Healthcare Reform

Everyone agrees that the Affordable Care Act needs to be reformed to make it more effective and affordable. The Republican complaints and solutions are totally misguided. Donald Trump has no idea of what health insurers and health insurance is all about.
To begin, Trump wants insurance to be purchased across all state line.  This means disarming state health insurance laws and licensing.  Many states will resist, but it needs to be done.  You need one set of rules.  Secondly, health insurance, for the most part, requires a network of doctors and hospitals to provide access and cost control. It can be done, but not with the current cast of federal legislators, who like the wild, wild west form of control.
What is really needed is a much better system of utilization and quality control.  The ACA has gone the first step with not paying for repeated readmissions to a hospital setting and trying to implement reimbursement based upon the anticipated quantity of care need to provide quality care.
electronic medical records and a system similar to what France has had for years would also help with the continuity of care.  In  France, you are issued what referred to as a green card which acts as your medical record.  Every time you seek care your record and your green card is updated.  When you go to a new doctor or facility, your card can be read as any and all pertinent information, which may be lifesaving, are retrieved.  The WHO ranks France as #1 in the best heal care system in the world. The U.S. is ranked 37th.  Sad!
France has private insurers you can choose from.  All are not for profit and don't have stockholders clamoring for higher profits.
While our legislators complain about the cost of health insurance under the ACA, what needs to be remembered is that the primary focus of the ACA is to provide low or no cost insurance to those who could not afford it.  Access to health service actually lowers the cost of health care in the future.  However, what's missed is the tremendous pool of premiums and other health care related expenses borne by private companies, government entities, and government subsidies.  Included in this number should be the contributions towards coverage, deductibles and coinsurance by covered individuals.  Pool all of this together and I assure you, we could provide a good, solid basic health insurance plan for all.  Every hour an employee works, which includes those who work and don't have access to an employer plan, will pay something, with the possibility of exemption for low paid workers.  I'm certain many employers would be relieved and may save from having the burden of health insurance lifted from their consideration. If an employer or an individual wants more comprehensive coverage, they can buy it or self-fund it. Individuals would have subsidies based on their income levels, hospitals would be reimbursed and not have uncompensated care. Everyone who is registered with Social Security would be covered.

Getting Ready

Janice and I are looking forward to our trip to Tuscany and Rome in early October.  We are staying about 15 miles from Sienna.  We are going with three friends from Santa Ynez Valley and staying at the house of one of our trip mates sister.  I don't believe there is a book about Tuscany we haven't bought.  Expect to visit most of the major towns and eat well.  We have a chef and wine expert coming one night to prepare a feast for us.