bring new troops aboard this year, in what is widely considered the worst recruiting environment since the end of the Vietnam War.

While leaders from the different military branches have all acknowledged the problem, they also have been unable to move the needle in a positive direction, as the desire of young Americans to join the military falls off the statistical cliff.

The Inflation Reduction Act is set to lower drug prices for millions of people in the U.S. — but experts fear pharmaceutical companies could exploit loopholes in the bill, ultimately keeping prescription costs high for many.

The law takes aim at insulin costs, caps out-of-pocket spending for Medicare beneficiaries, and allows the federal government to negotiate prices on the costliest prescription drugs. It also will require drugmakers to pay a rebate to Medicare if they raise prices too sharply.

The Biden-Harris Administration has made lowering prescription drug costs in America a key priority — and President Biden is delivering results. Today, the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced 20 prescription drugs for which Part B beneficiary coinsurances may be lower from April 1 – June 30, 2023. Thanks to President Biden’s new law to lower prescription drug costs, some people with Medicare who take these drugs may save between $1 and $372 per average dose starting April 1, depending on their individual coverage. Through the Inflation Reduction Act, President Biden and his Administration are lowering prescription drug costs for American seniors and families.

“The Biden-Harris Administration believes people with Medicare shouldn’t be on the hook when drug companies inexplicably jack up the prices of their drugs,” said HHS Secretary Xavier Becerra. “President Biden made lowering prescription drug costs for Americans a top priority and we’re using every lever we have to deliver results. With the inflation rebate program, we are fighting to ensure seniors can afford the treatments they need, taxpayers aren’t subsidizing drug company excess prices, and the Medicare program is strong for millions of beneficiaries now and in the future.”

[Cambridge Dictionary, “Expand”, Cambridge Printing Press, ] 

*sth- something 

The verb expand means to make something bigger or wider. It might refer to something concrete, as when you blow into a balloon and make it expand, or something more abstract, as when you study to expand your mind. 

Expand is a combination of the Latin words ex-, meaning "out," and pandere, "to spread." The idea of spreading out was always there, though the current idea of something actually becoming larger was first recorded in the mid-17th century. Expand is a versatile word that can refer to anything getting bigger, from a nation's growing influence in a neighboring country to a waistline that needs a larger belt. 

Health care is a human right, not a privilege. That’s why Bernie has been running on Medicare for All, a single-payer program that will guarantee comprehensive health care coverage to everyone in America. What will this mean for seniors who are covered by the existing Medicare program? It will mean an expansion of benefits.

Medicare for All will expand on the existing Medicare program by including dental care, hearing aids, routine vision exams, podiatry, and more. Further, home-based health care and community-based services, rehabilitative services, durable medical equipment and assistive technology will also be covered, so seniors can get the help they need to remain in their homes and communities without having to first exhaust all of their savings.

2 - to begin to practice or use (something, such as an approach or manner) 

people who adopt a healthy lifestyle 

Those of us that want to pay attention to the way we write and do not want to appear careless or sloppy, might find ourselves confused at times in regards to proper capitalization of certain words and phrases. It’s true that some phrases present a challenge, as depending on the context of their use, they may or may not need to be written with an upper case letter, when used in a sentence. This becomes even more difficult, in the case of phrases, which are a group of words, often used in conjunction to describe something. One of the most common examples is the phrase “social security”. So, should social security be capitalized? The quick answer – this depends on the context in which the phrase is used. 

Is “Social Security” Capitalized? 

This publication explains the federal income tax rules for social security benefits and equivalent tier 1 railroad retirement benefits. It is prepared through the joint efforts of the IRS, the Social Security Administration (SSA), and the U.S. Railroad Retirement Board (RRB).  

Social security benefits include monthly retirement, survivor, and disability benefits. They don’t include Supplemental Security Income (SSI) payments, which aren’t taxable. 

Social security benefits include monthly retirement, survivor, and disability benefits. They don’t include Supplemental Security Income (SSI) payments, which aren’t taxable.