Tag Archives: medicare

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

No to reconciliation.

Want a good reason to vote next month? Here’s one: Paul Ryan’s “Better Way” agenda, which he will drive home like lightning if his party is successful on election day. With a Republican congress and a Trump presidency, Ryan can pass the most regressive political program ever contemplated on the national level. At the core of this agenda will be another raft of massive tax cuts for the rich, including a 20% cut for corporate taxes, which will drain trillions of dollars from the Federal budget and (no surprise) prompt austerity action on social programs like Medicare, Medicaid, and Social Security.

Why is this man smiling?On top of that, the “Better Way” will use reconciliation votes to repeal sections of the Affordable Care Act, including Medicaid expansion. Ryan tested his caucus’s ability to use this tactic on non-fiscal legislation this past term when he brought an ACA repeal vote via reconciliation. This will be repeated next year, but with a Republican president, their vile legislation will get a signature. Ryan will be able to move forward with converting Medicare to a voucher. You can already hear right-wing pundits floating the concept of expanded Health Savings Accounts as part of their “repeal and replace” strategy – that and the seemingly evergreen notion of allowing insurance to be sold across state lines. This should be great comfort to the hundreds of thousands thrown off of Medicaid by their so called “better way.”

Whatever your misgivings about Hillary Clinton (and I have plenty), voting for her is the best way to shut Ryan down. I strongly suggest you also consider voting down-ballot for Democrats. There’s an outside chance that Dems could take the House and a stronger opportunity to retake the Senate. That’s our best opportunity to ensure that we’re not massively losing ground over the next four years, even if we’re not leaping forward in great strides. I feel strongly enough about this that I have been volunteering for our local Democratic candidate for Congress (Kim Myers), mostly because her principal opponent is an anti-choice zealot who once referred to the head of the Oneida Nation as “spray-tan Ray” in a Trump-like drunk tweet. Classy.

There’s plenty we need to do to build a more progressive, equitable, and sustainable political reality. Voting is a very small but important part of that. It’s the best way at this point to say “no” to Paul Ryan’s agenda. Let’s stop that mother cold.

luv u,

jp

Inside August.

Posted another podcast, as you can see, and it’s chock full of whatever the hell we’ve been doing for the past three months. If after listening to it you can explain to me what that may have been, I’d be eternally grateful. Just contact me at:

Joe Perry of Big Green
Behind the hot water pipes
Cheney Hammer Mill
Somewhere in Upstate New York

I’ll get it.

Anyway, here’s what we have on the menu for August:

Ned Trek 19 – Careact
This episode is loosely based on “The Changeling”, an episode of classic Star Trek that features a killer space-probe named Nomad that thinks Captain Kirk is its long-lost mother. In our version, instead of killing everything in sight, the probe gives every living being it encounters single-payer health insurance. Hilarity ensues.

The episode includes six new Big Green songs that sort of drag the plot forward in a somewhat haphazard way. These include:

Spiro’s Song (Die-de-die) – A surprisingly introspective number for the android ex president, featuring android Spiro Agnew on backing vocals and a big beanfeast singalong.

Sick Poor Jerk in a Herd – Ned’s song about his assessment of health care in the good old U. S. of A. …. I mean, Confederacy of Planets.

Sonny who?Some Health Care – Mr. Welsh pulls it out again with a posthumous number about how crappy coverage hastened his untimely end. Perhaps the first song in the English language to use “Space Probe Machine” as a refrain.

Romneycare – A jazzy little number about just what it says, and what Mitt plans to do about it.

Well, Well, Well – Richard Pearle’s ode to profitability and health. A bit overproduced, but perhaps appropriately so, given the singer’s high opinion of himself.

Medicare – Doc Coburn rock out plaintively about the bane of his existence … that damned socialist menace, concocted by LBJ.

Put the Phone Down
Yeah, we talk about some stuff. Mostly disposable, but give it a listen. You never know what we’re likely to say, right? We read out of a 1991 recording magazine, Matt does some funny voices and threatens to sue the memory of Sonny Tufts. That sort of thing.

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

Samesville.

Back again, right? Every couple of months or so we are faced with a manufactured fiscal crisis. Again, this is by design, not by necessity. The Republican party – particularly the hard core of yargle-bargle types known as the “tea party” – has long pursued the practice of enormous deficit spending while they hold the White House and austerity when they are in the opposition. This time around, it’s austerity with a vengeance. Sure, the president signed on to this sequester deal, but it was in response to another manufactured fiscal crisis, brought on by the newly-installed G.O.P. Congress in 2011. In other words, if it wasn’t the sequester, it would be the debt ceiling, or the budget, or some key appropriations bill – anything to jam up the works.

Patron saint of the whiners. There is nothing surprising about this. Grover Norquist, patron saint of the cheapskates (and clearly someone who did not like eating his peas when he was 4), articulated it quite clearly when he said, in effect, when Democrats are in power, force them to rule like Republicans. Parse out the irony (as mentioned earlier, Republicans are much more generous with presidents of their own party) and you can see the sense in what they’re doing. Of course, it goes beyond that. I think most Republicans are smart enough to know that the kinds of cuts they’re advocating will result in a second recession. That works to their political benefit. Winning is paramount to them, even (and perhaps especially) when they lose. If they can discredit a Democratic president, so much the better.

The Democrats are enablers of this continuing train wreck. They were handed the reins in 2009, and instead of meeting the financial crisis with a response of an appropriate magnitude, they allowed conservatives to talk them down to a small-bore strategy that simply was not sufficient to pull us out. The stimulus worked to the extent that it was designed to work; when the money ran out, so did the steam. Now we are in what Krugman rightly calls a depression – an economy that is not shrinking, but not really gaining ground either – and all Washington can talk about is cutting the freaking deficit. The problem is unemployment, not short-term debt. Fix one, and the other will take care of itself. Want to solve long-term debt? Stop maintaining health insurance as the province of private profit-making industry; expand Medicare and you will make it solvent.

How do you get these people to do the right thing? To borrow a phrase from V.S. Naipaul, a million mutinies now. Tell your representative and your senators that you want them to invest in the economy, not starve it.

luv u,

jp

Ryan’s express.

So it’s budget guy. Interesting choice, governor. At least we know where he stands (even if your position is still a little vague). We’ve apparently reached a pass in American politics where an unapologetic acolyte of Ayn Rand can be put forward as a candidate for vice president. This may have been unthinkable a year ago, when the Occupy Wall Street movement was in full swing, at least in terms of media coverage. Now that the “austerians,” as Tom Tomorrow calls them, have once again found their full-throated voice, Ryan can be seen as a serious contender for high office. Though they are backing away from the details of his Medicare proposal like it’s a live grenade, concentrating instead on Medicare reductions in the Affordable Care Act – reductions that are included in Ryan’s budget, incidentally.

My favorite dodge, though, is the one about sparing current retirees and near-retirees from painful cuts. Everyone 55 and over will keep the same system as current law, they claim; people younger than that can expect a voucher. Maybe that will buy some time with the elderly, I don’t know. But it seems to me that they’re risking pissing off people in the 45-55 bracket (namely, people like me), who have been in the private health insurance market their entire lives and have seen the magic of the marketplace at work first-hand. After decades of that, I can tell you that the notion of being handed a voucher when I’m finally allowed to retire is unacceptable.

Let’s take a closer look at Ryan’s competitive healthcare marketplace that will somehow work for seniors now better than it did prior to the advent of Medicare in the 1960s. The fact is, we’ve had competition in health insurance basically forever with respect to people under 65. Has the price gone down at all? Next question. If competition results in skyrocketing premiums for younger, relatively healthier people whose healthcare costs tend to be  more manageable, what will happen with elderly people who inevitably incur higher costs due to deteriorating health, age-related illness, palliative care, etc? That’s the reason why Medicare was created in the first place as a government guarantee of coverage for elderly people. Pushing more of its costs onto the people it’s supposed to be protecting is hardly a solution.

Same deal with Ryan’s Medicaid brainstorm. The super-genius wants to whittle that down by replacing it with block grants and reducing it by a third. People hear Medicaid and they think poor people (and, therefore, get apathetic about it). But when it comes to being elderly and needing nursing home care, practically everyone is poor… poor enough to need Medicaid. That’s where a good deal of custodial care funding comes from. Ask someone with elderly parents or someone who has done basic estate planning. Only the Romneys of the world need not rely on some kind of insurance support in their dotage.

This is a good conversation to have, frankly. Let’s have it, and make certain the elderly and the near-elderly understand what’s at stake before the November election.

luv u,

jp

Issues and non-answers.

A little more off the top of my head. One of these weeks I’m going to take some pains over this posting, but… not this time.

Don’t worry, Kyoto. Canada’s pulling out of the Kyoto Protocol (can you say “tar sands”?) and Durban was a bust. What’s it going to take, people? We had massive tornadic storms this past year. We don’t have the luxury of another decade of inaction and ignorance.  

See you in health. One of the issues that comes up in our perennial presidential campaign is that of health insurance, mostly in the context of so-called “Obama Care”. What doesn’t get discussed so much is, well, the only possible positive solution to the current situation, which is bankrupting individuals, bleeding businesses dry, and threatening to drown the government in red ink. The only constituency the current health insurance system benefits is private health insurers. Seems like we, as a nation, sacrifice a great deal to preserve their profitability. That has got to end. We need a national health insurance system – basically universal Medicare with some enhancements – that covers everybody.

When GOP strategist Ed Gillespie was on the Daily Show the other day, he seemed to suggest that he didn’t have a problem with the notion of insurance exchanges or the idea that veterans, for instance, should have government coverage because they deserve the best. And yet his – and I think most Republicans’ – solution to the ongoing health crisis is to throw everyone into the private market. I can tell you from experience – that is not a good place to be unless you’re very young, very healthy, and can afford very steep premiums. And the employer based system isn’t working either, partly because it’s based on the pool of employees covered by the plan. If there are a lot of illnesses in a given year, that sends the premiums through the roof. The only way to control costs is to a) get everyone in the freaking country into the same pool, and b) cut the profit out of it entirely so that, as with Medicare, practically all of the money goes to patient care. 

Private, employer-based health insurance is an anachronism that should go the way of the typewriter. It was designed for an age of close to full employment, when companies needed to incentivize people to come to work for them. If the GOP wants to reduce “uncertainty” for their friends in business, they might consider making it possible for them to get out of the health insurance business altogether. The only reasonable way to do that is through a national health plan administered by the federal government.

War’s end. The Iraq war is coming to a close, at least with respect to American troops (though many contractors remain). Of course, there are those amongst us who consider withdrawal a mistake, such as Cheney, McCain, and nearly all of the GOP presidential candidates. I know – who cares what Cheney thinks, right? Has a man ever been more consistently wrong (or despised) than he? Still, I don’t think we should be too dismissive of their views. If Cheney, McCain, Lindsey Graham, Michelle Bachman, and other foreign policy super-geniuses want us to stay in Iraq, we should ship them over there. Good place for them. And they can stay as long as they want.

Of course, we could never really allow that to happen. I mean, haven’t the Iraqi people have suffered enough?

luv u,

jp

Weeks away.

Just a few hurried comments on the events of the day. (The events of the day are keeping me from the events of the day. Shall I say that a second time?)

Cain Mutiny. Presidential candidate Herman Cain has some more difficulties maintaining his myth of marital bliss, and this may be a game stopper for him. Naturally the death knell may come about over something that doesn’t matter a damn. Aside from his family, who the hell cares who he sleeps with, so long as it’s consensual and doesn’t involve minors, animals, etc.? Somehow this seems to bother people (and the mass media) more than the fact that the man has given zero thought to anything having to do with public affairs. He must be the first presidential candidate I’ve ever seen fail to give an opinion when someone asks him about something like the Libya intervention. He had to ask the interviewer what side Obama (i.e. the United States) was on. What the … ? Has the man been living in a pizza box? He is running for the G.O.P. nomination and apparently has no concept of what the pro-life and pro-choice positions actually mean.

Why the hell does this man want to be president? He smells to me like a cut-out for the Koch brothers, but what he says is that God encouraged him to run. Personally, I think God may have just been trying to order a pizza.

Deficit of Imagination. They’re sparring over the payroll tax cut – otherwise known as The Only Tax Cut That Needs To Be Paid For. With the Occupy movement receiving eviction notices from coast to coast, Congress is managing to turn the conversation back to debt with a good bit of help from the major news organizations. I heard Joe Scarborough sparring with Sherrod Brown about Medicare costs and showing “courage” by acknowledging that those costs were tantamount to a cancer on the body politic. His solution? Cut, cut, cut. Which is basically shift the burden onto the elderly, the ill, etc.

I didn’t hear Brown say this (he may have), but the courageous position to my mind would be to advocate expanding Medicare to cover everybody. The reason we have deficit Medicare spending projected for the next few decades is simple – we are subsidizing the profitability of private health insurers, who get to cover the least costly consumers while the government covers the most costly ones (i.e. the ones private insurers don’t want). The courageous thing to do would be to say, we can’t afford this model any longer.

I’m waiting to hear that from someone. Anyone?

luv u,

jp

Barry’s hand.

The ongoing debate over raising the debt ceiling has dominated another week’s worth of news coverage. Now Moody’s has put the U.S. government “on notice” – something I thought only Stephen Colbert could do – that our debt rating may be downgraded if the current impasse continues. As I mentioned in my last rant, this is a manufactured crisis. It’s a standoff not over debt yet to be incurred, but debt already booked by Congress by virtue of budget items already agreed to. There is no reason for this threatened default other than to make political points… and yet it continues, even though the downside risks are substantial.

How substantial? Default – or even near-default – could cause a global financial disruption on a scale that would dwarf that of late 2008. At the very least, a downgrade of the investment rating of U.S. Treasury bonds would be not only unprecedented but extremely costly, making service on our existing debt far more costly, blowing an even bigger hole in the federal budget. If that alone were to happen it would be bad enough. But these facts just don’t seem to register on Capitol Hill.

It’s often been said that, in a Democracy, we get the government we truly deserve. Last fall, the American people – by voting or by abstaining to do so – sent to the House of Representatives a class of Republicans that amount to the American version of the Taliban. The core of this class are fanatical believers in their own delusions; they see reality as a nefarious socialist plot. Fueled by tea party faux-populism, the new G.O.P. goes beyond their party’s traditional obsession about cutting taxes. Anything – anything – that brings more revenue to the Federal government is to them an unacceptable burden on the American taxpayer. (i.e. rich people. They apparently don’t consider burdensome the enormous costs displaced to workers, pensioners, etc. as a result of the massive cuts to Medicare, Medicaid, and other programs they demand.) That much is a given. The only wild card is in the president’s hand – what will he sacrifice to appease them?

This is what we voted for, whether we realize it or not. More likely not, since the Republicans did not advertise this part of their program. (It was going to be jobs, jobs, jobs, remember?) While it’s far from the only thing we need to do as citizens, it’s obvious that voting is essential… just as it’s clear that we need to hold our leaders – namely Obama – accountable when they give away the store.

luv u,

jp