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GOP Debate Candidates Can’t Answer Fla. Woman Who Asks for Health Insurance

8:31 pm in Politics, Republican party by Scarecrow

Don't ask Mitt how to solve Florida's uninsured problems (photo: Gage Skidmore/flickr)

During Thursday night’s GOP debate, a woman from Florida told the candidates she’d lost her job and with it her health insurance.  What would each of the candidates do to get her covered or otherwise provide the health care she needed?

You had to listen carefully, but the effective answer they all gave her was, “this is your problem, not ours.”

Let’s first recall that this woman is not alone.  Millions of Americans have lost employer-provided health insurance.  That was happening before the recession but has become much worse during the recession.  That may be because they lost their jobs and can’t afford COBRA coverage, and the government’s stimulus subsidies for COBRA have expired, or because, even if they still have jobs, their employer stopped providing coverage because of its rising costs.  Or they may have lost effective coverage, because even if they have a job, their employer-provided coverage is so weak or so costly with deductibles, exclusions, and co-pays that they’ve effectively lost affordable, meaningful coverage. In the meantime, those on the individual “markets,” which are dominated by highly concentrated oligopolies, are confronted with insurance premiums they simply cannot afford.

As FDL’s Jon Walker has noted, America now has the highest percentage of uninsured in decades, and that’s not going to change unless/until the Affordable Care Act kicks in by subsidizing private insurance and providing millions with access to expanded Medicaid. So unlike many of the debate topics, this woman’s question was extremely relevant to literally tens of millions of Americans.

The answers she/we heard cannot have been reassuring.  Mitt Romeny said he’d adopt policies that would lead to her getting a new job.  Okay, maybe that happens in a couple years or so, or maybe not.  But even when, pre-recession, we had much lower unemployment, we still had tens of millions of people without insurance, and those who thought they had insurance were often ambushed by insurance company rescissions, exclusions, denials and then refusals to re-insure those with pre-existing conditions.  Millions of people faced these problem before the ACA and before the recession.

Moreover, if these Republicans were successful in repealing the ACA and block-granting Medicaid, as the GOP-Ryan Plan they all eventually suppported provides, then the woman would not be able to get either subsidized private insurance on a health care exchange or government-provided Medicaid.  In Florida in particular, the Governor and state legislature have been particularly vicious in cutting funding for hospitals and providers that treat Medicaid patients, and the GOP-stifled Congress has refused to consider expanded Medicaid beyond the original stimulus, so it would be even less likely this woman could get coverage there.

What’s left?  Read the rest of this entry →

Krugman Exposes GOP Ryan’s Unicorn Budget, Catches Heritage Burying Number

8:26 pm in Uncategorized by Scarecrow

Paul Krugman spent Wednesday combing through the details of Tea-GOP genius Paul Ryan’s budget and in a series of blog posts utterly destroyed the Ryan budget’s phony math, implausible assumptions and unicorn forecasts. Kudos to MSNBC’s Rachel Maddow for picking this up.

Krugman once called Ryan a “flim flam” man, a virtual con artist, and yesterday, he proved it. Let us count the ways.

1. Beginning Tuesday with “Groundhog Day,” Krugman warned of a giant bait-and-switch in which the claimed goal of reducing the deficit would provide cover for what in fact would be a proposal not merely to privatize Medicare (or Social Security) but to do so in a way that actually increased costs, if not to government, then for beneficiaries. He was right.

As we’ve been saying all along [see here, here, and here], Ryan’s Medicare mandate plus vouchers would lower government costs only by shifting even more uncontrolled costs to seniors, disabled and poor people, eventually forcing them to forego treatment for which they could not afford insurance.

2. In the 2022 Medicare Crisis, Krugman echoes Matt Yglesia’s point that Ryan’s Medicare mandate and voucher system sets up an unstable, indefensible discriminatory system for seniors. Starting in 2022, those already over 65 would continue receiving traditional full Medicare benefits (and have the choice of getting the equivalent from private insurers via Medicare Advantage) but those just reaching 65 from then on would receive only private insurance that, year after year, covered less and less of the costs and care as older retirees. Ryan assumes the “savings” from this discriminatory treatment would be accepted by the disadvantaged group and that Congress would ignore the unfairness.
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To NYT Editors: It Helps to Use Facts, Analysis To Explain Paul Ryan’s Budget Plan

9:53 am in Uncategorized by Scarecrow

One of the more distressing habits of today’s badly managed/edited New York Times news section is to cast the mindlessly destructive Congressional budget battles as some political phenomenon happening to President Obama and Republicans, and not something that’s being inflicted on real people, the public interest and particularly America’s most vulnerable citizens.

The Times’ editors chose as Sunday’s lead article Carl Hulse’s story, “Budget Battle to Be Followed By a Bigger One,” with the subheading in my delivered dead-tree version, “Clash on Programs LIke Medicaid and Size of Government.” It sounds ominous, urgent, and the real story is indeed urgent, since it involves the Tea-GOP and Congressman Paul Ryan’s proposals to make draconion changes to Medicare and Medicaid.

So one would expect the article to provide facts and logical analysis explaining what the Tea-GOP’s budget leader, Paul Ryan, is planning to do about Medicare, Medicaid. But either Mr. Hulse doesn’t know, or his editors don’t think that’s important. Instead, we read that whatever it is, it will have some political effect on Obama and the Republicans. No kidding, but is that what really matters?

The article suggest we just don’t know the details of what Ryans wants. Not true. We do know what Paul Ryan wants to do, because he’s told us in his “Roadmap” and numerous statements since. And those details have been analysed and found not merely wanting but total flim flam by many analysts, including the Time’s own economics and health care writers, none of whose analysis is even hinted at in Hulse’s article.

There have been dozens of media articles and reports explaining that the cost problem with Medicare and Medicaid is not that poor and elderly people get too much health care via government programs. Instead the problem is the cost charged by private health care providers is way to high, about twice the cost paid by every other advanced nation. If we paid the same or even slightly more than what other nations do for care just as good and more univeral coverage, there would be no long-run US debt problem.

For the umpteenth time, we don’t have a public “entitlements” problem, as the Tea-GOP zombies claim; we have a problem with private health costs. Do Hulse’s editors not know this?

We know that drug makers have oligopoly price-fixing cartels, that government limits its own ability to bargain for better prices, that drugs are protected by patents that are too long, that companies routinely sign non-compete agreements that violate antitrust laws against price fixing with impunity. We know hospital ownership is becoming increasingly concentrated, that most states have no meaningful competition between health insurers, and medical specialization and health care management practices have driven up total costs. And some believe some of the Medicare payment structure reforms in the Affordable Care Act, which the Tea-GOP would repeal, will help fix that, though everyone thinks much more is needed.

But none of what we know and the Times should tell its readers appears in the Time’s article. Instead it mentions Paul Ryan’s efforts to extract trillions from Medicare and Medicaid without noting that Ryan has zero proposals to control the actual costs that are the underlying problem. Nor does the Times note that even if Medicare and Medicaid were eliminated — so they wouldn’t be a federal budget issue — the underlying private cost problem Ryan neglects would still swamp the private economy as private health care costs continue to grow much faster than GDP.

In other words, everything Tea-GOP budget genius Paul Ryan is doing is misguided, even stupid and counterproductive, not to mention cruel, because he knee caps the only enitity with sufficient authority and market power to tackle the cost problem. Then Ryan wants to shift the unmitigated risks of rising health care costs onto the very people — seniors and the poor — least able to fight back.

Under Ryan’s Medicare plans, the government would put powerless individuals into unregulated individual markets dominated by oligopolies, cartels and price fixing arrangements and force them to choose between paying excess prices or going without health care. For Medicaid (see David Dayen’s post), Ryan would provide less money, package it in block grants to states, and force them to provide less coverage or knock people off the system.

And we know what that means, because credible studies find that when 50 million people can’t afford health insurance, tens of thousands of them die, every bloody year. So Mr. Ryan’s “budget” plan is, in effect, a death sentence for many of those who can’t afford to pay the rising costs for necessary care.

Those would seem to be important facts, analyses, logic to explain to readers if you’re telling them on your front page that there’s this bigger budget battle looming that involves health care. Numerous articles and studies available to the Times — try Google — some even appearing in the Times, have explained this, but neither Hulse nor his editors think their readers need to know that.

Rand Paul Exposes His Moral and Intellectual Hypocrisy

7:03 am in Uncategorized by Scarecrow

I’ve been thinking more about the insulting remarks Rand Paul made in Kentucky when he suggested that skilled, unemployed folks should just suck it up and settle for whatever lower-paying job they can get. What I wrote here doesn’t fully expose his moral and intellectual poverty.

It’s bad enough that Paul doesn’t seem to know that with 15-20 million people under- and unemployed, hundreds of people will be lining up for a handful of jobs. His condescending "tough love" lecturing is oblivious to the enormity of the jobless problem. It’s even more insulting that he assumes folks at the ends of their hopes are not already doing everything they can to stay afloat.

It is a favorite theme of Republicans of varying stripes that the unemployed and poor are there because they deserve to be; their status proves they’re undeserving. Lecturing them on moral virtues is what conservative Republicans have always done.

But the worst part is the cynical hypocrisy illustrated in the same Blue Grass Politics article, in which Rand Paul was also asked how he felt about taking government Medicaid/Medicare payments for his medical practice.

To understand the full hypocrisy of this common Republican belief, recall that because of obstruction by Republicans and DINOs (Lieberman, Bad Nelson) who think just as Paul does, the Congress has failed to pass a modest jobs bill that would fund youth summer jobs and prevent states from having to lay off hundreds of thousands of teachers and cut Medicaid services, while extending unemployment and COBRA health insurance benefits. Yet our can’t-get-its-priorities-straight Congress and dysfunctional Senate have agreed on a measure to keep Medicare from cutting fees to doctors.

Even though he rants against government spending, Rand Paul hasn’t said boo against Congressional efforts to shield doctors from taking less pay for what they do. Instead, he told the interviewers this:

In another radio interview, with a Bowling Green station on Wednesday, Paul defended his acceptance of Medicare and Medicaid payments as an eye surgeon for the last 17 years. Paul said he wants sweeping cuts in federal spending, but as a doctor, he has little choice but to serve patients covered by the massive federal health-care programs.

“I work hard and I don’t see any other person in this country who’s gonna work hard and not be paid for it,” Paul said.

What Paul is saying is that a doctor works hard and is highly skilled, so it’s only fair that persons performing an essential public service be fairly compensated. I think most would agree with the principle. But when Paul speaks to an unemployed teacher with a Masters Degree in Education, even though the country’s educational system is crying out for skilled, energetic teachers anxious to teach, she should suck it up and consider flipping burgers. It’s tough love for her; subsidies for him.

But in Rand Paul’s world, we shouldn’t apply "tough love" to him, because he’s not one of the undeserving:

Paul declined to say how much money he gets from the programs, but he said approximately 50 percent of his income is Medicare and 5 percent is Medicaid. According to the Kentucky Cabinet for Health and Family Services, Paul has been paid $130,461 over the last five years through Medicaid. If that represents 5 percent of his income, then Paul’s Medicare payments over the same period would be more than $1.3 million or about $260,000 a year.

Rand Paul: tough love is only for the undeserving but not for his privileged class.


One more point
: I’d have thought a true libertarian would offer his services, and if he can’t sell them at what people can afford to pay, he would accept the market’s verdict and try another job. But what he essentially says here is he’s entitled to a comfortable living as a doctor. He has "little choice" because he can’t prosper as well as he believes a doctor is entitled to, unless he accepts Medicare/Medicaid patients and government payments. And his patients in turn can only afford his services if government pays him the fees he assumes he’s entitled to.

I think that’s a classic illustration of an entitlement system for doctors. Some libertarian.