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While I don’t pretend to understand non-dimensional chess, it seems to me the President is succeeding in his unrelenting efforts to resurrect and lend credibility to Republican ideas.
The last confirmation is on the front page New York Times article this a.m., in which reporters Pear and Herszenhorn, in the only paragraph above the fold, state their opinion as fact:
When Republicans take President Obama up on his invitation to hash out their differences over health care this month, they will carry with them a fairly well-developed set of ideas intended to make health insurance more widely available and affordable, by emphasizing tax incentives and state innovations, with no new federal mandates and only a modest expansion of the federal safety net.
[that's followed by this]
But Congressional Republicans have laid out principles and alternatives that provide a road map to what a Republican health care bill would look like if they had the power to decide the outcome.
Wonderful. These must be serious people with serious proposals.
As we read further, we learn that one serious Republican proposal, to allow mega-insurers to sell across state lines, will "encourage competition and drive down costs." The Times does not explain that this would allow the mega-insurers to bypass stronger state’s regulation or that these same mega-insurers have already drastically curtailed competition and created highly concentrated markets in most of the country. These near monopolies have no problem telling a state as large as California that they intend to raise premiums by as much as 39 percent this year.
We learn that Republicans would solve the nation’s shameful uninsured/affordability problems by encouraging more states to create/expand "high-risk pools" to cover those with chronic diseases. The reporters don’t explain that many states already do this and yet we still have 45 million plus still completely uninsured and tens of thousands still going bankrupt even where such insurance is offered.
Nevertheless, the reporters assure us that unlike the Democrats’ efforts to "remake the health care system" — that’s presumably not as bad as Medicare for all, which would likely destroy the galaxy — the "Republican leaders favor a more modest approach." What a relief! Since the current system is killing 18-45,000 people per year and threatens to bankrupt the country, there’s no reason to get too ambitious about the issue.
Our reporters can’t bother to explain or critique the Republican’s core "ideas" put forth by Rep. Paul Ryan (R. Wisc), because then they’d have to report that Ryan’s great idea is to move the risks of higher health care costs from the federal budget to seniors. It would do that, as James Kwak has explained in detail, by providing vouchers in lieu of guaranteed care for future Medicare recipients, but the vouchers would increase more slowly than escalating care costs. As Yglesias notes,
Ryan’s vouchers will buy some kind of health insurance for all seniors, but over time that insurance will start looking pretty skimpy relative to prevailing standards of care. Lots of seniors will die preventable deaths due to lack of funds.
So the Ryan/Republican plan would destroy economic security for seniors; the plan isn’t to kill granny directly; it’s to give granny less coverage as she ages and let her choose how to die. That’s the Republican plan. The Tea Baggers should love the individual freedom to choose how to die, and Sarah Palin will explain why this isn’t f**king retarded.
But don’t expect Pear and Herszenhorn to explain any of this. They’re job in On Health Care, the G.O.P.’s Road is a New Map is to help Obama make Republican ideas sound reasonable, because that’s the only way this essentially Republican President and the Republican crazies he’s resurrecting can sell undermining America’s safety nets.
More:
Baseline Scenario/James Kwak, The Republican Plan II, You’re On Your Own
CAP, High-risk insurance pools; a flawed model
Yglesias, House GOP Medicare Elimination Plan Puts Conservatives in a Pickle, and see Uncompensated Care
41 Comments
Serious Republicans my ass
thanks for pointing this out. looks like more of our “liberal” media in action carrying water for the republican party. *retching*
When is O gonna switch parties? That’s real bipartisanship at work.
He hasn’t already?
No, and I sent him an email suggesting it. Geez, even W stopped saying “evildoers” when I sent him an email pointing out that it was one (or two, depending on your editor) of his vocabulary of 12 words. Amazing to think that I had more influence on W than on O.
2011.
Good guess.
I wonder what the, “keep your government hands off my Medicare!” crowd thinks of the voucher program.
Right. Time for a Republican town hall?
Sounds too much like socialism. They’ll just let the “democrat party” hold ‘em then come by and disrupt the whole thing with yelling and carrying on.
I don’t know but this Medicare recipient thinks the whole stinking debate about “entitlements” is about squeezing out more money for the military-industrial complex and not about the very serious issues of Medicare. Right off the bat, Medicare’s allocations are badly skewed and need re-alignment, but there’s a whole research and assessment process that has to proceed that process. Some extremely entrenched interests, think AMA, have to be moved aside. All the issues in fees have to re-thought so that the distribution of monies can be re-worked. It’s a huge undertaking and it desperately needs doing, but we’re stuck in a senseless scrum over crap, distractions: fucking shit nothing, actually.
I have bills for Medicare funded procedures and let me tell you, Medicare whacks the hell out of med bills. Doctors are not paid too much, by my Medicare Summary Notices. The important issue, that needs proper alignment, is which doctors gets paid what, which is a value of service issue and is currently considerably biased to surgeons and surgery procedures. It’s one of the biggest problems in attracting med school grads to primary care: not enough money in it. And it absolutely governs those cramped and rushed office visit schedules, which everyone who’s ever cooled her heels waiting for the assistant to call her name knows all too well. Yes, doctors do overbook. There have always been some who just had the habit, 35 years ago I left a doctor because he habitually overbooked and hour and a half waits were common, but now it’s the norm.
Back when doctors didn’t have much to offer patients, a doctor probably knew you from birth thru death, literally. Now doctors have much more to offer but don’t know much about any of their patients. Specialization has fragmented medical practice and divided up patients lives into tiny little specialized pieces on an assembly line of practices and procedures. The mechanical quality of it all is overwhelming and the anonymity is frightening. Most of the doctors you deal with know nothing about you outside the very narrow confines of their specialties, and see nothing outside those confines. Nobody in medicine today knows the whole you, nobody has your big picture. There is no such thing as holistic practice in medicine today. And it’s terrible for patients, the lack of familiarity and the way medicine is practiced in segments, in pieces of patients lives.
Terminally ill people have nothing left to lose. I sincerely hope they all remember that when the time comes.
I have recently been pointing out, obama is a “trickle down” economist, everything he proposes or pushes is top down, give assests and considerations to the top in the hope it makes it down to the middle class
it’s a rediculous concept but obama actually believes it or has been persuaded to use it
I’ve noticed that the “too big to fail” banks are still not lending money for home mortgages. Maybe they need more Repuke tax cuts. Repukes believe that tax cuts for the wealthy cure everything. Fox News and NPR have seemingly convinced many working class citizens that tax cuts (aimed squarely at the rich) are also good for them.
When will Obama give in and leave those Bush Tax Cuts alone? They’re working (to further bankrupt the US).
All the talk on NPR was about the all important “austerity measures” needed worldwide. Anytime anyone wants to do something for the people, its a really bad idea that we can’t afford.
War, Inc. No Problemo. Give the MIC all it needs to “fight terra”. Really, they’re in bizness to make sure that terra continues unabated. Its how they eat in all the best restaurants.
Top Down Obama. Austerity.
The reason it’s all top down is because Goldman is running the government. Don’t expect this to change either.
When criminal bankers are rewarded with unlimited taxpayer trillions to play with, and the entire country gets 80 billion in tax cuts to create jobs, that’s a real kick in the teeth. They just toss out another bone so they can say they’re putting people back to work and keep us quiet.
If they are going to go back and start over, here’s my naive take on what the Dems should counter the REpublicans and Obama with –
A relatively simple public option. Going into an election year, that’s a populist and simple concept and it addresses the “too complex” issue the Republicans used for their talking point. Not a mish mash of incentives and state pressures, but a simple public option.
Then they couple that populist issue with the following: Acknowledge that because of the all the problems in the health insurance industry for delivering affordable insurance to people who are older or who have pre-existing conditions, the public option will be disproportionately used by those who are more expensive to cover – an older, high risk, and pre-existing conditions pool. As a result, to cover the costs for the fact that the public option will attract this more expensive to cover pool, the public option will be funded by a tax on the revenues generated from policies that do not provide guranteed coverage for this older, high risk and pre-existing coverage pool. This will give the insurance companies choices. They can choose to avoid any additional taxes by providing coverage that includes these higher risk, higher expense individuals or they can decline to cover those segments of the population (forcing the public at large through government to cover them) and pay a higher tax on the revenues they get by only selling policies to the most profitable and healthy segments of society.
This is an easy to understand and relatively easy to sell approach that cuts most of the arguments – other than direct health ins. $$ – off at the knees. If Obama is willing to go back to scratch to accomodate Republican propaganda that they want to share their ideas – the Dems ought to give everyone an itch for that scratch.
Mary — if I drew two pictures of how the money flows, and which patients wind up in which plans, one picture of your proposal, and one of the proposed exchange, with a PO, with a weak regulatory system wrt to the requirement to take all customers, but with a exchange-wide transfer of dollars through a risk-adjustment mechanism — I think the two pictures would look about the same.
I don’t think so – and I think a direct tax mechanism is very different as well, plus I never said anything about weak regulatory aspects – either they put up a plan on which they won’t be taxed or they don’t. To escape the tax, the plan would have to meet tough standards (but those aren’t your talking point/sales point) and you are talking, not about an exchange but a direct buy in to a medicare type federal plan and that plan is the one against which the comparisons are made for private plans escaping, or being assessed with, the taxes – also the tax is on the recipient of the revenues, the insurance company, as is a more typical and workable situation in general.
But is doesn’t matter much, bc neither is going to pass (bc too many Dems – not the majority, but too many – are not going to do anything that really does put the insurance companies in a tough spot). What does happen with this approach is that it steals back the narrative and it makes as the centerpiece of that narrative a strong public (anyone can buy into the public option) and a payment discussion as a part of that narrative that focuses on insurance companies milking off the most profitable insureds and leaving the rest for govt to deal with. If you don’t put those points front and center in the discussions, you’ll lose overall.
If something like what I outlined were to catch hold, though, to add a mandate in a few years and as more and more have opted in for the public option and as there has been some insurance company shakeout with lesser profitablility – would be way more workable and would also be the way to begin a second round battle of moving towards single payer.
But the narrative at this point is almost as important as the plan. If the narrative isn’t simple enough to be digested and central enough on the populist point (federal public option) and directed enough towards the insurance company failings, it’s all dead in the water imo
Sorry (I wasn’t clear); the proposal you’re describing at comment 10 is essentially the same as the common features of the House bill (or a Senate bill with a PO).
In the exchange, insurers are supposed to accept everyone, but it’s expected that private insurer will seek to cherry pick the lower-cost/risk patients. That’s the same as your first assumption.
If they succeed, then there is a risk adjustment mechanism that literally takes money from the insurers with lower-cost patients and reallocates it to insurers with higher costs. The idea is to discourage cherry picking and to equalize revenues enough so that those insurers stuck with higher-cost patients are NOT disadvantaged.
If the PO became this insurer of last resort, as several of us here have predicted, then the risk adjustment mechanism would perform essentially the same function as your “tax,” reallocating money from the low-risk/cost insurers to the PO (or any other insurer covering high-risk/cost patients).
The pictures would look the same, but with different labels.
My prediction:
Obama’s “revised” healthcare plan passes with 41 votes, all Republican.
How do you pass a bill with only 41 votes? The math works differently when playing non-dimensional chess.
Obama needs to end these outreaches to this crazy batch of Republicans.
“The definition of insanity is doing the same thing over and over again and expecting different results”
- Albert Einstein
help him, help HIM!
Apparently, it’s more fun to curse the darkness. No pun intended.
That’s a line from Catch-22,
Tired of all this, watch the Saints Parade LIve!
Tried to reread Catch-22 last summer. Couldn’t get beyond 10 pages. The U.S. is sooo post-Catch-22.
35 years ago I camped on the beach in Mexico where they filmed it, the airstrip was still there.
What I meant by post-Catch-22 is that world or snark now seems mild and quaint by today’s standards. Such a deterioration makes you want to rip your hair out.
I didn’t see the movie, but nice nostalgia to spend some time where it was filmed.
Ohhh, so true. So pitiful. Unbelievable that what seemed outrageous, incredible satire is now pretty much everyday fact. This is part of why the average person – now under 50 — takes so much s–t for granted that we DFH’s still find outrageous.
Sometimes I think that fact – that he’s under 50 – accounts for some of Obamas’s willingness to accept stuff he shouldn’t. Since Reagan, we’ve been encouraged to “define liberty down.”
What’s now called liberty, freedom, not-socialism is really quite anti-liberty, and very anti-American. Viz. the people shouting “traitor” and worse at the anti-Holder rally Jane Mayer describes in her New Yorker article about the terror trials.
hey just curious, did they ever show that tebow anti-abortion ad during the superbowl? i wasn’t paying attention
Maybe the Democrats could impeach him before the November election and they lose big.
The New York Times, with few exceptions, is the last refuge of scum whose respiration is a waste of oxygen.
I’m sorry but I don’t see what’s wrong with high-risk pools. Frankly they seem like a good idea since they defeat the whole idea that we must have a mandate.
Considering that the average person/biz can’t afford medical insurance today, I can’t for the life of me see how charging more for sick people solves the problem.
What are you talking about?
For long term stability, nothing defeats the idea that there has to be a mandate (everyone paying into the system). Letting there be a high risk pool doesn’t defeat the issue that you don’t have long term stability without having the healthy committed to pay in, just like you don’t get an interstate highway system that works if you only charges trucking companies to build the roads.
Waiting for people to be desperate or to alredy need full costs services and THEN letting them buy in doesn’t work. Just like waiting for people to be ready to retire and THEN letting them have a plan they can buy into doesn’t work.
What does make sense is not to put the mandate as a mandate ahead of making a voluntary plan available that people have a chance to get some confidence in before requring that everyone participate – through insurance purchase mandates or, by then, possibly a payroll/investment earnings tax like a FICA that applies to unearned income as well as earned income and that gets you to single payer.
REquiring participation without first building the trust in the plan is a non-starter politically and practically imo.
I’m very wary of any type of mandate, with the only way I could consider supporting a mandate is with a strong PO. To paraphrase Candidate Obama, you don’t have the same people get you out of the mess who got you into the mess, but that’s exactly what he’s doing with HCR (as well as many other areas) by having private insurance supposedly be the answer to what ails us. Also to paraphrase Candidate Obama, you don’t need a mandate because people will voluntarily buy health insurance when it is decent and affordable. It’s not that people don’t want insurance, it’s that they don’t want crap insurance and they in particular don’t want to be forced to buy crap insurance as the only stability that provides is for healthcare industry execs bonuses. Coverage is not care afterall.
ScareCrow your following diatribe is basic left wing drivel!
“So the Ryan/Republican plan would destroy economic security for seniors; the plan isn’t to kill granny directly; ( A load of BS) it’s to give granny less coverage as she ages and let her choose how to die. (More BS)
That’s the Republican plan. ( Ignorance is bliss! You know nothing about the plan)
The Tea Baggers (You mean independents)should love the individual freedom to choose how to die,(not a government panel)
and Sarah Palin ( she’s got your attention) will explain why this isn’t f**king retarded. (Thank You Rahm)
The Plan includes
• Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality,
appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information
• Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality
with the input from all major stakeholders in health care, as well as the general public
Scarecrow needs to take that stick out of it’s “Booty!”
The American people cannot take another year off to hear your left wing crapola!
Read the links, especially James Kwak’s detailed analysis and Yglesia’s reactions. From Kwak’s discussion of how the Ryan Roadmaps shifts risks from the government to households :
No less than 10 years ago you folks were complaining about the National Debt, now Obama is your man, Debt is not a problem….What matters is that we do not leave future generations with mountains of debt. Instead of bailing out General Motors, Unions, and special voting interets, we could use “stimulus” to support folks that can’t afford insurance. Pre-existing, purchase across state lines, tort reform, let’s see how serious the left is about reform. Not redistribution!
If you read the comments here, I don’t think Obama is “our” man. I disagree with the way he’s handling a lot of issues, including the economy, but W did start two wars and piled a whole lot of debt for these same future generations. You also forgot Goldman and Wall Street as the largest recipients of the “stimulus.” Cheers.
The rapid increase is at least partly the result of so many people losing jobs, and so many others having benefits downgraded. Cost-shifting. Shit rolling downhill, with the individual premium buyer at the bottom and all those $90k a year prison guards near the top. Caleefornya, baby!
It’s going to be a long 3 years with this man.