“We only provide you with “access” to health care. Don’t bother us with details about how to pay for it. Stop being not rich. That’s your problem, ya know. Stop being poor and middle class. “
“We only provide you with “access” to health care. Don’t bother us with details about how to pay for it. Stop being not rich. That’s your problem, ya know. Stop being poor and middle class. “
The Congressional Budget Office may release numbers on the GOP’s ACA replacement as early as 4 PM EDT today. Just remember who appoints the CBO’s leader as the Republicans try to backpedal and say the numbers are biased when the CBO estimates just how many poor and middle class people are going to lose health care coverage under Trump and the GOP.
Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools, for people who have health problems.
But critics say even some of the most successful high-risk pools that operated before the advent of Obamacare were very expensive for patients enrolled in the plans, and for the people who subsidized them — which included state taxpayers and people with employer-based health insurance.
Craig Britton of Plymouth, Minn., once had a plan through Minnesota’s high-risk pool. It cost him $18,000 a year in premiums.
Britton was forced to buy the expensive coverage because of a pancreatitis diagnosis. He called the idea that high-risk pools are good for consumers “a lot of baloney.”
“That is catastrophic cost,” Britton said. “You have to have a good living just to pay for insurance.”
The argument in favor of high-risk pools goes like this: Separate the healthy people, who don’t cost very much to insure, from people who have preexisting medical conditions, such as a past serious illness or a chronic condition. Under GOP proposals, this second group, which insurers expect to use more medical care, would be encouraged to buy health insurance through high-risk insurance pools that are subsidized by states and the federal government.
Republican Speaker of the House Paul Ryan made the case for high-risk pools on public television’s “Charlie Rose” show in January.
“By having taxpayers, I think, step up and focus on, through risk pools, subsidizing care for people with catastrophic illnesses, those losses don’t have to be covered by everybody else [buying insurance], and we stabilize their plans,” Ryan told the TV host.
Minnesota’s newest congressman, Rep. Jason Lewis, a Republican representing Burnsville and Bloomington, recently endorsed high-risk pools on CNN.
“Minnesota had one of the best … high-risk insurance pools in the country,” Lewis said. “And it was undone by the ACA.”
It’s true that the Affordable Care Act banned states’ use of high-risk pools, including the Minnesota Comprehensive Health Association, or MCHA. But that’s because the MCHA was no longer needed, the association’s website explains; the federal health law requires insurers to sell health plans to everybody, regardless of their health status.
Supporters of the MCHA approach tout a return to it as a smart way to bring down the cost of monthly premiums for most healthy people who need to buy insurance on their own. But MCHA had detractors, too.
“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” said Stefan Gildemeister, an economist with Minnesota’s health department.
MCHA’s monthly premiums cost policyholders 25 percent more than conventional coverage, Gildemeister pointed out, and that left many people uninsured in Minnesota.
“There were people out there who had a chronic disease or had a preexisting condition who couldn’t get a policy,” Gildemeister said.
And for the MCHA, even the higher premiums fell far short of covering the full cost of care for the roughly 25,000 people who were insured by the program. It needed more than $173 million in subsidies in its final year of normal operation.
That money came from fees collected from private insurance plans — which essentially shifted a big chunk of the cost of insuring people in the MCHA program to people who get their health insurance through work.
Gildemeister ran the numbers on what a return to MCHA would cost. Annual high-risk pool coverage for a 40-year-old would cost more than $15,000 a year, he says. The policyholder would pay about $6,000 of that, and subsidies would cover the more than $9,000 remaining.
University of Minnesota health policy professor Lynn Blewett said there is a better alternative than a return to high-risk pools. It’s called “reinsurance.” In that approach, insurers pay into a pool that the federal government administers, using the funds to compensate health plans that incur unexpectedly high medical costs. It’s basically an insurance program for insurers.
The big question is whether lawmakers will balk at the cost of keeping premiums down for consumers — whatever the approach, Blewett said.
“The rub is, where that funding is going to come from?” she said. “And is the federal government or the state government willing to put up the funding needed to make some of these fixes?”
The national plan Ryan has proposed would subsidize high-risk pools with $25 billion of federal money over 10 years. The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.
Researchers at the consulting firm McKinsey & Company say reinsurance would likely cost about a third of what the high-risk pool option would.
This story is part of NPR’s reporting partnership with Minnesota Public Radio and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. It is reprinted here with permission.
Give Republican Sen. Charles Grassley of Iowa some credit. While many of his Republican colleagues have been ducking the angry crowds in their home districts, Grassley has been facing them head-on, according to this article from the Washington Post:
In the politest possible way, Sen. Chuck Grassley (R-Iowa) asked his constituents to keep their voices down.
“I learned a long time ago that if I keep shut, I learn more,” Grassley said on Tuesday afternoon, to the crowd spilling out the doors of a community center meeting room. “If people just kind of respect other people speaking, it’ll help everybody to hear.”
It was Grassley’s second town hall of the day, the umpteenth of a political career that began with a 1958 race for state legislature. He wrote down each question as it was spoken to him — about the confirmation of Secretary of Education Betsy DeVos, about whether Congress would probe Russia’s election meddling, and whether he’d favor the impeachment of President Trump.
And he faced round after round of questions on the Affordable Care Act, from people who sometimes choked up as they described their specific, positive interactions with the law. After one woman emotionally described how her family would have been “destroyed” had the ACA’s subsidies not defrayed the cost of her husband’s illness, Grassley assured her that the law would not simply be repealed.
“There isn’t one piece of legislation put together yet,” he said. “If there is, it would be along the lines of giving the states some options of either staying under Obamacare or having some flexibility to do Medicaid.”
For 22 years, Nick Fugate washed dishes at a local hotel near his home in Olathe, Kan.
“There was nothing easy,” said the 42-year-old man who has an intellectual disability, chuckling. “I just constantly had to scrape the dishes off to get them clean.”
The work did sometimes get tedious, he said, but he didn’t really mind. “Just as long as I got the job done, it was fine,” he said.
Nick’s father, Ron Fugate, said the job was the key to the self-reliance he’s wanted for his son ever since Nick was born with an intellectual disability 42 years ago.
“From our perspective,” Ron said, “having a job, being independent, participating in the community, paying taxes, being a good citizen — that’s a dream parents have for their children in general.”
But things got tough last year when Nick lost his job and his health insurance. For the first time, he enrolled in Medicaid. He got his basic medical care covered right away, but in Kansas, there’s now a long waitlist — a seven-year wait — for people with intellectual disabilities to get the services they need. Decades ago, Fugate might have been institutionalized, but Medicaid now provides services to help people remain independent — including job coaching, help buying groceries, food preparation and transportation. These are the services Nick is eligible for but must wait to receive through Medicaid.
In the months since losing his employment, Nick has had to pay around $1,000 a month out of pocket for help buying groceries, career coaching and transportation. Those expenses are quickly burning through his life savings.
This year, families like the Fugates have been speaking out about that long waitlist and about other Medicaid problems at public forums like one held at the Jack Reardon Convention Center in Kansas City, Kan., in May.
In a basement meeting room, hundreds of people with disabilities, their families and caseworkers railed against KanCare — the state Medicaid program. Some heckled the moderator. The state has been gathering feedback because it needs the federal government’s permission to continue running KanCare.
In 2013, Republican Gov. Sam Brownback put KanCare under the management of three private companies that promised to improve services, cut waste and save enough money to end the long waits for the kind of services Nick needs.
Two and a half years later, many families say they’ve seen few signs of improvement, especially in terms of shortening the waitlist. In fact, it’s actually grown by a few hundred names to about 3,500. And, except in emergency situations, the wait to get treatment averages seven years.
But an end is in view, insisted Brandt Haehn, commissioner for Home and Community Based Services, part of the agency that oversees KanCare.
“I think everybody in the system is doing the best job they can do to provide the people services,” Haehn said.
In August, the department announced it had eliminated a different waiting list — the one for getting physical disability services. That claim has been challenged by advocates, who say many people were dropped from the list without notice.
But state officials say the progress that’s been made in speeding up the start of services for KanCare applicants who have physical disabilities demonstrates that the agency can get results.
Haehn did acknowledge that cases like Nick Fugate’s, of developmental disability, are more expensive and complicated than physical disability cases. It will take time, he said, to come up with $1.5 billion — the state’s share of a $2.6 billion program — that’s needed to make sure that, at least through 2025, everyone qualified for these important services can get them without having to wait.
“Nothing would make me happier than to write a check and give all these people services, but that’s just not reality,” Haehn said. “So I have to deal with what reality is and try to use the money that I have to effect positive change in the most people.”
But Ron Fugate said KanCare had its chance. “We’re not treading water, we’re drowning,” he said. Families like his are quickly losing lifelong savings, he said, and their life situations are getting worse while they wait for the state to provide services.
“It’s not getting any better,” he said. “We’ve got to start taking some serious action on this and get it addressed. We’ve kicked the can down the road too long.”
The U.S. Department of Justice is investigating the waiting lists, although it declined to comment for this story.
The ability of the state of Kansas to act may be limited. Gov. Brownback’s tax cuts, which he initiated to boost the economy, have instead blown a hole in the state’s budget, leaving little money to apply to something like reducing the length of the KanCare waitlist.
Meanwhile, Ron Fugate and other advocates have been studying the ways Missouri recently eliminated its waiting list for similar services, in hopes of persuading Kansas legislators to adopt the same strategy.
Ron and his wife are both in their 70s and say they’re now watching their carefully laid plans for their son’s future slip away.
“After 22 years, it looked like he was going to be able to complete a career,” Ron said, “and it didn’t happen that way. All of this comes at a time in our lives where we’re in the waning seasons. We did not anticipate this kind of a challenge at this point.”
Kansas submits its application the federal government to reauthorize KanCare this month.
MADISON, Wis. — Having health insurance is vital for 21-year-old Mercedes Nimmer, who takes several expensive prescription drugs to manage multiple sclerosis. So Nimmer was thrilled to get health insurance last year through the Affordable Care Act’s marketplace and qualify for a federal subsidy to substantially lower her cost.
Yet, the government assistance still left her with a $33 monthly premium, a hefty amount for Nimmer, who makes $11,000 a year as a part-time supply clerk.
Nimmer, though, doesn’t have to worry about even that expense thanks to a United Way of Dane County program that has provided premium assistance to about 2,000 low-income people since 2014. The program, called HealthConnect, is funded by a 2013 gift of $2 million from UW Health, a large academic hospital system connected to the University of Wisconsin that also runs its own marketplace health plan.
“Oh my gosh, this is a big deal for me to get this help,” Nimmer said, noting the insurance is vital to cover her medications. The money she saves from the assistance program goes to help pay for gas to get to work, she said.
HealthConnect is one of several community-based programs across the United States helping thousands of lower-income Americans with their Obamacare marketplace premiums. Similar efforts operate in Texas, Oregon, Washington, North Carolina and South Carolina.
But premium assistance programs have come under fire from insurers. They argue that it is not fair for hospitals, other health providers and disease advocacy groups financed by providers to try to steer people who could be covered by Medicare or Medicaid into marketplace plans with higher reimbursement rates.
The federal government has banned hospitals from directly subsidizing patients’ health insurance premiums. But America’s Health Insurance Plans, the industry’s lobbying group, wants the Obama administration to prohibit all premium assistance programs that are funded directly or indirectly by hospitals and other providers with a financial interest in the patient’s care.
“In many cases these practices are harming patients and undermining the individual market by skewing the risk pool and driving up overall health care costs and premiums,” AHIP said in Sept. 22 letter to Andy Slavitt, the acting administrator of the Centers for Medicare & Medicaid Services. The letter notes specific concerns about plans assisting patients requiring kidney dialysis. It says one insurer saw its spending on those patients rise from $1.7 million in 2013 to $36.8 million in 2015 when the number of patients with serious kidney disease rose from 28 to 186.
AHIP officials also said patients could face consequences if the third-party groups stop paying premiums or the government determines patients are receiving a federal subsidy for which they are not eligible.
America’s Health Insurance Plans wants the Obama administration to prohibit all premium assistance programs that are funded directly or indirectly by hospitals and other providers.
In response, CMS says it is considering new rules for third-party payment programs.
Nonetheless, insurers are taking action. Aetna, which announced this summer that it was scaling back its marketplace offerings, said that third-party groups steering patients to the individual market had contributed to an unhealthy mix of customers in its marketplace plans.
Blue Shield of California in July filed suit in a state court against CenCal Health, which manages the Medicaid program in Santa Barbara and San Louis Obispo counties. Blue Shield alleges that CenCal was avoiding millions of dollars in medical care claims by enrolling around 40 of its very ill members in Blue Shield’s individual health plans and paying the premiums on their behalf. CenCal denied the allegations in lawsuit, saying it paid the patients’ monthly Blue Shield insurance premiums so they could afford private insurance. It has since discontinued the practice.
UnitedHealthcare filed a lawsuit in federal court in July against kidney dialysis provider American Renal Associates, accusing it of encouraging patients in Florida and Ohio who were eligible for Medicaid or Medicare to move to the insurer’s commercial plans to extract up to 20 times more than the $300 or so that the federal programs pay in reimbursements. American Renal Associates has said the suit is without merit.
The suit alleges that the patients’ premiums were paid by the American Kidney Fund, an advocacy group for patients.
AHIP officials note that the fund is supported by dialysis providers who stand to benefit financially from patients gaining marketplace coverage over payments from Medicaid or Medicare.
The nonprofit American Kidney Fund has helped more than 6,400 people with their marketplace premiums. The fund’s officials said it’s not trying to steer people away from government coverage but trying to help those who otherwise couldn’t afford coverage.
“It is critically important to emphasize that people with disabilities in general — and with end-stage renal disease in particular — should not be broadly excluded as a class from the insurance marketplace if they are unable to afford their health insurance premiums,” LaVarne Burton, the fund’s CEO, said in a statement.
Some patient advocates, like those at HealthConnect in Wisconsin, say third-party payers have an important role in helping low-income customers afford their coverage. UW Health said in a statement that HealthConnect helps all providers, including UW Health, by reducing the number of uninsured patients and potentially helping people seek care earlier in their illness.
The program pays an average of $109 monthly per person in premium assistance. For every dollar spent, HealthConnect generates $2.26 in federal subsidies, said Krystal Webb, a spokeswoman for United Way of Dane County.
United Way said it structured HealthConnect to avoid a conflict of interest. Eligible people first buy their policy, which can be any of several silver-level plans on the federal marketplace. After that, they can apply for a HealthConnect subsidy. The program is administered by United Way, and UW Health plays no role in patients’ choice of health plan, although its marketplace plan, Unity Health, refers people who may be eligible there.
Despite AHIP’s concerns, some health insurers in Dane County say HealthConnect is filling a need, according to interviews with several plans. “We support United Way’s HealthConnect efforts as a way to provide affordable insurance options to the residents of Dane County,” said a spokesman for Dean Health Plan, one of the larger marketplace plans in the county.
In Texarkana, Texas, Christus St. Michaels Health System donated $200,000 last year to an assistance program serving 138 people with marketplace coverage. The program is run by a local government agency called the Ark-Tex Council of Governments, and Christus has no control over who enrolls or what plan they choose.
“Our mission is to help the poor and this is certainly one of the ways to do that, and it gives people the opportunity to have health coverage when they normally wouldn’t,” said Mike Hargrave, the hospital’s manager of employee assistance and community outreach services. People with incomes between 100 and 150 percent of the federal poverty level (about $11,880 to $17,820 for an individual) are eligible.
Hargrave doesn’t deny the hospital could benefit when more people gain insurance, but he notes other hospitals in the region benefit, too.
The insurance industry is also troubled by premium assistance programs funded by anonymous donors since they could be hospitals looking to protect their identity, said AHIP spokeswoman Clare Krusing.
For example, PremiumHealth.org, run by United Way of the Greater Triangle in North Carolina helps more than 850 people with incomes between 100 percent to 175 percent of the federal poverty level in Durham, Orange and Wake Counties.
An anonymous donor provided $1.2 million in funding for the program, said Melanie David-Jones, a senior vice president for United Way. She would not say why the donor wished to remain anonymous.
Noel Pitsenbarger, 48, of Durham, said the program made it possible for him to have health insurance this year by covering the $200-a-month premium for his Blue Cross Blue Shield of North Carolina policy. With insurance, he said, he got a colonoscopy, physical exam and help paying for several medications. And it saved him from having to pay a $1,000 bill after he cut his finger and had to go to the emergency room.
“It’s been extremely beneficial,” he said.
With major insurers retreating from the federal health law’s marketplaces, California’s insurance commissioner said he supports a public option at the state level that could bolster competition and potentially serve as a test for the idea nationwide.
“I think we should strongly consider a public option in California,” Insurance Commissioner Dave Jones said in a recent interview with California Healthline. “It will require a lot of careful thought and work, but I think it’s something that ought to be on the table because we continue to see this consolidation in an already consolidated health insurance market.”
Nationally, President Barack Obama and other prominent Democrats have revived the idea of the public option in response to insurers such as Aetna Inc. and UnitedHealth Group Inc. pulling back from the individual insurance market and many consumers facing double-digit rate hikes.
The notion of a publicly run health plan competing against private insurers in government exchanges was hotly debated but ultimately dropped from the Affordable Care Act when it passed in 2010.
Health insurers have long opposed the idea, and other critics fear it would lead to a full government-run system.
Most of the discussion surrounding a public option, however, has focused on a nationwide plan, not one emanating from a state. In July, Democratic presidential nominee Hillary Clinton said she would “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan.”
Jones offered few specifics on what a public option might look like in the Golden State.
“I don’t want to begin to prejudge it,” said Jones, an elected Democrat serving his second term as head of the state Department of Insurance, one of two insurance regulators in California. “I don’t know whether you would start in certain areas of the state and expand from there. I think there would be significant reservations about the state running it. There would be a wide variety of governance models you could come up with.”
Politically, the proposal may gain more traction in Sacramento than Washington with Democrats firmly in control of the state Legislature and many lawmakers eager to go beyond the boundaries of the federal health law. Depending on what form it took, a public option would require state legislation, some type of federal approval and some source of funding.
The idea of a California-style public option drew mixed reaction. Some consumer groups say they welcome another run at the public option after a disappointing outcome in 2010.
“We’re certainly very interested,” said Anthony Wright, executive director of Health Access California. “This is something we advocated for in its most ambitious form during the debate over health reform and there are elements of the proposal that could be adapted for California.”
Some health-policy experts questioned whether the proposal would backfire, ultimately reducing competition.
“I don’t know what would compel other insurers to stay in the market, so the public option could quickly become the only option,” said Katherine Hempstead, who directs the Robert Wood Johnson Foundation’s work on health insurance coverage. “I think that is only a clear win when the alternative is nothing.”
State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee, said a public option could make sense in some underserved areas. But he said it may not address the problem of large health systems dictating high prices, and it could interfere with the progress made by the Covered California insurance exchange.
Covered California said 7.4 percent of its 1.4 million enrollees will only have two health plans to choose from for 2017. The state’s biggest markets of Los Angeles, San Francisco and Orange County all feature six to seven insurers.
“I don’t know if a public option will create a lower price [for] the consumer,” Hernandez said. “Covered California has done a good job of keeping rates fairly stable and it has enough plans.”
Health insurers agreed. “Covered California has arguably one of the strongest and most stable exchanges in the country. There is robust consumer choice so we don’t think we need to mess with something that isn’t broken,” said Nicole Evans, a spokeswoman for the California Association of Health Plans, a trade group.
For years, Jones has criticized the lack of competition in Covered California, and more recently he has opposed the mergers proposed by industry giants Anthem Inc. and Aetna Inc., saying they’re anticompetitive.
Anthem wants to acquire Cigna, while Aetna is trying to merge with Humana, but the U.S. Justice Department has sued to block both deals.
Covered California has fared better than many states in terms of insurer competition. Eleven health plans are participating in the state-run exchange for 2017, but UnitedHealth is dropping out after just one year in California’s individual market.
Consumer advocates had hoped UnitedHealth would become a strong rival to the state’s four largest insurers. Anthem, Blue Shield of California, Kaiser Permanente and Health Net (now a unit of Centene) account for 90 percent of the state’s exchange enrollment.
After modest 4 percent rate increases in 2015 and 2016, Covered California premiums are set to climb by 13.2 percent on average next year.
Jones said he anticipates that critics will cite the failure of numerous co-ops across the country as evidence a public option won’t work. But he said that criticism is unjustified because the Republican-led Congress eliminated crucial funding that many of the co-ops were depending on.
The co-ops are nonprofit insurers backed with federal loans and designed as an alternative to commercial health plans.
One of the great myths put forward by the Tea Party crowd is the idea of poor women wanting babies so they can live off the pubic assistance each child provides; despite the fact that public assistance benefits are often poverty level, at best.
Yet those same people block every effort — birth control, safe and legal abortion, family planning counseling — to help those women prevent unwanted children. It’s one of the confounding paradoxes of right-wing thinking: we don’t want poor people having babies but we’ll do everything we can to make sure that they are saddled with children they — and taxpayers — cannot afford.
Obamacare is making a difference in this regard, as this Chicago Tribune article points out:
Health economists say the financial barrier to birth control drives up unintended pregnancies and, ultimately, the taxpayer burden.
The monthly co-pay for pills, though typically under $50, adds up. And the cost of an IUD, arguably the most effective method on the market, can reach $1,000.
It’s too early to tell how cheaper contraceptives may be affecting the birth rate. Years of research show the stakes remain high, no matter where you stand politically, when it comes to broader access to birth control.
A poor woman in the United States is five times as likely as an affluent woman to accidentally become pregnant and have a baby, the Brookings Institution recently found.
Unintended pregnancies, in general, cost taxpayers $21 billion a year, according to the Guttmacher Institute, a nonprofit reproductive health organization. That averages out to a cost of about $366 per every American woman of child-bearing age.
State programs show a stunning connection between increased birth control availability and decreased teen pregnancy.
Between 2007 and 2012, for example, Colorado saw the highest percentage drop in birth rates among teens 15 to 19 in the country, according to a CDC report. Its teen birth rates over that period dropped 39 percent, compared to 29 percent nationwide.
Health officials said a simple public program sparked the change: 30,000 IUDs, offered for free (or close to it) by the state’s family-planning clinics.
The best babies are babies born into families where they are planned, wanted and able to be raised by parents ready for the challenges both personal and financial.
Another sign that we need single-payer health care:
More than a quarter of adults who bought health insurance on exchanges created under Obamacare skipped important doctor visits and medical tests because they could not afford to pay, a study published Thursday by Families USA found. Among low- and middle-income adults, the proportion of people who avoided care was even higher, at nearly one-third.
More than 14 million people in the United States gained health insurance through Obamacare, landmark legislation officially known as the Affordable Care Act that was passed in 2010. Nearly 12 million people signed up for health coverage plans on exchanges created under Obamacare, according to the website ACAsignups.net.
But more than half of the adults who bought such plans had deductibles of $1,500 or more, Families USA, a Washington nonprofit organization focused on health care, found. A deductible is the cumulative amount a person has to spend on health care before his or her insurance company starts to pay. Despite receiving tax credits to help offset the cost of coverage, these deductibles were prohibitively expensive.
“Simply having health insurance is no guarantee that consumers can afford to pay for health care,” the report noted. When people decided to forgo medical care, fees that would have to be paid out-of-pocket were a major contributing factor, the report, which surveyed adults with lower- and middle-income levels, found. The report did not include people who had health insurance through Medicaid or those who had health insurance through their employers.
Overall, the Affordable Care Act made health insurance and health care itself more affordable, in part by subsidizing the cost through tax credits to those who qualify. But for some Americans, it was not affordable enough, the report showed. Of adults who were insured for a full year, 25.2 percent did not get necessary medical care, including tests, treatments and medications. Of lower- to middle-income adults, 32.3 percent reported not getting care they needed.
It’s all well and good that people can actually sign up for health insurance they would not otherwise have. But it’s kind of pointless if those people have deductibles so high they don’t even go to the doctor.
If you think you don’t have to care, you should. One of the main points of the fight over Obamacare was to get as many people as possible onto health insurance of some sort so that the taxpayers don’t keep footing the bill for uninsured people who get sick or have accidents. It was also to get people going to the doctor so that potentially serious problems might be caught before a minor problem turns into a more serious (and more expensive) ailment.
We will eventually need single-payer health care. If our leaders can get over the health care gridlock that almost consumed Obamacare, and manage to get the health establishment on-board. That might be a tough job. One of the chief reasons health care costs are out of control is not so much waste by each consumer — although that plays a part — as much as it is the simple fact that there is a lot of money to be made on health care and a lot of vested interests don’t want to see that gravy train disappear.