Democratic presidential candidates have spent years building a new vision of American policy, one where a lot more of us get our health insurance from the government.
I see President Trump’s newly released budget as his counterproposal to all that. It envisions a really different future, one where government-run health care shrinks — and public programs become more difficult to sign up for.
Here are some key health policy features of the Trump budget (you can read the full thing here):
- Repealing Obamacare and replacing it with Graham-Cassidy. Those who followed the Obamacare repeal debate closely will certainly remember the replacement proposal from Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA). As I’ve written previously, this plan would allow insurers to discriminate against those with preexisting conditions and significantly cut insurance subsidies for low- and middle-income Americans.
- Cutting $845 billion from Medicare. These are some pretty significant cuts that are already getting a lot of attention. To be honest, I don’t see them as the most notable part of this budget. As Axios’s Sam Baker points out, a big chunk of these Medicare cuts are ones that have bipartisan backing — so much so that they the Obama administration proposed them in years past. Even Obamacare cut Medicare by $716 billion — something Republicans continually brought up in the 2012 election. At the same time, there are certain changes in the budget that could have a negative impact for patients: for example, the budget proposes requiring prior authorization for certain medical procedures that are likely to be the subject of fraud — which could make it harder for seniors to get care.
- A nationwide work requirement for Medicaid. Republican governors in places like Arkansas and Wisconsin have recently begun requiring their Medicaid enrollees to work, go to school, or be job-searching in order to qualify for health benefits. The idea is to use the medical coverage as an incentive to get more Americans to join the workforce — but early data (primarily from Arkansas) suggests that these types of work requirements can be difficult to comply with, and people who really rely on their Medicaid plans are starting to lose coverage. The Trump budget would create a nationwide Medicaid work requirement that would save the government an estimated $245 billion — cuts that would likely come from fewer Americans getting coverage through the program.
- Bigger copayments in Medicaid too. The Trump budget proposes “additional flexibility around benefits and cost-sharing, such as increasing copayments for non-emergency use of the emergency department.” We know from a lengthy body of health policy research that when you have higher costs associated with health care, patients cut back on their doctor trips — both the ones are needed and those that aren’t quite so necessary. You’d expect that a change like this might cut back on some unnecessary ER visits, but it’s also going to deter patients from seeking emergency care in cases where they really need it.
- No more premium-free Obamacare plans. In many parts of the country, low-income Americans qualify for “zero premium” insurance plans: health coverage where the entire premium would be covered by their government tax credit. The Trump administration wants to put an end to that. In order to “increase consumer engagement,” the White House proposes that “all subsidized individuals that purchase health coverage on the Federal Exchange to contribute something to their healthcare coverage.” How exactly this would happen is not made clear in the budget proposal.
Higher copayments, work requirements, no more zero-premium Obamacare plans — take it all together and you create a health care system where it’s significantly harder and more expensive to go to the doctor.
There are some benefits to this type of health care system, no doubt. When fewer people get public coverage — and those remaining people go to the doctor less because their copays are higher — then the government spends less money on health care. So if your biggest goal is reducing the deficit, this plan would check that box.
But those spending cuts come with some undeniable human consequences. Bryce Covert recently wrote a compelling piece for the Nation, exploring the human consequences of Arkansas’s new Medicaid work requirement. One of the things she finds is that those who are having trouble keeping up with the bureaucracy of the work requirement — who are working but haven’t properly reported that to the state — are struggling to hold on to their coverage.
What we’re seeing right now is two really different visions of the future of American health care. We have one from the Democrats that envisions a robust health care system, one without any copayments or deductibles. There are still holes in that vision — namely, how to pay for such a generous version of American health care — and I’d guess these proposals get revised to include some type of cost sharing as they work their way through Congress. All that being said, what Democrats are offering right now is a clear vision of how they think medical care should be in the United States: easily affordable and accessible to all Americans.
The other vision offered today by the Trump administration lays out a future where the government spends less on health care — and, as a result, vulnerable populations get less medical care.
This vision does not come with the difficult “how do you pay for it” questions that plague any Medicare-for-all proposal. But it comes with its own big question: namely, how are low-income Americans going to get by in a country where they get a lot less help affording basic medical services?
The answer to that question is probably that they don’t get by very well. The future the Trump budget lays out is one in which richer Americans can do just fine buying their own health care. There aren’t big changes for those who get insurance at work, as higher-income Americans typically do. But it’s a future where, if you’re poor, seeking care gets a lot harder.
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.
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20 People Share Secrets From Their Jobs and Now We Can’t Sleep Well
Almost every job has its own secrets and nuances that very few people know. The people of different professions shared secrets from their jobs on Reddit and on Twitter and some of their stories may seriously change the way you see the world.
We at Bright Side, of course, don’t have any secrets like these, but as it turns out, not all other professions are as transparent as they seem to be.
- Truck driver: 9 out of 10 truck drivers travel with a smartphone on their windshield watching a TV-series. Stay away from big trucks.
- Disney World employee: There are secret tunnels underneath both Epcot and the Magic Kingdom (and probably other parks too) that enable the cast members to travel across the park pretty quickly and easily.
Comment from a park-goer: My father suffered a heart attack while visiting Epcot. I have never witnessed a faster medical response with professionals appearing from seemingly nowhere with just as fast transport through underground tunnels. It was a lifesaver. He was transported to a Disney hospital where he received great care after an emergency surgery and our stay was extended by 3 weeks.
- IT support people: (help desks, computer repair shops, Geek Squad, etc.) are mostly just better at Googling than you are.
- Employee at a flour factory: Wheat flour is not actually white. We use chlorine to make it look more attractive. This also increases the gluten level in flour, and this is why people are more gluten-sensitive today.
- Rescue team member: When you are a young lifeguard, you always have a radio with you 24/7. And you always listen to what happens in the city. If you are going, for example, to a birthday party in your own car and then you hear there is a fire on a nearby street, you turn the car and drive there! (I have my own gear in the car). @Moscow_Spasatel
- Olive oil factory employee: We had only one kind of oil but we put it in 27 different containers and sold it at different prices. Some of them were labeled as imported, some were called the highest quality oil. But it was the same oil in every single bottle.
- IT-service engineer: When someone is fixing your computer, they also often look through the data on your hard drive searching for something funny or embarrassing. So, before you give your computer to an IT service, clear your browser history, and copy all the important data to an external drive.
- Candle factory: Paraffin candles are dangerous and poisonous. Because I know what we added in there (even to the candles that say “100% paraffin”), I will never ever use candles again. If you need to use them for some reason, buy candles made of bee’s wax without any scents.
Sommelier: Wine isn’t vegan. It’s not even vegetarian in some cases. The filtering (refining) process uses egg whites, and sometimes isinglass (fish parts).
- Movie theater: A large bag of popcorn that costs the customer $5.99 (at the time) cost the movie theatre 6 cents to produce, including the butter, the kernels, the bag, the power used by the popper and the time it took the concession employee to fill up the bag and give it to the customer.
- Internet services: Most “subscription services” will raise their prices over time because they expect you to just live with it. This applies to phone bills, cable packages, internet service, insurance plans… Call up, politely complain about the price. Skip the canned “well the price has gone up because inflation/rising costs/age/end of promotion” and continue to politely say it’s too much, your budget can’t handle all your outgoings and you may need to drop the service. Either you are speaking to someone who can reduce the price, or they can put you through to a person authorized to reduce the price.
- Mechanic: If you want to go on vacation and you don’t know where to leave your car, get it to a mechanic. Many people do this. It’s ridiculously cheap and you can be away for a month! It is much more expensive to use parking lots. @Neformatws
- Pharmacist: I’ve worked at several factories that manufacture medications. And the rules were the same everywhere: if you dropped pills on the floor, just put them back into the bottle. So, maybe your medications are not as clean as you think.
- Librarian: The amount of toilet paper, random items, and bills used as bookmarks that are left in returned library books is unbelievable!
- Doctor: We spend so much time to be good at what we do, that we know almost nothing about other things.
Is there something about your job that is kept secret?
The spring equinox is Wednesday, March 20: 7 things to know about the first day of spring.
The vernal equinox is upon us: On Wednesday, March 20, both the Northern and Southern hemispheres will experience an equal amount of daylight. For those of us in the Northern Hemisphere, it marks the beginning of spring, with daylight hours continuing to lengthen until the summer solstice in June. For those south of the equator, it’s the beginning of autumn.
Technically speaking, the equinox occurs when the sun is directly in line with the equator. This will happen at 5:58 pm Eastern time on Wednesday. (A few hours later, at 9:43 pm, you can look out for the “supermoon”, the last one until 2020.)
Below is a short scientific guide to the most equal night of the year.
1) Why do we have an equinox?
The equinox, the seasons, and the changing length of daylight hours throughout the year are all due to one fact: The Earth spins on a tilted axis.
The tilt — possibly caused by a massive object hitting Earth billions of years ago — means that for half the year, the North Pole is pointed toward the sun (as in the picture below). For the other half of the year, the South Pole gets more light. It’s what gives us seasons.
Here’s a time-lapse demonstration of the phenomenon shot over the course of a whole year from space. In the video, you can see how the line separating day from night swings back and forth from the poles during the year.
And here’s yet another cool way to visualize the seasons. In 2013, a resident of Alberta, Canada, took this pinhole camera photograph of the sun’s path throughout the year and shared it with the astronomy website EarthSky. You can see the dramatic change in the arc of the sun from December to June.
This is a 6 month pinhole photo taken from solstice to solstice, in Medicine Hat, Alberta, Canada. We are one of the sunniest cities in Canada, and this shows it nicely.
Posted by Ian Hennes on Saturday, December 21, 2013
(You can easily make a similar image at home. All you need is a can, photo paper, some tape, and a pin. Instructions here.)
2) How many hours of daylight will I get Wednesday?
Equinox literally means “equal night.” And during the equinox, most places on Earth will see approximately 12 hours of daylight and 12 hours of night.
But not every place will experience the exact same amount of daylight. For instance, on Wednesday, Fairbanks, Alaska, will see 12 hours and 15 minutes of daylight. Key West, Florida, will see 12 hours and six minutes. The differences are due to how the sunlight gets refracted (bent) as it enters Earth’s atmosphere at different latitudes.
That daylight is longer than 12 hours on the equinox is also due to how we commonly measure the length of a day: from the first hint of the sun peeking over the horizon in the morning to the very last glimpse of it before it falls below the horizon in the evening. Because the sun takes some time to rise and set, it adds some extra daylight minutes.
Check out TimeAndDate.com to see how many hours of sunlight you’ll get during the equinox.
3) Over the course of the entire year, does every spot on Earth get an equal number of daylight hours?
In the summer months, the northernmost latitudes get a lot of daylight. Above the Arctic Circle, during the summer, there’s 24 hours of daylight. In the winter, the Arctic Circle is plunged into constant darkness.
So does this mean the number of daylight hours — in total, over the course of the year — equal out to places where the seasonal difference is less extreme?
The answer to this question is somewhat surprising: Roughly speaking, everywhere on Earth sees a similar number of daylight hours every year. But the equator actually gets slightly fewer daylight hours than the poles.
As astronomer Tony Flanders explained for Sky & Telescope magazine, sunlight at the poles gets refracted more than sunlight at the equator. That refracting results in the visible disc of the sun being slightly stretched out (think of when the full moon is near the horizon and looks huge — it’s being refracted too). And the refracted, stretched-out sun takes slightly longer to rise and set. Flanders estimated that the equator spends around 50.5 percent of its year in sunlight, while the poles spend between 51.5 and 53 percent of their years in sunlight.
And, of course, this is how much sunlight these areas could potentially receive if the weather were always perfectly clear; it’s not how much sunlight they actually see, nor the strength of the sunlight that hits their ground. “Where are the places on Earth that receive the largest amount of solar radiation?” is a slightly different question, the answer to which can be seen on the chart below.
4) Can I really only balance an egg on its tip during on the equinox?
Perhaps you were told as a child that on the equinox, it’s easier to balance an egg vertically on a flat surface than on other days of the year.
The practice originated in China as a tradition on the first day of spring in the Chinese lunar calendar in early February. According to the South China Morning Post, “The theory goes that at this time of year the moon and earth are in exactly the right alignment, the celestial bodies generating the perfect balance of forces needed to make it possible.”
This is a myth. The amount of sunlight we get during the day has no power over the gravitational pull of the Earth or our abilities to balance things upon it. You can balance an egg on its end any day of the year (if you’re good at balancing things).
5) Is there an ancient monument that does something cool during the equinox?
During the winter and summer solstices, crowds flock to Stonehenge in the United Kingdom. During the solstices, the sun either rises or sets in line with the layout of the 5,000-year-old-monument. And while some visit Stonehenge for the spring equinox too, the real place to be is in Mexico.
That’s because on the equinox, the pyramid at Chichen Itza on the Yucatan Peninsula puts on a wondrous show. Built by the Mayans around 1,000 years ago, the pyramid is designed to cast a shadow on the equinox outlining the body of Kukulkan, a feathered snake god. A serpent-head statue is located at the bottom of the pyramid, and as the sun sets on the day of the equinox, the sunlight and shadow show the body of the serpent joining with the head.
This is easier to see in a video. Check it out below.
6) Are there equinoxes on other planets?
Yes! All the planets in the solar system rotate on a tilted axis and therefore have seasons. Some of these tilts are minor (like Mercury, which is tilted at 2.11 degrees). But others are more like the Earth (tilted at 23.5 degrees) or are even more extreme (Uranus is tilted 98 degrees!).
Below, see a beautiful composite image of Saturn on its equinox captured by the Cassini spacecraft (RIP) in 2009. The gas giant is tilted 27 degrees relative to the sun, and equinoxes on the planet are less frequent than on Earth. Saturn only sees an equinox about once every 15 years (because it takes Saturn 29 years to complete one orbit around the sun).
During Saturn’s equinox, its rings become unusually dark. That’s because these rings are only around 30 feet thick. And when light hits them head on, there’s not much surface area to reflect.
7) I clicked this article accidentally and really just want a mind-blowing picture of the sun
The image above was taken by NASA’s Solar Dynamics Observatory, a spacecraft launched in 2010 to better understand the sun.
This past summer, NASA launched the Parker Solar Probe, a spacecraft that will come within 4 million miles of the surface of the sun (much closer than any spacecraft has been before). The goal is to study the sun’s atmosphere, weather, and magnetism and figure out the mystery of why the sun’s corona (its atmosphere) is much hotter than its surface. Still, even several million miles away, the probe will have to withstand temperatures of 2,500 degrees Fahrenheit.
It’s essential to understand the sun: It’s nothing to mess with. Brad Plumer wrote for Vox about what happens when the sun erupts and sends space weather our way to wreak havoc on Earth.
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