KEY AREAS OF FOCUS:
GIVE THE PEOPLE WHAT THEY WANT
Congress does not know what “We the People” want for our own health and for a national health insurance program; and they need to remind them! ACA enrollment has declined now for three years running. Many carriers originally involved in the programs have dropped out. Nationwide we now have only one carrier for over half of the jurisdictional counties in the U.S., creating a government-sponsored Cartel for health insurers with market restrictions reminiscent of the illegal railroad and oil trusts and restraint of trade that plagued the public in steel, iron, and telecommunications. Those cartels and monopolies were eventually broken up by the government and ACA should be no different. About 34 public option insurance companies were created as a result of Obamacare and the federal government poured millions of dollars into their operations. All but four of them have gone out of business.
Meanwhile, we have 30 Million Americans that lack health insurance, and premium rates have increased over 105% in the last four years. The Congressional Budget Office estimates rates will jump an average of 34% in 2019 and the early rate filings with HHS confirmed the validity of this estimate. Several state insurance plan marketplace exchanges have gone out of business, while others continue to relied on more state and federal subsidies to remain open and federal money to pay for "navigators" and outreach. Navigators are unlicensed employees trained by the exchanges to act like licensed insurance agents. There is no verification of their skills, no licensing, and no public scrutiny of their performance. Yet they are allowed to provide health insurance advice to the general public, often in place of licensed agents, who are regulated by the state, trained extensively in products and the ethical behavior necessary to properly represent them to the American people. The Affordable Care Act is by no means a program meant to appeal to the general public. It has become a source for subsidized health insurance coverage for those people that do not qualify for Medicaid and fewer and fewer of the non-subsidized people can afford it.
100% Universal Coverage is a Myth. (Why Didn't They Sign Up for the ACA?)
In 2016, according to the Kaiser Family Foundation (KFF) “Some (low-income) individuals may have remained uninsured because they were not aware of the ACA plan options or they faced barriers to enrollment. Even though they were eligible for financial assistance under ACA.” “Cost still poses a major barrier to coverage for the uninsured”. When KFF surveyed them to learn why they didn't sign up for Obamacare, the most common reason given, when asked the question, “What is the primary reason you are uninsured?” was they couldn't afford it!
A new study published by Finkelstein, Hendren, and Shepard (April 2017), professors from MIT, Harvard, The Kennedy School of Government, and NBER, entitled “Subsidizing Health Insurance for Low-income Adults: Evidence from Massachusetts” takes this inquiry much deeper.
The study concludes that even a modest enrollee premium contribution can be a major deterrent to universal coverage among individuals with a low-income.
This is one of the reasons the Medicaid expansion is so successful. The program is FREE! Understanding the reason enrollments in ACA were so comparatively disappointing is more complicated than one would think. It is not simply because of adverse selection or Republican sabotage, but because low-income people are NOT willing to pay the (gross) cost of coverage. Senator Rand Paul could have saved these Ivy league researchers a lot of time. On Fox News, Senator Rand Paul asked, “Why would any smart citizen on a tight budget want to pay health insurance premiums for twelve months, for a high deductible health plan, if they can get away with a small-dollar penalty at tax time and sign up for the health plan without penalty anytime they get sick?” Good Question!
The Harvard professors found that health insurance leads individuals to consume more health care (as much as 25% more) than they would have consumed if they were uninsured. This is normally considered a good thing, as the value of providing the coverage is to get people to take advantage of it. A KFF Study found that uninsured adults are far more likely to postpone health care or forgo it altogether, with potentially severe consequences, particularly when preventable conditions or chronic diseases go undetected. However, low-income people are smarter than some of these researchers give them credit for. They know that they are more likely to get providers to forgive them for uncompensated care if they are "NOT" insured. Some research indicates that they can often settle their health care bills for 20% to 35% of the cost of care, but not if they have any kind of health insurance. I know some people, who purposely tell their health care providers that they have no health insurance, even though they have it; for this very reason.
This study of mature programs in Massachusetts, shows the existence of a significant degree of resistance to sign-up for health insurance, even with very generous premium subsidies. They found that premium rates at 25% of carrier cost will at most get only Half or less (<50%) of the potential uninsured enrollees. And, even if government subsidies lower the premiums to 10% of average health carrier cost, Twenty (20%) percent of the uninsured would remain uninsured under normal circumstances.
As a nation, after we add the nineteen plus (19+) Million Medicaid expansion folks, we only have about Ten (10%) of our population without health insurance. Premium subsidies would have to increase dramatically to close the gap between the cost of insurance and their willingness to pay. Unless we decide to just give all of the uninsured individual's health insurance, we will never ever reach the goal of 100% universal health insurance coverage in this country, unless, for the very poor, it is FREE! However, on the bright side, the uncompensated care situation can be delimited.
The Massachusetts Study reveals that low-income adults may have become strongly accustomed to the lack of health insurance, just as adults with higher incomes cannot imagine being without health insurance. It is mind-boggling for each to seriously consider the position of the other. To some degree, it is easier for low-income people because they usually have less to lose. Anyone who has taken a trip to the ER sees with their own eyes that the uneducated, unemployed, and working poor still use the ER as their primary care physician.
Many of our needier citizens learn from experience that EMTs respond immediately with an ambulance and they never have the slightest reluctance to using the emergency room or calling 911 whenever they feel the need. Since they generally never pay the bill, the service is free to them and hopefully a lifesaver, especially when it is necessary. People do not often die (as some Democrats are fond of claiming) or go without acute health care when they need it. However, we certainly can develop a less expensive and more effective way to treat their minor ailments. That is what Medicare-Advantage-For-All (MAA) is all about!
The ACA failed and MAA believes we have learned more about the character of the uninsured individuals in our health insurance market. The effort to do better than the ACA should incorporate how best to use our limited national resources to address the need to deliver the highest quality health insurance for the lowest possible cost to our low-wage uninsured population in the United States. Medicare-Advantage-For-All will continue to press this issue with our congressional representatives and the White House.
What Really Happened with the ACA?
It is no wonder Speaker Nancy Pelosi told the House of Representatives they had to vote on ACA before they could read it. To sum up, the ACA insurance carriers did not get too involved in any REAL risk underwriting, because the Obama Administration agreed to establish risk corridors through which to pay the insurance carriers for their losses. Promising (to pay a health insurance company) to cover their unexpected losses is like throwing the fox into the hen house. There was absolutely No incentive for the insurance companies to charge reasonable rates. They knew the federal government was going to bail them out. They low-balled the rates so they would attract more members and after they could. When the losses developed, they fell back on the federal taxpayers to pick up the tab and make them whole again. And, this is almost what happened with the risk corridor payments and the reinsurance payments. But, the federal government did eventually run out of discretionary funds that Obama could pull from other programs. They ran out of money to cover these unauthorized reimbursement schemes and still, to this day, some health insurance carriers remain unpaid and are suing. These carriers, most notably Highmark BlueCross BlueShield bills are suing the federal government in court and we may still be forced by the courts to pay up.
In this way, the Obama Administration collaborated with the health insurance companies to create the perfect storm of health insurance. President Obama's mantra was “Your rates will be lower" and "You can keep your doctor”. In our humble opinion, both the Obama Administration and the health insurance industry wanted to attract as many participants into ACA as possible and deliberately created a situation that contributed significantly to the underfunding of the programs, leaving the federal and state taxpayers hanging out to dry.
Karen Ignagni, the former top lobbyist powerhouse for America's Health Insurance Plans (AHIP) in Washington D. C., was the one person, in the beginning, considered to have the influence to stop Obamacare. “Some conservatives regarded her as the enabler of Obamacare, willingly submitting the industry to vast government oversight in exchange for new customers and receiving Millions of Dollars in federal subsidies. At the other end of the spectrum, progressives saw her as a defender of the for-profit insurers that made out like bandits under the flawed health law that could have done so much more for the consumers.” Wendell Potter, a former insurance official turned chief consumer watchdog with the Center for Public Integrity, was quoted by Politico speaking about Karen Ignagni informatively to Politico's Palmer, Haberkorn, and Paul Demko (05/21/2015) in an interview entitled, "Top Lobbyist Calls It Quits at Key Moment for Obamacare": “She knew that the industry would do better under the law. She was able to envision, even with the new consumer protections, that the industry would get many billions of dollars in new revenue that can be converted into profits, and that is exactly what happened."
In sum, ACA had NO limitation on uninsured enrollees with pre-existing conditions, NO medical or personal qualifications for participation, NO deductibles, and NO coinsurance for many participants signing up, and NO risk of significant loss for anyone that did NOT sign up for the program. In most cases, there was NO or artificially low premiums. Consequently, insurance companies did not really compete with one another for the business. In short, they appear to have been in a race for the rock bottom lowest possible premium in a risk-free proposition, which guaranteed them protection against losses. The insurers obviously led their programs with teaser rates. And, as anybody would expect, some of them lost a lot of money and were subsequently motivated to drop out of the program, creating even more chaos. Other carriers raised their rates to the point of ridiculousness. And here we are today. What a mess!
MEDICAID REFORM, EXPANSION AND ENROLLMENT DECLINE
KFF reports total Medicaid spending equaled $553 Billion Dollars, which was greater than Seventeen (17%) percent of the total national healthcare spending. Sixty-three percent (63%) of the total was federal spending. The average increase in spending overall was just 2% - 3%. Historically, the federal percentage of cost-share for the Medicaid program has averaged about fifty-seven percent (57%) of the total; however, under the ACA Medicaid Expansion, the federal government picked up 100% for the cost for newly eligible Medicaid Expansion participants. Starting in 2017, this rate is to decline slightly until it reaches 90% in 2020. Consequently, the Expansion States are expecting an increase in spending in the coming years.
In 2013, the total Medicaid enrollment was 55.4 million Americans. In 2018 the Medicaid enrollment was 72.9 Million, an increase of 17.5 people. That means the Medicaid Expansion resulted in more than 17.5 Million Americans getting health insurance for perhaps the first time. While we are focused on 8 Million ACA members, the Medicaid took in twice that many. This explains why Graham-Cassady was such an important piece of legislation for the Republican-led Senate.
And, to our surprise, the total enrollment in Medicaid actually dropped by a full 1.6 Million people in 2018. This included 912,000 children leaving the CHIP program. Presumably, this drop in enrollment was because their parents got jobs and were no longer eligible for the program. KFF is studying this phenomenon as we speak. This is GREAT news. CMS views Medicaid as a transitional program. It was originally designed to help people stand on their own two feet and presumably gravitate to other insurance coverage. Hopefully, MAA will be an answer for some of these people. Obviously, there is some movement to better insurance coverage when the economy reached more full employment. This is an important safety net, but it shouldn't be an end in the road for able-bodied American workers.
Medicare-Advantage-For-All advocates support a robust Medicaid Reform package that should include the following:
- Relatively uniform state coverage for low-income citizens who may not otherwise be covered by health insurance or have access to health care service.
- Federal expenditures for the program should be converted to capitation reimbursement schemes to create an incentive for the states to spend federal Medicaid dollars wisely.
- Medicaid should have work (or community service) eligibility requirements. The focus of the program should be to help the participants to improve their lives and graduate to other forms of government or private health insurance wherever possible.
- We should increase the number of qualified people that can be enrolled in the Medicaid program wherever possible.
- The program must reduce uncompensated health care incurred by our health care providers and thereby reducing the ripple effect causing increases in the overall cost of health care and everybody else's health insurance.
- Require states to improve their measurable health outcomes and introduce professionally managed care administration wherever possible.
- Develop special high-risk pools within the Medicaid program to cover all those with uninsured and uncontrolled pre-existing medical conditions, that are unable to qualify for MAA or other non-group coverage. The cost of this condition should be funded directly by the Medicaid program in a cost-plus manner and shared equally between the state and federal governments.
- Encourage the development of Health and Wellness programs consistent with program options made available through Medicare-Advantage-For-All and other government-sponsored programs.
The current Congressional reforms do not generally work toward achieving these goals. Medicaid was originally intended to cover low-income families with children, pregnant women, disabilities, and long-term care. Approximately twenty-five percent of the budget pays for nursing home care. This is an essential program for assisting low-income families but it has a lot of problems and there are a lot of gaps in it. This program costs upwards of 790 billion dollars in 2018 according to www.CMS.gov's National Health Expenditure Data. Obamacare now covers only about 8.4 Million federally enrolled members and its cost of 124 Billion, or about one-sixth the cost of Medicaid. ACA/ Obamacare is the tail wagging the dog. It makes us think that the most important aspect behind the Affordable Care Act was the Medicaid Expansion. We are our brother's keepers, so no complaints but why can't we do a better job?
WOLF IN SHEEP'S CLOTHING
President Obama spoke about Republican efforts to repeal the ACA law as a "wealth transfer". His comment makes us think that the ACA was in his community organizing mind, a wealth transfer to the poor. Did he view Obamacare as simply a wealth transfer; taxing the rich and the businesses to support health insurance give away for the poor? There is nothing inherently wrong with the goal of providing affordable health insurance to more of the poor, but selective taxation with a broken administrative system is NOT the best way to do it. The American tax-payers are NOT Robin Hood. The ACA was supposed to benefit everybody. Maybe it didn't turn out that way because it was a Wolf in Sheep's Clothing? Or, maybe it was just a poor attempt at reform?
This web site covers "What Went Wrong" with Obamacare and argues that what we need to do is create an honest program that accomplishes what the Affordable Care Act was supposed to do "Make Health Insurance More Affordable for Everybody" and reduce the number of American without health insurance. Medicaid is a very important piece of this mosaic.
The federal government is supposed to share the cost of Medicaid with the States on a $1 for $1 basis with exceptions, including the cost of the ACA Medicaid expansion. As of the 2018 Mid-term elections, this expansion increased Medicaid enrollment by at least 11 million people in 31 States. The Obama Administration agreed to pay 100% at first, gradually reducing to 90%. The 19 States that didn’t accept this offer, perhaps because they didn’t trust Obama’s Trojan horse, do not now face federal budget cuts, but they are under threat from HHS in their ability to participate in certain enhancements to the Medicaid program. Supporters of Medicaid expansion have taken to the ballot-box with public interest questions and in states like Maine and Virginia, Medicaid expansion is a big battle.
Although coverage in the expansion states successfully added millions of presumably medically needy people, Senator John Barrasso, M.D., WY, a very active participant in Senate health care debate, described his State’s experience with this give-away expansion as follows, “Obama made Medicaid the dumping ground for low-wage employees in Wyoming, making it more difficult for those people that really need the program to get the health care they need.” This is an important perception, because just maybe Medicaid is NOT the best way for us to take care of our low-wage working population that qualified for the Obamacare Medicaid expansion? We have developed a viable federal Community Health Center system. It is conceivable that a Medicare-Advantage-for-All insurance option that appeals specifically to this population, using the federal Community Health Clinic system. Throughout this great land of ours, we now have over 3,000 federally approved Community Health Centers with 11,000 service locations, employing over 40,000 medical professionals and successfully delivering vital primary care to over 25 Million deserving Americans, at no or a low cost sliding scale fee. This is one of the truly greatest achievements of the Department of Health and Human Services and the U.S. Congress in the delivery of health care. It essentially fills the gap in the ability of poor people in the nation to receive necessary and affordable. primary health care.
These Community Health Centers started in the Johnson era, have long enjoyed bipartisan support and we at Medicare-Advantage-for-All.Com were instrumental in getting Congress to extend the funding during the last great debt limit expansion approved by Congress. However, even as we were successful, the Clinic system was only funded for two years, thru 2010. The Community Health Center system and the CHIP program used to be funded simultaneously but this tandem routine was broken in the last cycle, maybe due to the fact that the health Center system may provide family planning services in some cases. Community Health Centers may be the most appropriate way to offer this needy population affordable primary care healthcare and comprehensive health insurance? Many of these Clinics are now (and could be expanded) into more urban opportunity zones and rural areas, to take of a population which is not well serviced by the Affordable Care Act. Please see our explanation of the "Community Health Center Insurance Plan" that we propose below, for more details.
The federal government, being generally a more than equal partner in the Medicaid program, rightly insists on dictating most of the regulations (like Obamacare / ACA- does) to the health insurers. However, this often prevents states from making basic changes to their programs without 1332 Waiver approvals, which in some cases, are slowing down the efforts of the states to organize their programs and make them cost-effective. This is true for Medicaid Work Requirements. HHS has been quite vocal about the need for congressional action to streamline this waiver process. Prominent Governors, included Florida’s former Governor (now U.S. Senator) Rick Scott, have successfully lobbied the Trump Administration for greater freedom to opt-out of harmful Title I regulations, and allow their states to determine the fate of their own Medicaid programs. This sometimes allows the states to get more money for the programs in Block Grants. Block Grants allow the states to determine the best way to spend their health care dollars consistent with the goals of fairness and the dictates of federal law. This concept was confirmed in Dan Holler's Heritage Action for America email to their members on the Senate fight over Graham-Cassady on 06/17/2017.
Some states have done better jobs than others in organizing and developing their Medicaid programs. In June 2017 ten (10) Top Insurance Executives/CEO’s, in an Open Letter to Senators McConnell & Schumer dated June 20, 2017, noted that "Most states have turned to Medicaid managed care plans to leverage their experience and expertise to deliver coverage that coordinates and manages health care, improve health outcomes, and build partnerships with providers to curb fraud, waste, and abuse for the efficient use of public funds.” As examples, Massachusetts and Ohio have implemented public and private sector programs that saved billions of dollars for Medicaid.
GRAHAM-CASSIDY MEDICAID REFORM BILL
The principal problems with the proposed Graham-Cassidy ACA and Medicaid Reform proposals included the fact that the Medicaid managers from all 50 states avowed their inability to make the necessary changes proposed in Capitation Funding, etc. required by the legislation. We also have to affirm that state budget cuts all too often result in reductions to covered services or provider reimbursement under the state Medicaid programs. It happens all the time because the population being served is generally without political representation. To understand this point, you need only read Paul Krugman’s April 24, 2018, OP-ED in the New York Times entitled, "We Don’t Need No Education“… You need to know what the government in America does with your tax dollars.
As one old-timer described it, the federal government is basically an insurance company with an army: nondefense spending is dominated by social security, Medicare, and Medicaid. State and local governments, however, are basically school districts with police departments. Education accounts for more than half the state and local workforce; protective services like police, (Medicaid) and fire departments account for much of the rest. So what happens when hardline conservatives take over state capitals, as they did in much of the country after the 2010 tea party wave? They almost invariably push through big tax cuts. Usually, these cuts are sold with the promise that the lower taxes will provide a huge boost to the state economy.
This promise is, however never – and I mean never – fulfilled; the political right’s continuing belief in the magical payoff from tax cuts represents the triumph of ideology over overwhelming negative evidence. What tax cuts do instead sharply reduce revenue, wreaking havoc with the state finances. A great majority of states are required by law to balance their budgets. This means that when tax receipts plunge, the conservatives running many states can’t do what almost All of our past Presidents and our federal congressional representatives do at the federal level. They simply raise the budget deficit balloon. Instead, the states that have to balance their budgets, have to cut their spending.”
This invariably results in cuts to school budgets as well as what many consider to be essential health services to the poor and disadvantaged residents covered by their state Medicaid programs. We need to look no further than the State of Florida, which last year was forced to strip over $500,000 Dollars from their Medicaid budget paying for hospital services. Since Medicaid constituencies are not usually the most active and vocal constituencies, Medicaid is usually an easy target. Although, the Kaiser Family Foundation recently noted that the opposition to Graham-Cassidy clearly demonstrated that Medicaid has more political support than most people previously thought possible. Since many states have turned over their management of the Medicaid programs to health insurance companies, these programs are now huge sources of revenue for them. This is good for the Medicaid recipients and good for the taxpayers.
The Graham-Cassidy ACA/ Medicaid Repeal and Replace effort was a proposed Medicaid reform to allow the federal government to use capitation reimbursement to pay the states for the federal share of Medicaid responsibility. This capitation payment method is essentially the same (per capita funding) that is being used successfully to keep the costs of the Medicare Advantage plans (Medicare Part C) for the Over age 65 retirees under control. This is further verification that the capitation method of reimbursement is a valid way for the federal government to save taxpayers money. Creating a Medicare Advantage For All will save everybody a lot of money.
ACA and Medicaid programs suffer from similar circumstances. In the reform bills proposed by the House and the Senate, the federal government is planning to cap the Medicaid program with the same tools and techniques the government uses with the Medicare Advantage (MA) insurance carriers, i.e. to convert federal reimbursement to the states to a “per capita” system. This is the same funding mechanism used by CMS for Medicare Advantage plans. As you know, Medicare-Advantage-For-All has been advocating for Medicare Part C to use capitation funding to make health insurance more affordable for everybody!
COMMUNITY HEALTH CENTER AND RURAL HEALTH INSURANCE REINVESTMENT ACT
"We the People" are respectfully requesting that Congress act to give us Better Health and Better Health insurance. We think they can accomplish both of these things by creating a special Medicare Advantage For All Insurance Plan. However, even when Congress does that, it is likely that some Americans are not going to sign up for the program. In fact, we know, from the studies in Massachusetts that, " even if government subsidies lower the premiums to 10% of average health carrier cost, as many as twenty (20%) percent of the uninsured would remain uninsured under normal circumstances."
That being the case, what can we do for those people who either do not qualify for the MAA program subsidies, or for whom the premium contributions are too high? KFF has verified through numerous studies that cost is the reason more of the currently uninsured residents do NOT sign up for Obamacare.
What we can do is build in a COMMUNITY HEALTH CENTER PRIMARY CARE INSURANCE PROGRAM that relies upon the Community Health Centers to provide comprehensive primary care for all residents of the United States that are NOT eligible for, OR covered by any other health insurance program, such as Medicaid, Medicare, and private insurance.
This insurance plan would be offered as an option under the Medicare Advantage for All program and will fill an essential GAP we have within the 30 Million uninsured Americans. This will certainly be a popular option for health insurance because the federal government will pay the Community Health Centers directly for the participants' primary care, making the only required premiums for the tertiary program coverage and services that are not normally provided by the Health Centers. Consequently, this option will be by far the best deal for comprehensive insurance coverage in the nation.
However, like health maintenance organizations (HMOs), only those people within the Community Health Centers service area will be able to take advantage of the program. But for those that are able to take advantage of the program, this option will provide for their primary care they need through the Neighborhood Clinic system in both urban and rural underprivileged service areas. This is the most cost-effective approach to meeting their needs. The wrap-around health insurance product will cover subscribers for any tertiary health care they may require it. This is the most efficient use of our limited resources, making full use of the federally approved Community Health Centers, and taking care of the most basic health care needs for those residents that have the greatest difficulty getting adequate health care in the United States.
We will still extend MAA to the under age 65 population and build in fair sliding scale premiums and tax credit subsidies to make the programs affordable for those that are below the poverty lines and the unemployed. However, for those people, who don't qualify or just plain will not sign up for the program, who make up approximately 20% of the target uninsured population, this special Public Option Health Plan will be available. The CHC can be the sole primary care home for Forty-five percent (45%) of the uninsured Americans, who think the ACA is too expensive. As Americans, we will be able to say that everyone in the United States has access to basic health care for themselves and their families.
The Community Health Center network (CHC) has approximately 10,000 centers, employing over 51,000 health care workers and serving 1,400 communities nationwide. Some of the Clinics are financially independent while others are substantially supported by the federal government. All of the health centers accept all forms of private health insurance, Medicare, Medicaid, and they also rely heavily on grants and philanthropic contributions wherever possible. Last year Congress just re-authorized CHC funding for another two years, just after funding the CHIP program. These two programs are usually coupled together as the backbone of our commitment to provide necessary health care to our most deserving residents. The Community Health Centers serve a large number of clients covered by Medicaid and CHIPS. Special expertise, support, and direction for CHC will be provided for this program by HHS.
The Community Health Center network is a True American Jewel in our health care system, a wonderful thing of which every American citizen should be very proud. True Americans believe in the value of our healthcare system and our need to care for one another. We should all be proud to deliver essential health care services to “We the People” in the United States of America through this network. Please don't miss the upcoming Sixth Edition (6th)- The True American for more information.
SPIRITUAL FITNESS
The Center For Relationships in Nicholasville, KY was created by Dr. Jan Cottrell, M.A. M.Div. D. Min, LPC, and Dr. Ken Cottrell, O.D. (husband and wife team) to provide Spiritual Direction, which is considered by many to be the province of the church. they believe that spiritual fitness is an essential characteristic of the ability of human beings to sustain their health. If a person does not have "it", the propensity to be sick is sometimes greater and the ability to heal from illness is sometimes more difficult! If you don't have it and you need it or want it, you may benefit from seeking Spiritual Direction.
Spiritual Direction is a time-honored tradition of having a professional accompany your own spiritual journey. This is an "ancient practice" common to almost all cultures and most spiritual traditions, including the mainstream religious traditions of Christianity, Buddhism, Judaism, Islam, and Taoism. The practice involves simply seeking the guidance of a trusted person or mentor to explore the significant spiritual questions of one's life. In the ancient Celtic Church, this guide was called an Anam Cara, or "Soul Friend" who often took the form of a priest or monastic with whom individual seeking guidance would meet privately to discuss matters of the spirit, something similar to the practice of psychiatry and psychotherapy. In the Buddhist tradition, this "Soul Friendship" is most clearly demonstrated in the relationship between student and teacher, an integral component of the Buddhist spiritual practice. Regardless of the terms, one uses to describe it, or the tradition in which it is practiced, Spiritual Direction is a precious and sacred thing through which the seeker may discover the nature of the human condition and our ability to heal ourselves from illness with the help of a spiritual guide. Thomas Merton famously opined:
"What can we gain by sailing to the moon if we are not able to cross the abyss that separates us from ourselves? This is the most important of all voyages of discovery, and without it, all the rest are not only useless but disastrous."
Why Seek Spiritual Direction?
People seek Spiritual Direction for many reasons … Some people seek it as a way of deepening and strengthening their spiritual life. Others seek greater structure or discipline in their spiritual practice, especially if they are dealing with the challenge of healing from a serious illness. Still, others may come to the practice with a desire to experience a greater sense of freedom and exploration of their own inner nature. Sometimes, not infrequently, miraculous healing occurs from this practice!
It does not matter if you come from a strong religious tradition or come to Spiritual Direction without any kind of connection with a spiritual community at all. Many people recovering from Post-Traumatic-Stress-Disorder (PTSD) or engaged in the 12-Step Recovery Program, benefit tremendously from Spiritual Direction. With it, they find companionship, support, encouragement, witness and sometimes they discover spiritual resources of which they were unaware.
A Spiritual Director has a very special place in the heart of those people, who have been wounded and hurt by religious communities or religious institutions. Being shunned, ridiculed, condemned, or harshly judged by people and communities from whom one may have previously sought support, affirmation, love, and compassion, can leave lasting scars on a person's soul. These painful wounds can sometimes take a lifetime to heal. Qualified Spiritual Directors are aware of this pain and can help such people develop a rich, meaningful spiritual life. Without Spiritual Direction, victims are often left with little or no resources to guide them towards wholeness and spiritual healing. Many such individuals have never been given permission to ask spiritual questions or have been discouraged from seeking help with spiritual issues. Deprived of access to such loving kindness, which should be the birth-right of every human being, establishing a relationship with a qualified Spiritual Director (particularly one in the Jungian training) can provide the safety and support to restore a persons' loving, empowering connection to their inner soul.
Today, too many people are only vaguely familiar with spiritual teachings and as a result, nothing in their lives is changed by this passing acquaintance. Faith can make you well and end this suffering. If you truly want to heal, you must reach out, move beyond curiosity, and believe that your faith can heal you.
Does spiritual healing actually occur? My friend and doctor James Roach, MD, one of the worlds leading integrative medicine experts, answers like this: "Suppose you went to a friend's house at midnight, wanting to borrow three loaves of bread. You say to him, "A friend of mine has just arrived at my house for a visit and I have nothing to feed him." And, suppose he calls out from his bedroom, "Don't bother me. The door is locked for the night and my family and I are all in bed. I can't help you." But this I tell you - though he won't do it for their friendship's sake, if you keep knocking on that door long enough, he will finally get up and give you whatever you need, because of your shameless persistence. And, so I tell you … Dr. Roach says, "keep on knocking and the door will be opened" to you. So, what do you have to lose?
The Medicare-Advantage-For-All.Com Family has Foibles:
We are somewhat skeptical about the efficacy of the Old Paradigm medicine to produce a sustainable state of health for the American people. We are dumbfounded by the fact that while we spend way more than any other nation on health care, the illness conditions suffered by Americans over the last two decades have increased. That is to say that the CDC Health, United States Report for 2017 shows that the extent to which the American people suffer from heart disease, cancer, diabetes, hypertension, cholesterol, and obesity have all increased over the last twenty years. There are more than a few conflicts of interest involved in our health care system. A few glaring examples are the fact that the CDC owns the patents on some 56 vaccines, meaning this government agency actually benefits from providers using their vaccines? Hopefully, the American people also benefit from the use of these vaccines?
We already pointed out that the federal government, through the ACA, created a Cartel of health insurance carriers that have isolated exclusive state markets with no competition. The formerly competing non-qualified health insurance products were declared illegal. So, in these restrictive markets, which account for over 50% of the jurisdictional counties in the United States, there is no real impetus for these private health insurance companies to advocate health insurance reform, improve their products or services or restrain their rates. The grand-fathered and grand-mothered non-qualified health plans are still considered valuable products maintained by their subscribers since the ACA's inception. Their legal existence has been extended by executive actions annually, however many of the companies stopped selling the policies altogether. The Medicare Advantage For All.Com core belief:
There is the undeniable bias that public illness feeds the medical system. If nobody got sick, there would be no illness to treat, now would there be? Of course, we do not believe there is any medical professional nor health care institution or purveyor of health care in the United States that would, in any way, do anything that would arbitrarily support or promote the increase in the cost of medical care. The only things we are absolutely sure of is that the health conditions suffered by the American people have deteriorated over the last twenty years. We believe that competition between health insurers and medical providers is the key to cost containment. The motivation to produce a profit leads to is the highest and best use of limited capital resources and the health care industry in the United States is the best in the world, because it is in quasi-private hands not in spite of it. In Congress, we are not debating how to send everyone to the VA. What we need to do is open up our markets, eliminate unnecessary government regulation and laws restricting liability, reduce bureaucratic red tape and eliminate partisan political bickering over what is in the best interests of the health and well-being of "We The American People". Medicare Advantage for All has the potential to be that kind of health insurance option and we believe it can drastically improve the health of the American people, reduce the cost of health insurance, give every resident of this country the option to be insured and reduce the NHC-GDP to a world competitive level. We can preserve our high quality of health care and the competitiveness and world market viability of our businesses, upon which we rely for our prosperity.
DR. MILLER'S FORMULA FOR SUSTAINABLE HEALTH
In Dr. Miller's world, maintaining a healthy diet is one of the most important things necessary for the maintenance of a healthy lifestyle. Americans sometimes get led astray from what he believes are the best dietetic practices. Take the American Food Pyramid for instance. It was meant to be our guide to a healthy diet. This nutritional guide was first introduced in the United States in the early 1970s. It has been substantially revised over the years and the healthful nature of the revisions may have suffered from political influence. The USDA and Congress are beholden to the food industry giants and our diet pyramids have been reflective of their interests for sustainable business income, sometimes more than our sustainable health.
How do we know that? Luise Light, who was the lead USDA nutritionist in charge of the revisions planned in the 1990s said that her team made many revisions for the Pyramid's Chart and the governments Dietary Recommendations that were substantially changed by the Secretary's office to make the changes more acceptable to the food industry. The recommendations were altered to emphasize Processed Foods over Fresh and Whole Foods, to downplay lean meats and low-fat dairy, huge increases in the number of recommended servings of wheat and other grains were introduced, even to the point of changing the color of meat on the chart's picture from red to purple, because red might connote negativity. Changes were also made to the guidelines recommending Americans "eat less" to "avoid too much". Obviously, a lot of factors go into this kind of decision making and some of these things have been addressed in subsequent revisions of the pyramid but the results are clear. Today, the critics of the current guidelines still maintain that the public interest is corrupted by advancing the commercial concerns of agribusiness and large food processors and scientists' intent of preserving their points of view. The bottom line is the United States is not only the biggest spender on health care on the planet but it has the highest percentage of citizens (66%) that are over-weight and obese (just < 40%) with practically the highest rates of chronic disease the world has ever known. Correlation does not equal causation and it's likely there are a lot of other factors in play into it, but one thing is absolutely for sure, some of the old Food Pyramids did not help!
Fortunately, the Food Pyramid is now OUT! In 2017, Michele Obama helped usher in the new USDA Food Plate. Dietary Guidelines are changed every five years under very involved political machinations. The new food plate image reflects the 2010 Dietary Guidelines for America, which unlike the earliest pyramids, promotes measures like switching to fat-free or low-fat milk, opting for drinking water over sugary sodas, and filling half of the plate with fruits and vegetables. Toby Smithson, R.D., of the American Dietetic Association, likes the new message, which is not so much avoiding foods (as maybe it should) but at least choosing the right things to eat.
The American people are by no means short on diet plans, but like the Food Pyramid, some sustain good health better than others. Dr. Miller refers to the Pyramid as sub-optimal. He believes proper nutrition for cellular structure requires a whole new approach. If we are informed, we are on one of the new and improved diets and we are eating the right things. Dr. Miller has developed five diet plans, four of which are shown below. His first proprietary "Elimination Diet" plan consists of SOME foods you can eat, and Foods to avoid 100%! His Elimination Diet is the one through which his other diets must be filtered. He also has a Paleo Diet, a GAPS diet, and a Gluten-Free Diet. But the Best diet he has developed is, "The Last Diet", which he swears is the last diet we will ever need.
Dr. Miller's Formulas:
Dr. Miller's Formula for sustainable health is so novel and attention-getting because we are only human. He recognizes and confronts our weaknesses and is willing to tell his patients the truth! He believes there are only two reasons good health does not occur and only two reasons why we stay in poor health: 1.) We don't know what we are doing. or, 2.) We are NOT making an effort. In his book, it is one or the other. There is no #3.
In order to stay sustainably healthy, he teaches that we have to take ownership. Our body is a Living Temple. Each of us, if we are lucky, was born with a perfect body and a perfect mind. It is what we do with them (and what happens to us) after birth, which causes all the problems. If we are in poor health, we often need a new Modus Operandi of wanting to do the right things, rather than needing to do the right things. Sustainability is the key. Getting well and staying well frees us from needing doctors and drugs. We, as patients, are not just eliminating symptoms, we are building a sustainable healthy lifestyle. Dr. Miller, as a physician, is not just eliminating his patient's symptoms, he is helping them adopt a sustainable healthy lifestyle. As we get older, we are supposed to become more mature. Our childlike behavior is supposed to slip away. Knowing what to do is part of it, but doing what we know we should do is the game-changer. Sustained health requires our maturity, obedience, and skilled direction.
The New Medical Paradigm (Predictive, Preventative, Personalized Medicine or PPPM) allows physicians to become more Predictive of future potential illness, Prevent that illness from occurring with recommendations for lifestyle changes, exercise routines, supplements, and diets, etc. and Personalized required treatments for any illness the patient suffers (PPPM). A case in point would be a teenager, who is over-weight with parents who are over-weight. He is hyperactive. His cholesterol is high and he eats a regular diet of pizza, soda, school lunches, snacks, and sweets. He is inactive, doesn't play sports, and is glued to his computer and iPhone on social media. He is obviously a candidate for diabetes, high blood pressure, and possibly cardiac illness in the future unless there is a change in lifestyle. If he visits the doctor for a check-up, will anything be prescribed? The New Medical Paradigm has his doctor taking the time to diagnose the problem, educate him and his parents, and following up. Our system of paying primary care physicians does not support this New Paradigm. But, unless their behaviors change, the Predictive future of his health will not change. A NEW Patient Paradigm is also needed. A Patient Paradigm shift requires new ownership that supports optimal health and locks in an elevated lifestyle, that is above short-term episodic symptomatic cures and behavioral modifications. This New Paradigm requires the HHS focus on Advanced APMs that Seema Verma has been harping on for years, where clinicians are required to accept some risk for their patients’ quality and cost outcomes and meet other standards. This area (pioneered by the CMS Innovation Center) may be most useful to HHS in the implementation of the New Paradigm. This will be an integral part of the Medicare Advantage For All plans (MAA) and the health and wellness programs that support them.
In Buddhism, there is a relationship between a teacher and a student. Dr. Miller believes a patient can be both a teacher and a student. He teaches that once we know the HOW to create optimal health, our inner teacher will know to make the optimal choices that will allow us to become the truly healthy person we were meant to be. Our student tends to have a built-in forgetter. The more time one spends with the teacher, the better! The intensity and enthusiasm Dr. Miller brings to his medical practice is the same intensity and enthusiasm that he instills in his patients. By training them to achieve their health goals, he enables them to live healthy lives. Every day, we Americans face a minefield of temptations and choices on the streets, in the bars, liquor stores, marijuana emporiums, supermarkets, our workplaces, and our homes. How can we make the time to exercise? How can we stick with a healthy diet? How can we remember to take our medicines and supplements and all the things we need to maintain a healthy lifestyle? The more maturity, knowledge, enthusiasm, and determination that we bring to the task; the more successful we will be at it. As with most other things, it helps if we don't have to do it alone. Dr. Miller believes it is harder to be in poor health once you have an awareness of what you need to do to stay in good health. Let's face it, there is NOTHING more important than our health! Without our health we have nothing. We can't do anything. We can't make a living, enjoy our families, or have any peace of mind. This is without a doubt, the MOST IMPORTANT PRIORITY FOR THE UNITED STATES OF AMERICA and it has been overlooked. Sure, we have other issues and we have lots of disagreements but just try telling someone who is sick that there is something that is more important than their health. We must intentionally walk the walk and talk the talk, and that is what Dr. Miller helps his patients do. He practices medicine in the New Paradigm. We need more medical practitioners like him.
The following is a list of articles, nutrition, and detoxification ideas and diets written by Dr. Miller. They are copied here for your ready reference. They can not substitute for the personal experience of his practice of medicine in his office at True Health Solutions in Lexington, KY. He also helps patients long distances from all over the world by telephone, mail, and email. His foreign patients fly in to see him periodically. The results he has achieved with patients that have failed treatments with other medical practitioners is remarkable. He has an extensive proprietary battery of laboratory tests that allow him to assess a patient's illness and develop a treatment plan. He provides clear instructions on the improvements necessary to eliminate poor health and then teaches his patients how to sustain a healthy lifestyle, today and every day. This is an uncommon medical practice and focuses that we need to perpetuate in our Country. Please call Dr. Miller directly with questions about his protocols, recommendations, and diets, or if you need his help to create a healthy lifestyle. Call Dr. Mark Miller: 1-859-223-2233.
Dr. Miller's Pathways To Health
SUSTAINABILITY IS KEY TO STAYING WELL
TRUE SOLUTIONS - EASE. DIS-EASE. DISEASE
GOOD HEALTH - IS IT EASY? YES! (Poor health is difficult!)
HEALTH & THE MUSTARD SEED (It is not how much... It is how often!)
HEALTH & WHAT YOU SEE IS WHAT YOU GET (Watch your focus.)
HEALTH & YOU. YOU ARE THE TEACHER … (do not be the student.)
HEALTH & MATURITY vs. IMMATURITY
OPTIMAL HEALTH - OUR CREATORS GIFT.
HE CALLED IT "THE LIVING TEMPLE'"
VICTORY QUOTIENT (and the number #1 Rule.)
AUTONOMIC NERVOUS SYSTEM CHART
Dr. Miller's Diets:
"Let your food be your medicine and your medicine be your food" Hippocrates (The Father of Medicine).
DISCLAIMER: It is important to keep in mind that the above Pathway recommendations and following diets are NOT meant to treat or heal any specific illness, disease, or condition, but rather to provide a general guide to restoring balance and vitality in your life. Dr. Miller believes these dietary guidelines are worth their weight in GOLD! He hopes that one day everyone will have access to them. However, please keep in mind that we realize that normally when someone gets something for FREE, the item, no matter how valuable, loses its inherent value in the eyes of the possessor. Perhaps this is true with this advice, which is freely given. However, if you, or someone you know, really needs a restoration of their health or would like to avail themselves of Dr. Mark Miller's skills and expertise, for heaven's sake, call Dr. Miller's office directly in Lexington, KY at True Health Solutions: 1-859-223-2233. He believes in the value of telemedicine and has managed patient care long distance for many years. So call him today!
YOU NEED NUTRITION … NOT SO MUCH FOOD.
FOUR (4) BASIC DIET / LIFESTYLES: We believe there are only four basic diets/lifestyles that will persevere. Every year new fad diets are introduced to make it interesting with new names, like the Primal Diet or the Whole 30 Diet. But, don't be fooled. Their basic components usually resemble the following four (4)basic diets:
- ELIMINATION DIET- We filter all the diets through the Elimination Diet. This is the basic diet through which all the other diets are layered.
- PALEO DIET
- GLUTEN-FREE DIET (Part 1, Part 2)
- THE LAST DIET (Part 1, Part 2, and Part 3) - Your Daily, Weekly, and Monthly Guide to eating while promoting healing and Optimal Health. Call Dr. Miller's office for a full description of The Last Diet.
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SUBSIDIZING HEALTH INSURANCE FOR LOW-INCOME ADULTS ...
Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts Amy Finkelstein, Nathaniel Hendren, Mark Shepard April 2017 Abstract How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts’ subsidized insurance programs.
https://research.hks.harvard.edu/publications/getFile.aspx?Id=15
THE EFFECTS OF MEDICAID EXPANSION UNDER THE ACA: UPDATED FINDINGS FROM A LITERATURE REVIEW
The is a KFF review of a substantial body of research on the Medicaid Expansion under the ACA, which thru 2018 has added 17.5 million people to the Medicaid roles at almost a 100% cost to federal taxpayers. Enrollment increases substantially reduced the uninsured rate in expansion states. Most of the research demonstrates that Medicaid expansion positively impacted access to care and the utilization of health care services among the low-income population.
http://files.kff.org/attachment/Issue-Brief-The-Effects-of-Medicaid-Expansion-Under-the-ACA-Updated-Findings-from-a-Literature-Review
MEDICAID AND CHIP ENROLLMENT DECLINE SUGGESTS THE CHILD UNINSURED RATE MAY RISE AGAIN
Combined enrollment for Medicaid and CHIP declined in 38 states by 912,000 children in 2018. Everyone is worried because an annual decline has only happened once in the last 20 years, back in 2000. It seems logical that the decline is related to the decline in adult Medicaid contracts overall and is due to the fact that we have a strong economy and the lowest unemployment rates, however, skeptics say this question can not be answered until the U.S. Census Bureau's American Community Survey data becomes available this fall.
Medicaid and CHIP Enrollment Decline
Suggests the Child Uninsured Rate May Rise Again
Contact Medicare Advantage For All Consultants to support a practical solution to America’s health care crisis. Our goal is to achieve affordable, comprehensive Medicare coverage for citizens nationwide.
