Tag Archives: medicaid

Step one.

There’s a lot to say about the Republican’s craven plan to push through a massive tax plan in a matter of days. I needn’t point out that the final bill is likely to be a cobbled together mess, one that we’ll be struggling with for many years to come if it ever finds its way to Trump’s signing hand. Nor do I need to repeat the obvious fact that this is a tremendous giveaway to the richest Americans, to corporations, and to the GOP’s donor base, one that demonstrates the degree to which the Republicans’ supposed concern over budget deficits is just another ploy.

Rich folks get THIS much.What I find most infuriating about this legislation is that it is being proffered at a time when its chief beneficiaries – the richest of the rich – are doing just fine, thank you very much, and corporate America is sailing from strength to strength. The last thing they need is more money in their pockets. This is also a time when our armed forces are deployed in conflicts all around the world. Trump just signed into law a $700 billion defense bill, subject to repeal of the sequester agreement. When we’re spending this kind of money and putting people in harm’s way, why the hell are we cutting taxes? What effing justification is there for that? It is beyond shameful, frankly.

Even worse, this is just part one of a two-step routine the Republicans have been rehearsing for a generation now. Step one: cut the hell out of rich people’s taxes, and blow a huge hole in the federal budget. Step two: almost immediately afterward, feign panic over a ballooning deficit and use that as a rationale to cut core social programs, like Social Security, Medicare, Medicaid, and other extremely popular programs. They have tried this numerous times before, with only limited success. This time might be different, as they are more craven than in previous decades and control every lever of power. They really don’t need any Democratic votes to push these cuts through.

The GOP has always hated Social Security and Medicare/Medicaid, largely because they are defined benefit, pay as you go institutions. To the current crop of crazies running Congress, insurance is now tantamount to Soviet-style top-down socialism. Don’t think they won’t try this: Paul Ryan has been working on setting this up for many years. We have to be ready to fight back, or you can kiss these vital public institutions goodbye.

That fight begins with killing this tax bill. Best get started.

luv u,

jp

Sickness.

As I write this, the Senate Republicans have pulled their version of the ACA “repeal and replace” legislation – a bill that’s really more a massive tax cut funded by massive cuts in Medicaid. This temporary hiatus is mostly down to the many thousands of people across the country who made their voices heard in various ways, and so to all of you I say job well done. That said, this job is not, in fact, done. The Republicans will be back very soon with a slightly amended version of the bill that can garner 50 votes, after having bought off key senators with part of that $300 billion-plus deficit reduction bundle built into this piece of legislative ordure. Just watch.

Two old men who will never need Medicaid.This entire situation – I won’t say “debate” because there hasn’t been any – is ridiculous largely because no one in Washington will admit to what the ACA’s core problems are. The Republicans, and to a certain extent many Democrats, continue to insist that competition and a freer market in health insurance will deliver affordable coverage to everyone; just pull those sick people out of the system and into an underfunded high-risk pool, and the market can do its magic.

Bullshit. The “free market” approach to individual coverage doesn’t work because individual health insurance is not a profitable line of business; insurers have known this for decades and have been pulling out of individual policies because they carry too much downside risk. They prefer large employer plans, where the only money being risked is that of the client company, not the insurer. Even if you start an individual health policy in good health, things inevitably go wrong and then the company is on the hook. Sure, they prefer younger, healthier folks as customers, but even they get cancer once in a while. Individual policies are not a money maker unless the market is so drastically tilted in the insurer’s favor that they can basically sell nominal “coverage” to healthy people.

This is why Medicaid is such a popular program. Even the GOP’s complaints about it all center on cost, not care. (They just see it as a cash cow.) Medicaid is not provided on market principles; neither is Medicare nor the veterans health program. No health insurance should be market-driven, because treating it like a commodity severely disadvantages poorer, older, and sicker people. Those categories apply to most everyone at some point in their lives. The only way to ensure that coverage will be there for all of us when we need it is single payer.

Last word: this Senate bill is sick; it is a tax cut scheme built on gutting Medicaid and pulling money from Medicare. And it will be back.

luv u,

jp

Bugs in the system.

So the government’s Affordable Care Act web site doesn’t work. Does that surprise anyone? It’s a big, honking, outsourced engineering project that has had the budget axe swinging over it for the past three years. It’s been under constant threat of being defunded or declared unconstitutional, subjected to incessant political attack in Washington and around the country by a party dedicated to disabling it anyway that they can.

The fact is, the most dysfunctional part of the Affordable Care Act is Medicaid expansion, not because it doesn’t work but because half of the states in the union have refused to participate, even with 100% funding from the federal government. We hear so much about the Web site being a piece of shit (and rightfully so), and yet I don’t see anyone on the right wringing their hands over the fact that something like 7 million people, the vast Four star general in war on healthmajority of whom are working poor, will have no access to health coverage simply because the governors and legislatures in their state capitals are intent on making a political point. Throw needy (working!) families under the bus, and that’s fine. But build a buggy Web site? Unforgiveable!

It’s pretty clear, in fact, why Republicans are pulling the rug out from under their needy constituents. Chris Hayes interviewed an Ohio state representative on Wednesday night, and while the fellow tried his best to conceal his objection to Medicaid behind some blather about legislative process, he eventually got around to saying that Medicaid was a program people would get “locked into” because they would enjoy the benefit so much, it would be a disincentive for them to raise their standard of living to the point where they wouldn’t receive it anymore. Health coverage makes you lazy. The same old G.O.P. and conservative Democrat trope about welfare, still with us after all these years. They don’t like owning up to it, but it’s still there.

I have to say that this nationwide refusal by Republicans to sign on to Medicaid expansion is certainly one of the most craven domestic policy decisions I have witnessed in my adult life. Hearing them complain about a Web site would be laughable … if this were a laughting matter.

Once again – they’re the reason our kids are ugly.

luv u,

jp

Fighting ground.

Okay, let’s get one thing out of the way at the start: very few people enjoy paying taxes. To that I can only add my own personal observation that the people who seem to complain the loudest about taxes are the ones who can most afford to pay them. They have an excellent means of making their complaints heard, too – it’s called the Republican Party. In fact, in service to those who would pay not a single dime more than the historic low rates they’re paying today, the G.O.P. is creating a default crisis out of whole cloth by linking the authorization of additional borrowing to the conclusion of a draconian budget agreement that will gut the essential social programs they have always sought to defund, privatize, etc.

The two things, of course, have nothing to do with one another in the real world. Raising the debt ceiling is merely addressing financial commitments that have already been agreed upon. It is something the Republicans have gladly passed many times before under their own presidents, as well as under Democrats. They have seized upon it because it offers an opportunity to, in effect, put the entire nation up against a wall until we give up on the idea of not spending our elderly years in penury. (That’s sooooo 1960’s of us.) The Republicans see an opportunity here to realize what they could never accomplish during George W. Bush’s tenure – privatization of Medicare, pirating Social Security, and locking in massive tax cuts from now until perdition. And they sense, perhaps correctly, that the Democrats don’t have enough fight in them to stop it.

I will gladly crib Bernie Sanders, Keith Ellison, and Dean Baker on this – Social Security is not – repeat, not – part of any budgetary problem. It is fully self-funding for the next 25 years with no changes whatsoever. How many programs can make that claim? The G.O.P. and spineless Democrats merely want to pirate the fund to pay for extending Bush tax cuts for the richest people in the country. Regarding Medicare and Medicaid, they are single-payer systems dedicated to the elderly, poor, disabled, and stricken amongst us. The rest of us – those who are relatively young, fit, and almost never need a doctor – are reserved for the profit of private insurers. Single payers systems only pay for themselves when everyone – sick and well, old and young, rich and poor – participates in them. If we want to solve the funding problem, we need to decide whether we can continue to afford contriving a profitable market for companies like BlueCross.

In short, the deficit hawks in the Republican caucuses are blackmailing us into funding tax breaks for wealthy people – including the fuckers who caused the financial crisis – by crippling our already inadequate social safety net.  I say, call their bluff. This is ground worth fighting for.

luv u,

jp

Wunderkind.

Paul Ryan has come up with a remarkable innovation – gradually bring elderly and disabled folks back to the standard of living they enjoyed in the 1930s. Brilliant! Obviously the idea behind moving Medicare to a voucher system is to save the government – and, therefore, the collective “us” – money.  But it’s only a savings if you don’t count the vast, vast majority of elderly people for whom that voucher will be worth very little in terms of health services. This is a very serious issue for anyone planning to become elderly one day. (Note: if you care nothing about the elderly and disabled and plan on jumping off a cliff when you turn 65, the Ryan plan will probably be fine by you.)

I’ve blogged about this before, so forgive me for covering the same ground – it’s just that when a person of influence advances a legislative plan that overtly calls for the dismemberment of Medicare and Medicaid, I feel compelled to repeat myself. This isn’t a question of saving money. This is a question of what we collectively decide is necessary to preserve the well-being of the nation. I’m not trying to appeal to your sense of charity. I’m saying that virtually every one of us is liable to need this type of coverage at some point in his/her life. Like investing in first responders, this is something we all have an interest in preserving.

No matter how much Ryan and his associates claim that is precisely what they are trying to do, don’t buy it. A voucher plan will throw elderly people into the private insurance market – one that is already way too expensive for pre-retirees to afford. What kind of premium will an Excellus ask of a 75 year old with a weak ticker? Seriously… Medicare is there for a reason. Before its existence, elderly people relied on charity, family members, etc., and many had access to neither.

The only reason why wunderkind Ryan and his express can feel comfortable criticizing such vital programs is that Medicare and Medicaid cost so much. They do because they cover those most prone to serious illnesses. If we had a reasonable single-payer system – Medicare for all – the system would also cover those many millions of us who see a doctor once a year and no more. Include them (i.e. us) and the system will finance itself. And frankly, wouldn’t you be willing to trade whatever plan you have (if you have one) for Medicare coverage at a reasonable cost?

Note to Dems: there’s a reason why Medicare is a third rail issue. It’s because it’s freaking necessary.  

luv u,

jp

Health and taxes.

There’s a t.v. ad that runs almost constantly in my area featuring a “regular-guy” type grocery store owner (not many of those left) complaining about the proposed soft drink tax in New York State. At some point in the ad he says, “Taxes never made anyone healthy.” Interesting statement. I guess he’s never heard of Medicare, Medicaid, Social Security, various Health and Human Services programs, and any number of other government services, from OSHA to the FDA, that in some respect help us stay healthier as a result of tax revenues. Yeah, I know the ad is about a “sin” tax, but you can also see how taxes on cigarettes and alcohol have had a positive effect health-wise. In a sense, it’s just a way of having the price of something reflect the true cost. Sure, we want people to be healthier. But we also want to recover some of the cost of their NOT being healthy, like emergency care costs for people who sugar themselves into heart disease, stroke, diabetes, and the like. Don’t we?

I’ve probably been on this rant before, but this is such a fundamental problem in our society that it cannot be said often enough. Nobody likes paying taxes. Nobody likes taking their medicine, either (well, most people don’t), or eating their oatmeal, or washing behind their ears, or doing their homework, etc. But at some point we must put childish ways behind us (1 Corinthians 13:11 – got your bible right here, kids!) and face up to the simple fact that, yes friends, we get what we pay for… and only that. If we want to have a modern society, we have to pony up some cash to pay for it. I think that should be done in the most equitable way possible – those more able to pay pay more, those less able to pay pay less, those not able to pay pay nothing. The usual method. But taking a “taxation is bad” philosophy to its most absurd extreme is just… well… childish and short-sighted.

And yet the philosophy continues to command respect. Somehow people like Grover Norquist and his ilk are still listened to, still asked for guidance. Meanwhile, the nation’s infrastructure is falling apart, our last major investments (beyond maintenance) in roads, bridges, tunnels, rail lines, etc., now decades old. A stiff wind storm knocks out power to whole states. Instead of investing in the future of this country, we’re putting band-aids over compound fractures. The most striking irony is that these programs are being starved by the kind of deficit hawks who constantly claim that they are doing this for our children and our grandchildren, i.e. not leaving them a huge debt. Fine. There’s a solution. Get people to understand that we need to pay for things, and that civilization is not free. That’s the central point of health reform, lackluster as it may be.

It’s just that we’ve reached the point, particularly in places like California, where people want all these services, but they won’t let their representatives raise the revenues to pay for them. Sorry… that will never work for long.

luv u,

jp