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Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

Democrats’ Aim Should Be Universal Coverage – Improving the ACA is the Right Vehicle

I get why the liberal wing of the Democratic Party is obsessed with enacting Medicare-for-All as the vehicle to universal coverage. I do. There’s no question that if we got it right, it would be both far more equitable and cost-effective than the present chaotic patchwork of a “system” that we’re currently lumbered with. I was raised in England and I know what a blessing the National Health Service has been, warts and all, in providing first class health care to everyone and without driving any of anybody into bankruptcy.

I also understand only too well the frustration of forever being told that it simply can’t be done, that the odds are stacked against it. How do we know unless we try, right?

Nevertheless, reality must intrude. First, as we have already seen with the few states that have tried to add a public option to their ACA markets that the health care industry will wage total war on any suggestion of even a modest expansion of of a public health care option. And when I say the health industry, we’re talking the insurance companies, the hospital industry, the pharmaceutical industry and much of the medical profession, particularly specialists, surgeons and the hospitals each of whom gain the most from the present lack of price controls on any but Medicare patients, and who will fight tooth and nail to keep it that way. Added to the health industry’s implacable opposition will be the Republican Party and the entire right-wing universe complete with relentless fear mongering and lies. And they will have a powerful issue that lends itself to demagoguery. Socialized medicine! Egads!! The fact that they’ve called the ACA, modest insurance reform at best, the same thing will of course be lost in the din.

Second, a total reform of the entire US health care system, one that dwarfs the enactment of the ACA, will require the support of most Americans, 180 million of whom currently have employer-provided health insurance which most of them believe is just fine, thank you very much. And Democrats would be asking them to give that up and see their taxes increase to boot – a hard sell even though insurance premiums will go away. All of this on the promise that expanding Medicare to include everybody, entirely rationale but something we’ve never tried before, would be better. And then there’s the seniors who are currently well satisfied with their Medicare and will be scared into believing (by you know who – see above) that somehow they will lose much of what they have if their health care is folded into a national scheme for the whole population.

In short it will not merely be an uphill struggle to enact Medicare-for-all but the policy equivalent of free climbing Half Dome in Yosemite National Park and to believe otherwise is delusional.

But there are other ways to universal coverage. In fact there are many models among developed countries that have achieved and did so with a system that incorporates private insurance albeit heavily regulated. Switzerland is one, for example. Check this link to the non-partisan Commonwealth Fund for a thumbnail sketch of the Swiss system and that of other developed nations from whose systems we can draw lessons .

Which brings us to the Affordable Care Act. Like all compromises on huge and complex pieces of legislation, the ACA is manifestly imperfect and in need of substntial improvement, for example by vastly reducing out-of-pocket expenses and greatly expanding the income cut off to receive premium subsidies. Yet the law has significantly increased the number of people with health insurance whilst proving unexpectedly resilient in surviving GOP efforts to repeal it and the Trump administration’s attempts to weaken it. If Democrats win the White House and Congress in 2020, they have an opportunity to undo all the damage of the Trump era and to make the ACA a far bigger success in providing affordable health coverage to a vulnerable population.

As well, Democrats have other costly priorities to address such as climate change and relieving our kids of the huge debt burden of college loans, to name but two. A full throated battle for a single payer health system will suck all the political oxygen out of the air and leave us with little energy to seriously tackle those issues. And that would be a tragedy.

Reports of Obamacare’s demise greatly exaggerated.

Reports of Obamacare’s demise greatly exaggerated.

To listen to Republicans, pundits and much of the media, the Affordable Care Act is already gasping for air; emitting what many hope is its death rattle. For Republicans and Fox News, Christmas has clearly come early thanks to the botched rollout (how many times have we heard or seen that phrase?) of the landmark health law.

The latest polls show that both President Obama and his signature legislative achievement have taken a serious hit. Some Democrats have already assumed that defensive crouch that seems to come so naturally to them when the going gets rough – witness the 39 cowards in the House who, disgracefully, voted for a GOP bill that would have seriously undermined the ACA.

The federal website’s dysfunction was bad enough but Obama’s inaccurate assurances that everyone who had insurance and a doctor they liked could keep them, making no exception for the mostly rubbish individual policies that failed by a country mile to meet even the modest basic requirements of the ACA, created an instant political storm. To make matters worse, this last problem was compounded by the failure of the website since those who had received policy cancellation letters were stymied in their efforts to find a new policy that would likely be both affordable (when subsidies were factored) and more comprehensive in most cases.

No question this was not the place those who support this law wanted to be at this point. Nevertheless, it is way too early to panic and even more absurd to speak of the law’s demise.

Amid the media hype and feeding frenzy that’s been targeting the administration’s missteps in the initial implementation of the law (where is that “liberal media” when you need it?) the steady progress being made in states that have embraced Obamacare has been largely overlooked, as this piece in The Washington Post by the governors of Washington State, Kentucky and Connecticut highlights and this piece from The Los Angeles Times.

Fourteen states plus the District of Columbia have their own health insurance exchanges and most of these are operating smoothly (Oregon’s is not functioning at present although the state has enrolled 70,000 newly eligible people into Medicaid). There is every reason to believe that enrollment in these states, which constitute about a third of all Americans, in both the private exchanges and in expanded Medicaid will continue to pick up. For all the current furor over the website’s problems, the angst that has accompanied the issuance of cancellation letters to a much smaller segment of the insurance market than the one which will benefit unambiguously from enrollment under the ACA, raises the following question: Who exactly is going to tell these new enrollees and the millions more to come, that their insurance will be cancelled? The answer is: Nobody.

Republicans were desperate to kill the ACA before it could be implemented because they feared that once the number of beneficiaries had reached a sufficient level, it would be impossible to turn back the clock. That dynamic has not changed, irrespective of the rollout issues. Furthermore, there is nothing in what has happened so far to cast any significant doubt that the law will not work as intended.

However, it is becoming clear that the benefits of the law will not be spread evenly throughout the country. For example, the populations of the fourteen states plus DC who have wholeheartedly embraced Obamacare stand to see a large reduction in the number of uninsured sooner rather than later over the next 1-3 years. It’s not merely that these mostly Blue States (Kentucky being the exception) have established their own exchanges and agreed to the Medicaid expansion. It’s that they also are putting federal and their own resources to work with communication and outreach strategies to enroll as many of their eligible residents as possible.

At the other end of the spectrum, we have the twenty-one states (four others are undecided) who have refused both the Medicaid expansion or to establish their own exchanges. For the folks in these GOP-led states, the adverse consequences go well beyond the current difficulties with the federal website. Some states have actively impeded the work of organizations and individuals tasked with providing information and assistance (“navigators”) to residents who may be eligible for enrollment under the ACA. This lack of cooperation combined with constantly talking down the law will inevitably have the effect of dampening enrollment.

Furthermore, a significant number of working poor in the Red States who would have qualified under the Medicaid expansion that their states have refused, will also be ineligible for federal subsidies with which to purchase a private plan on the exchanges because their incomes do not meet the minimum threshold. How’s that for a double whammy, compliments of their Republican legislators and/or governor.

The bad news for the poorer residents of these Red States does not end there, however, as this story from The New York Times shows. Hospitals in mostly rural areas which provide safety-net care for many without health insurance are seeing their federal subsidies slashed because it was assumed that the beneficiaries would be covered under the Medicaid expansion. Some of the hospitals have closed or may do so without the subsidies. Needless to say the GOP governors and legislators in these states are not picking up the slack.

The fact is that for many millions of Americans, Obamacare holds the very real promise of freedom from the insecurity and stress that comes from lacking health care coverage. However, that benefit will only accrue nationally if all states recognize the enormous opportunity offered by the ACA to make the lives of our citizens better and more secure.

Today’s seniors must not be exempted from any major changes to Medicare

Today’s seniors must not be exempted from any major changes to Medicare

There are signs that House Republicans, led by John Boehner, are pivoting away from employing extortion to force President Obama and Senate Democrats into defunding or delaying the Affordable Care Act as a price for re-opening the government and raising the debt ceiling and, instead, will be the using similar extortion to force concessions on the budget. Primarily these will be through cuts to entitlements, notably Medicare.

Looking forward to that happy time when the GOP and Democrats sit down to negotiate the budget without the latter having a gun put to their head as a bargaining incentive, the issue of Medicare reform will be front and center and so I have a suggestion that should move things along: Agree that any changes to the program apply to current Medicare recipients as well as future beneficiaries.

Why? Well in the GOP’s plan contained in Congressman Paul Ryan’s ten-year budget, he changes traditional Medicare to an income-support program – which is a fancy way of describing a voucher. Seniors would be given an amount of money and told to go find a plan they like in the private insurance market. A summary of the Ryan plan as reintroduced earlier this year follows, courtesy of CNN Money:

Workers who turn 65 in 2024 or later would be able to choose between a variety of private health insurance plans, along with the traditional Medicare option. They receive a subsidy from the federal government to cover or offset the cost of their Medicare premium.

The subsidy would cover the cost of the second-least-expensive private plan or the Medicare option, whichever is less, in the first year. So if seniors select pricier coverage, they would have to pay the difference in cost. And they would receive a rebate if they selected a cheaper plan.

After that, the subsidy increase would be based on a competitive bidding process, but the per capita hike would be no more than nominal GDP growth plus 0.5%. That currently works out to about 4.5% based on figures for 2012.

Lower-income seniors would be protected, while wealthier ones would pay a higher share of their premiums.

Setting aside the pros and cons of Ryan’s plan, you will note that it doesn’t kick in until 2024! This may seem perplexing in light of the apparent urgency placed on Medicare reform by the GOP as a way to reduce future deficits. So, why the delay, one might ask, given the imperative to find these savings?

Well the GOP has done quite well in recent elections among (mostly white) seniors, winning close to 60% in both the 2010 mid-term elections and the 2012 presidential election; and this despite their continuous assertions of the need to rein in entitlements. A clever trick but how have they managed it?

Well in large part because the GOP has a nudge-nudge, wink-wink thing going on with their cranky white senior support group. Republicans have let it be known that while they still want Medicare gutted, they’ll delay the gutting for a decade and grandfather in today’s seniors and those soon-to-be who can keep their current Medicare benefits. From 2024 new seniors will be lumbered with the voucher plan. Thus reassured, our current generation of selfish old codgers can happily vote Republican and the least informed among them denounce Obama for pushing the government to get its hands on their Medicare. (And even GOP congressmen seem to have trouble understanding that Medicare is a government program – see this piece from Gail Collins, a must read).

However, the GOP cannot argue with a straight face that on the one hand reforming Medicare is a critically urgent need but that on the other it can wait for a decade. Therefore, when the two sides eventually sit down to serious negotiations about entitlements, let’s not hear any more about ten-year phase-ins for Medicare reform. After all, even the ACA is being implemented after just three.

The Republican voucher plan for Medicare deserves a hearing and serious scrutiny. But any plan, including Ryan’s, should be seen to be acceptable to today’s seniors and not just tomorrow’s to ensure that future retirees are not given the shaft. After all, it’s only fair.

And having to produce a plan that passes muster with today’s seniors may actually bring the two sides closer together more quickly and make it a bit easier to come to some agreement on Medicare reform – albeit I suspect minus the voucher.

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

The first thing that needs to be understood is that the new budget proposal from Congressman Paul Ryan is not a serious document in any way. Rather, it is a GOP political manifesto, a document that clearly states what today’s GOP stands for and where it wishes to take the country. And it shows how unserious the GOP is about reducing our deficit and the national debt since the plan includes no new revenue and is all about cutting government programs – its real, indeed only priority.

The budget is even more harsh on the poor and middle-class than the last one since its putative purpose is to balance the budget in 10 years. In practice, if enacted it would almost certainly tank the economy and increase America’s poverty rate over its already unacceptably high level, thereby negating any financial benefit from cutting government programs.

The Ryan budget repeals Obamacare, keeps the sequester cuts on discretionary spending which would disproportionately hurt the poor and middle-class, and would actually increase reductions on domestic spending by allowing the defense budget to rise by $500 billion above the caps imposed by sequestration. It would reduce Medicaid by $750 billion over the decade and block grant it to states. It would lower taxes on the wealthy and on businesses.

Ryan’s budget would voucher Medicare but is careful to exclude seniors enjoying its current benefits and those over 55, an act of hypocrisy that is as breathtaking now as when it was first proposed. After all, if giving seniors a voucher is such a great idea from which they will benefit by exposing them to the wonders of the free market in healthcare insurance and save the country money to boot, shouldn’t we start it, like, now? Oh wait! We need to keep all those selfish old white voters in the GOP column come election day and they really don’t want Medicare messed with, at least not for them.

The budget completely ignores the fact that we just had a national election in which Ryan himself along with his ideas played a prominent role. His side lost, big time. But as far as Ryan is concerned it’s: Election? What election?

And the plans for Medicare and Medicaid demonstrate the sort of ignorance and blinkered, ideologically-driven thinking that has become the hallmark of today’s GOP. Despite the preponderance of studies that show both programs are more efficient and cost effective than the private insurance industry, and would be more so if the congressional GOP would allow them to negotiate with the pharmaceutical industry on the price of drugs, the Ryan/GOP budget plan pushes the poor and the future elderly into the vagaries of the private sector. If anyone is in any doubt regarding the lack of cost effectiveness and efficiency of the private health system in this country, they should read Steven Brill’s comprehensive report in Time: “Bitter Pill: Why Medical Bills Are Killing Us”.

The Ryan/GOP budget plan will go nowhere. That’s why Democrats were put on the earth. But it does do two things. It shows to those not yet clued in how far to the extreme right the GOP has moved in the last decade, something that may finally hurt them enough in the next election, even in the heavily gerrymandered House. But it also lays out an initial, albeit, outrageous negotiating position from which they can move left just enough, from uber extreme to merely extreme, to claim the mantle of compromise while still doing immense harm to the country. Obama, whose negotiating skills leave much to be desired since he starts in the middle and then moves further right, could learn a lesson or two.

The people of this nation, despite our differences, will soon need to make a clear choice between two distinct visions of America’s future because we can’t continue to lurch perpetually from one budgetary crisis to the next.

The first believes that while a thriving private market system is essential, so is a supportive and complementary government that regulates and softens the edges of capitalism, provides a firm safety net from its vagaries and provides a boost to the nation’s competitiveness by funding scientific and medical research, and building an infrastructure fit for the 21st century and beyond.

The other sees government as an impediment to, if not an outright enemy of the people and the free market, believes the poor and those struggling to make ends meet should largely fend for themselves, that massive income disparities are a good thing and that unfettered capitalism is the path to prosperity for all, or at least the ones who deserve it.

In a nutshell Democrats believe we should strive to be more like Scandinavia. Republicans aspire to take us back more than a century to a place that doesn’t exist any longer but we’d end up looking a lot like Mississippi today. You choose.

Cowardly GOP needs to be specific on spending cuts

Cowardly GOP needs to be specific on spending cuts

The striking aspect of the recently concluded (or postponed, or delayed – call it what you will) fiscal cliff debate was the extraordinary lengths to which GOP negotiators went to avoid spelling out the cuts they wanted in government spending. In fact, throughout the negotiations, they constantly pressed President Obama to put on the table larger spending cuts whilst refusing to do so themselves. And this is not unusual. The party of smaller government seems to have a problem specifying which parts of the federal budget they want to see reduced. On the face of it this is more than a little perplexing but actually it’s not.

Polls show that in the abstract the American public expresses support for smaller government. The problem for the GOP is that when you get to the specifics of programs to actually reduce or completely defund, that support largely evaporates. Or to paraphrase an old cliché Americans want to have their cake and eat it too.

This can be seen even in the most fanatical segment of the GOP’s own base in the form of the many white seniors who are ardent Tea Party supporters but who adamantly oppose any cuts to Medicare. Their silence in the recent fiscal cliff debate was telling. Of course these selfish seniors are strong supporters of federal spending cuts as long as it doesn’t impact them. But then as we all know, Medicare is one of the big drivers of federal spending and its share promises to get larger with each year that passes.

The point is that if we are to have a worthwhile debate on the relative merits of or necessity for government spending cuts versus increased taxation, the GOP has to display some guts and lay out what government programs they deem to be expendable. After all, it’s not Democrats who want to slash Medicaid and other programs for the poor and vulnerable, or who don’t place much of a value on infrastructure spending or expenditures on basic science research compared to keeping taxes low.

It’s simply not good enough for the GOP to talk about the need for smaller government and drastic spending cuts to reduce the federal budget deficit without allowing the electorate an opportunity to understand what that would mean in terms of government services denied or severely reduced, or to our future economic and social well-being.

A comprehensive debate would be a healthy thing for the nation. The GOP’s unwillingness to join that debate with any honesty is, on the other hand, contemptible.

John Boehner takes the wheel and careens towards the fiscal cliff with his insane Republican Party in tow

John Boehner takes the wheel and careens towards the fiscal cliff with his insane Republican Party in tow

Nearly a month has gone by since President Barack Obama was re-elected with an overwhelming victory in the electoral college and a convincing majority of the popular vote. Since then Congress has been haggling over how to avoid the “fiscal cliff”.

President Obama ran on a campaign on increasing taxes on the top 2% that was much debated throughout a very long campaign. Obama has said he will not accept a deal that does not include the expiration of Bush tax cuts on people with incomes over $250,000.

The president’s plan isn’t all about increased taxes on the rich. It also includes “$1.5 trillion in spending cuts that have already been enacted, $400 billion in additional targeted spending cuts, and additional measures to stimulate growth, including an extension of emergency unemployment benefits and new investments in infrastructure.”

Today John Boehner sent a letter to Obama with a vague outline of the Republicans’ counter proposal to the Democrats’ plan.

After a status quo election in which both you and the Republican majority in the House were re-elected, the American people rightly expect both parties to come together on a fair middle ground and address the nation’s most pressing challenges.

About that “status quo election”, may I remind everyone that Obama won his re-election with over 4 million more votes than Mitt Romney, he crushed Romney 332 -206 in the electoral college, the Democrats received 10 million more votes than the Republicans in the Senate races, and they received 1 million more votes than the Republicans in the House races. Okay, so the Republicans held onto the House, but mostly because of their gerrymandering of districts to ensure wins in spite of their being more Democratic voters than Republican voters. Hardly what I would call “status quo”.

So what did the Republicans offer? It’s very similar to what Romney/Ryan ran on: Reduced rates for everyone – except that instead of 20% cuts for all, they have pointed to the Simpson-Bowles plan that includes a 9% tax cut for the rich, and some undisclosed closures of loopholes. It also asks to cut Medicare expenses by $800 billion with a plan that calls for raising the Medicare eligibility age from 65 to 67.

The Republicans laughed out loud last week over Obama’s proposal. Obama must have laughed so hard he lost his lunch when he read the Republicans’ ridiculous plan. Why? Well for one, their tax plan doesn’t provide details of their spending cuts because they know the public would reject it outright. The only way it could raise revenue like they claim is by doing away with deductions that would affect the middle class more than the rich. Their plan would end up raising taxes on the middle class and reducing taxes on the super rich. And they think that’s a compromise? Always looking out for the “job creators” aren’t they? And adjusting the Medicare age up two years would hardly save any money because the younger seniors, those age 65-66 aren’t the drivers of cost. They are the healthiest group covered by Medicare.

After finding some way to quell his laughter, Obama asked White House communications director Dan Pfeiffer to issue a statement:

The Republican letter released today does not meet the test of balance. In fact, it actually promises to lower rates for the wealthy and sticks the middle class with the bill. Their plan includes nothing new and provides no details on which deductions they would eliminate, which loopholes they will close or which Medicare savings they would achieve. Independent analysts who have looked at plans like this one have concluded that middle class taxes will have to go up to pay for lower rates for millionaires and billionaires.

Obama has the upper hand in these negotiations, and word has it that he will not cave into Republican demands for lower tax rates on the rich.

Senator Patty Murray, from my state, has refused to budge and said it is better to go over the cliff than to agree to a Republican deal “that throws middle-class families under the bus.”

The Democrats are going to win this time as they should.

The efficient management of Medicare is the way to save it

The efficient management of Medicare is the way to save it

Medicare is a government program that provides a fee-for-service benefit to cover most of the health care needs of seniors in America. As with health care in general, Medicare costs have increased substantially but, nevertheless, delivers care more efficiently than the private sector insurance industry thanks largely to much lower overhead costs and a slower rate of growth.

The Republicans led by Mitt Romney and Paul Ryan under the pretext of “saving Medicare” propose a plan whereby seniors would be paid a fixed amount which they could use either for the traditional program or private insurance. This they euphemistically call “premium support”. The plan would spare current seniors already receiving Medicare (got to keep those votes in the GOP column!) and is aimed at coming generations of seniors. One may ask why, if the plan is so great, it shouldn’t take effect immediately after the plan is enacted. Maybe we’ll come back to that point.

We all know that Medicare has looming funding problems that threaten the future viability of the program. The GOP’s hated of Medicare is matched only by their fear of messing with an entitlement that happens to be popular across all age groups. Their solution to the conundrum has two steps: the first is to devise a plan that under the guise of saving Medicare effectively ends it in its current form through partial privatization.

The second step is to demonize efforts by Democrats and other supporters of traditional Medicare to find efficiencies within the existing system. How can anyone forget the GOP-Tea Party screams of “death panels” during the Affordable Care Act debate and opposition to such common-sense ideas as the Independent Payment Advisory Board (IPAB), an independent body comprised of medical experts tasked with recommending efficiency changes to Medicare’s payment system.

So the GOP impedes efforts to improve the efficiency of traditional Medicare, and then argues that the only way to reduce the program’s long term costs is to end it as a guaranteed benefit and introduce what they characterize as market efficiencies.

The problem is that, as with any free market approach to health care, the profit motive gets in the way. It’s difficult, after all, to make money from sick people, particularly the chronically ailing. The GOP plan, therefore, is likely to shift some of the costs of their care to many seniors themselves since it is unlikely the price support will keep pace with the rise in health care costs. The GOP trumpets that seniors will have lots more choices than they do now but, in truth, how many seniors are equipped to shop for a health care plan that suits their particular circumstances – and get it right? It’s difficult enough for younger working adults to manage. For an aging and financially vulnerable group like seniors, the risks in getting it wrong are far greater. No wonder the GOP grandfathered in (no pun intended) current seniors to keep the existing system.

The traditional Medicare system remains the best way to go. This is not to say that we can’t find innovative new ways, including the use of financial incentives for the private health care providers that deliver services to seniors, to make Medicare more cost-effective. For example, by adopting a fixed fee-for-care approach that emphasizes outcomes rather than the current fee-for-service system is an idea that deserves serious consideration.

But we need to move beyond sterile accusations of rationing health care. If the system is to survive, rationalization of Medicare services will be essential and unavoidable. We can do it the irrational GOP way which is to let the market decide who gets what services regardless of the health needs of the individual. Or we can keep the existing Medicare system with its guaranteed benefit, and work to make it more efficient and cost effective from within.

I think for most of us, it’s a no-brainer.

The Lack of Universal Healthcare Hurts US Productivity and Competitiveness

The Lack of Universal Healthcare Hurts US Productivity and Competitiveness

Both the United States and the United Kingdom have struggling economies in the wake of the Great Recession with high unemployment rates and levels of economic insecurity. But consider this: In the UK if a worker loses or changes his job, his access and that of his dependents to that nation’s universal healthcare system remains the same no matter what. And he will never be billed a penny for any medical treatment he or his spouse or his children receive.

Contrast that with his American counterpart. Assuming that he is fortunate enough to work for a company that even provides health insurance, he is always vulnerable to the possibility of out-of-pocket medical expenses not covered under his plan. (Medical debt is the single biggest cause of personal bankruptcy in America. 62% of personal bankruptcies are the result of medical expenses, and 78% of them had some form of medical insurance.)  If he loses his job he also loses his health insurance. And to get covered under a new insurance plan will be difficult if not impossible if he or a dependent family member has a significant pre-existing condition.

The Affordable Care Act will ameliorate some of the most egregious features of the private health insurance market and the gaps in coverage. However, Republicans are committed to repealing the law. Medicare and Medicaid provide medical coverage for the elderly and very poor but both programs are under assault from the GOP under the pretext of reducing the budget deficit.

In an economy that is struggling for air many companies are saddled with burdensome overhead to provide health insurance for their workers. For example, it’s been estimated that healthcare costs add up to $2,000 to the price of a car made in Detroit. It’s no accident that US automakers have plants in Canada where wage rates are comparable but they don’t have the same burden of worker health costs. And these adverse effects on our industrial competiveness are by no means limited to the auto industry.

The current argument over entitlement spending misses the point. The fragmented nature of the American non-system of health care coverage is the problem not Medicare and Medicaid. The private insurance industry, with its inordinately high administrative overhead compared with, say, Medicare, has proven to be as inefficient and ineffective at slowing medical inflation as it is at providing affordable insurance to the poor and ailing elderly. That is why Medicare and Medicaid exist in the first place. Cutting the benefits or eligibility of these entitlements, therefore, as the GOP wishes will simply shift costs to those least equipped to assume the burden.

A universal health insurance system to share the cost as well as the benefits as widely as possible makes both moral and economic sense. Just ask the people of every other advanced nation in the world.

Mediscare and Other GOP Healthcare Myths

Mediscare and Other GOP Healthcare Myths

Congressman Paul Ryan has been bleating pitifully of late about “mediscare” tactics from Democrats in their criticisms of his proposed 2012 budget. In doing so he glosses over the fact that he and all other Republican lawmakers spent 2009 and 2010 engaging in mediscare on steroids as they attacked the Affordable Care Act passed by Democrats and signed by President Obama.

The ACA merely calls for defunding government-subsidized private insurance supplementary plans and to find efficiencies in the Medicare program that don’t sacrifice quality of care. What we got from Republicans were screams of “rationing” and “death panels.”

What’s more Ryan’s budget does end Medicare as we know it and no rhetorical contortions, such as comparing it to the insurance plan of members of congress, or to the Medicare drug benefit, can conceal the fact. Ryan’s proposal differs in one critical respect: unlike those examples he cited in a desperate effort to reassure Americans, the value of his proposed Medicare voucher/benefit will not keep pace with health inflation meaning that, over time, its value will inevitably decrease and seniors’ out-of-pocket expenses soar. They will, in effect, be in the same boat as those working Americans who depend on the private insurance market and who are woefully underinsured. The chronically ill will take the biggest hit, a theme that runs through all GOP healthcare proposals (remember medical savings accounts?).

Ryan’s plan founders on two fundamental misconceptions held by the right-wing in this country: that healthcare is just another consumer product on which we should make our own decisions and thus can be successfully regulated by market forces; and that the free market is the most efficient way to control health costs.

The second proposition is easily disproved. America spends a much higher percentage of GDP on health than, say, the United Kingdom or Canada. Yet those countries (and all other advanced nations for that matter) provide universal healthcare with zero out-of pocket expenses to their citizens, while the private insurance system here leaves scores of millions of Americans either uninsured or so under-insured that they risk personal bankruptcy if they incur large medical expenses. The reason is simple. Government-regulated systems abroad are able to wring far greater efficiencies from employing rational rationing of services, than is the private insurance industry in America, which employs irrational rationing based on whether you are fortunate enough to have a job with health insurance or rich enough for it not to matter, or whether you are insurable because you don’t have a pre-existing condition. And Medicare, despite room for improvement, still delivers more bang for the buck than private insurance companies, with their 15% administrative overhead.

There are two key flaws in attempting to treat health care like any other consumer product. First, it assumes that we can make decisions on buying healthcare insurance and services as we do in deciding whether to buy a new car or pay for private school for my kid. The fact is I can do without those things if I decide I can’t afford them or they just aren’t cost effective. That isn’t the case with health care which will be needed by all of us, whether we like it or not, and where delay can be fatal. And secondly, am I really the best judge of what health services I need? Are any of us? That’s why we have doctors and other health professionals to help us through those decisions; making them alone based in part on the economics, which is the essence of the GOP’s health care ideology, has far greater potential for higher costs later and lousy outcomes as we delay or defer necessary and maybe urgent treatment, or purchase a bare bones policy with huge deductibles.

Everyone with a brain knows that Ryan’s privatization proposal for Medicare is not about cutting the deficit but, rather, a reflection of the GOP’s ideologically-driven hatred of a government program that works. The phony mantle of deficit reduction did not, however, shield the GOP from the ire of the electorate. To their credit even seniors who would be grandfathered (no pun intended) under the present system have rejected it.

There’s no doubt that many billions in savings are possible from making Medicare more efficient, but the starting point has to be to preserve it in its present form, and to implement the ACA in its entirety for the rest of us. For Americans to follow the GOP on health care is to court disaster.

Medicare in the Crosshairs of Congressman Ryan’s GOP Budget Proposal

Medicare in the Crosshairs of Congressman Ryan’s GOP Budget Proposal

There is almost nothing in Congressman Paul Ryan 2012 budget proposal to commend it. It masquerades as a deficit-fighting plan when, in reality, it is simply a right-wing wish-list for a GOP dream budget, with massive spending cuts to programs that help the poor, disadvantaged and middle class, while showering more tax cuts on the rich. It would widen the already shamefully gigantic income and wealth gap between the rich and everyone else. (Recent studies have found that the richest 20% of the country owns 80-85% of the wealth, while 40% of Americans have no wealth at all). It is voodoo economics (will the right never cease peddling the falsehood that tax cuts pay for themselves?). It makes preposterous assumptions about achievable spending reductions, so as to make room for the tax cuts and still maintain a pretense that it’s all about balancing the budget rather than extreme right-wing ideological predilections.

It is, as Paul Krugman says, a deeply unserious document.

However, it does accomplish one very useful service. While Ryan little deserves the kudos he has received for political “courage” in publishing this budget (since when has it taken guts to beat up on the poor, the disadvantaged and children in this country – none of whom vote?), I do credit him with his honest proposal to privatize Medicare. And let’s not engage in sophistry over whether his Medicare proposal amounts to privatization:  of course it does.

And it should, because dismantling Medicare has always been a GOP aim.  The problem for them is all those grumpy, selfish, seniors out there who don’t really care much about the rest of us but who ferociously defend their own government programs, and have a nasty habit of turning out on Election Day.

I came to the conclusion years ago that, although well intended, Medicare inadvertently set back the cause of universal health care in the United States by shielding the most vociferous and politically powerful voting bloc from the vagaries of the private, under-regulated, health insurance industry. It was a strategic political error which cost us dearly and has taken two generations to overcome with the enactment in March 2010 of the Affordable Care Act.

Now Ryan has put the GOP on record for privatizing Medicare, and sooner rather than later. Of course it will be a disaster for seniors, unless someone can explain how you reduce the amount of government expenditure on Medicare whilst adding middlemen in the form of private insurers to take their cut, and still maintain a reasonable level of service.  No, the outcome will be many seniors who actually get sick suffering from the additional disease of being underinsured and subject to huge out-of-pocket expenses – the same malady that currently plagues many of the rest of us.

The important point is that America’s seniors can no longer take comfort in the notion that the GOP will be satisfied merely with repealing the Affordable Care Act. Once Republicans have sufficient control of the reins of government to repeal the ACA, Medicare will assuredly be next on the hit list; something for seniors to think about when they go to the polls in 2012.