“An Irreducibly Tangible Question”: What Happens To The Uninsured If Health-Care Reform Is Dismantled?
When the Republican presidential candidates talk about health care, the discussion usually moves quickly toward the philosophical and the abstract.
Take Rick Santorum’s appearance at the Christian Liberty Academy last weekend in this Chicago suburb. Before a raucous crowd, the former senator from Pennsylvania portrayed President Obama’s health-care-reform law as an “affront to freedom.” In Santorum’s telling, the plan is not so much an attempt to reshape the health care system as the worm on a line meant to hook Americans on Big Government. “What tribute won’t you pay to the government if they can promise that if you give them more they will … take care of you?” he asked dramatically.
There’s no question that an ideological chasm over Washington’s proper role in health care separates Democrats and Republicans. And there’s no doubt that some Democratic strategists believe that average Americans will grow more tolerant of activist government if they see it providing them more direct benefits, such as health insurance.
But the debate over health care reform — which will intensify again next week as the Supreme Court hears oral arguments on challenges to the law’s mandate on individuals to buy insurance — involves more than competing philosophies or political strategies. At its core, it raises an irreducibly tangible question: what, if anything, to do about the nearly 50 million Americans who today lack health insurance.
Those millions of uninsured rarely intrude into the promises from GOP congressional leaders and the party’s presidential field to defend liberty by repealing Obama’s plan. But ignoring them doesn’t make them go away. If the 2012 election rewards Republicans with enough leverage in Washington to erase Obama’s initiative, they will face the choice of finding an alternative means to expand coverage or allowing the number of those without insurance to grow, with far-reaching consequences not only for the uninsured but for those with insurance as well.
Without some policy intervention, there’s little question that access to health insurance will continue to decline. Since 2000, the number of the uninsured has jumped from 36.6 million to 49.9 million, about one-sixth of all Americans.
That number would have been even higher if an additional 20 million people over that period had not obtained coverage through Medicaid and the Children’s Health Insurance Program. This growth partially offset the unrelenting erosion in employer-based care: The share of Americans obtaining coverage from their employer has declined every year since 2000, in good times and bad.
Earlier this month, the Congressional Budget Office forecast that, absent the new health-care law, the number of uninsured would rise to 60 million by 2020. That large a pool of uncovered Americans would create enormous strain for the health-care system.
The uninsured themselves would feel the most immediate effect, of course — studies show they are much more likely than those with coverage to defer or entirely forego needed care. But such an increase would also produce upward pressure on premiums for the insured as providers, especially hospitals, raise prices for those with coverage to offset the cost of uncompensated care to those without it. “The idea that repeal [of health-care reform] is somehow going to lower your premium is folly,” says Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics. More likely, he argues, repeal would increase premiums.
Obama’s health-care law, whatever its other virtues or flaws, represents a serious effort to break this cycle. CBO, echoing earlier projections, estimated last week that it would cover 33 million of the uninsured. No Republican has offered a plan to cover anywhere near so many. In 2009, the Congressional Budget Office estimated that the principal House Republican alternative to Obama’s proposal would cover only 3 million of the uninsured.
Both Santorum and Mitt Romney have proposed unspecified tax credits to cover some of those without coverage. Douglas Holtz-Eakin, president of the center-right American Action Forum, notes that Republicans believe that allowing interstate sale of insurance plans that offer more bare-bones coverage will reduce premium costs and expand access. Even so, he acknowledges, because so many of the uninsured have meager incomes, any tax credit big enough to meaningfully expand coverage still requires “a lot of money.”
But Republicans are proposing to shrink, not increase, federal health-care spending. Both Romney and House Republicans want to convert Medicaid into a block grant and cut federal spending on the program about in half by 2030. Even if those cuts provoked greater efficiency, the Urban Institute has estimated they could swell the number of uninsured by 14 million to 27 million beyond the effect of repealing Obama’s coverage expansion.
Leading Republicans almost all portray the health-care debate as a philosophical turning point between a limited central government and one they see as overweening and even tyrannical. But the debate also represents a much more practical turning point, between a society that attempts to approach universal health coverage and one that accepts millions of people living without insurance — with unavoidable costs for the uninsured and the insured alike.
By: Ronald Brownstein, The Atlantic, March 23, 2012
Romney said the plan introduced by House Budget Committee chairman Ryan (R-Janesville) “does not balance the budget on the backs of the poor and the elderly … It instead preserves Medicare and preserves Social Security.”
Look, this really isn’t complicated. Paul Ryan’s budget plan is simply brutal towards the poor and working families. Romney doesn’t have to like it, but he really shouldn’t lie about it.
Center on Budget and Policy Priorities
House Budget Committee Chairman Paul Ryan’s budget plan would get at least 62 percent of its $5.3 trillion in nondefense budget cuts over ten years (relative to a continuation of current policies) from programs that serve people of limited means. This stands a core principle of President Obama’s fiscal commission on its head and violates basic principles of fairness.
While giving a massive tax break to the wealthy, the Ryan budget plan Romney is so fond of slashes funding for Medicaid, food stamps, and other for low-income programs, nearly all of which Ryan’s plan would eliminate over the next couple of decades.
As the CBPP’s Robert Greenstein put it, “[T]he Ryan budget would impose extraordinary cuts in programs that serve as a lifeline for our nation’s poorest and most vulnerable citizens, and over time would cause tens of millions of Americans to lose their health insurance or become underinsured.” He added that Ryan’s plan “would cast tens of millions of less fortunate Americans into the ranks of the uninsured, take food from poor children, make it harder for low-income students to get a college degree, and squeeze funding for research, education, and infrastructure.”
If this doesn’t “balance the budget on the backs of the poor,” for crying out loud, what exactly would such a budget plan look like?
As for “preserving” Medicare, the Ryan plan that Romney supports would turn Medicare into a voucher program, scrapping the guaranteed benefit altogether; weaken Medicare solvency; and bring back the Medicare Part D prescription drug “donut-hole.”
So, what are we to make of Romney’s comments this morning? He’s either lying or he hasn’t read the budget plan he’s endorsed. It’s one or the other.
By: Steve Benen, The Maddow Blog, March 23, 2012
Even with his own sense of grandiosity, I doubt even Newt Gingrich truly believes a brokered convention is on the horizon. Mitt Romney, while still a weak candidate for the general election, is working his way steadily up to the required delegate count, and the leaders of the Republican Party—such as possible White Knight Jeb Bush—are throwing their lot behind Romney.
But Gingrich isn’t quite ready to drop the line, and his reasoning for why a brokered convention would help his party has become specious to a hilarious degree. Yesterday he suggested that it’d help Republicans because a brokered convention would just be so much darn fun to watch. Via GOP12, here’s what Gingrich said on CNN:
“That would be the most exciting 60 days of civic participation in the age of Facebook and Youtube. … the convention would be the most exciting convention in modern times, and whoever became the nominee would have the highest attendance, the highest viewership in history for their acceptance speech.”
As a political observer who will spend the last days of August searching for a good story in Tampa, I certainly share Gingrich’s desire for a convention with a bit of fun and uncertainty. But it’s hard to imagine how that would help the Republicans. Conventions are droll affairs of little interest except for the most diehard political junkies. Sometimes a young politician is introduced to the national spotlight with a great speech—such as Obama in 2004—but real drama doesn’t tend to help the hosting party. The Chicago Democratic convention in 1968 wasn’t lacking in excitement, but that didn’t work out so well for Humphrey in the general election. Or take 1976 and 1980, when an intra-party primary challenge against an incumbent president added extra intrigue, deflating the standing of the incumbent in both instances.
A brokered convention this year would attract viewers who might typically tune it out, and would create have a host of viral-ready clips to be spread across YouTube and Twitter. It wouldn’t be the harmonious kumbaya moments that would get passed around, it’d be clips of a discordant party at war with itself, not exactly the best posture for entering a general election against a sitting president.
By: Patrick Caldwell, The American Prospect, March 23, 2012
Geraldo, Geraldo, Geraldo. What were you thinking?
A black teenager is dead, through no apparent fault of his own, and you blame his wardrobe choice?
It was all the fault of the hoodie.
Most pundits say dumb things from time to time. But in weighing in on the killing of Trayvon Martin, Geraldo Rivera conducted a premeditated drive-by.
In a Friday morning appearance on Fox & Friends, the veteran journalist deflected some of the blame for the fatal shooting from George Zimmerman, the neighborhood watch captain who, like Rivera, is Hispanic.
While saying Zimmerman should be prosecuted if guilty, Rivera opined: “But I am urging the parents of black and Latino youngsters particularly to not let their children go out wearing hoodies. I think the hoodie is as much responsible for Trayvon Martin’s death as George Zimmerman was.”
Yes, he went there. Rivera is blaming the victim. The 17-year-old was armed only with a bag of Skittles, but he shouldn’t have worn that damn hoodie.
Geraldo didn’t stop digging the hole. While allowing that Trayvon was a nice kid who “didn’t deserve to die,” he sure must have looked like a crook.
“When you see a black or Latino youngster, particularly on the street, you walk to the other side of the street. You try to avoid that confrontation.” And: “I’ll bet you money, if he didn’t have that hoodie on, that — that nutty neighborhood watch guy wouldn’t have responded in that violent and aggressive way.”
I guess minorities in this country are to blame if they stir fears by wearing a jacket with a hood. White folks, of course, don’t have to worry about this.
Maybe there’s a time and place for a discussion of hoodies. But Geraldo, with much of the country disgusted by this killing for which no one has been charged, this sure wasn’t it.
By: Howard Kurtz, The Daily Beast, March 23, 2012
For every black man in America, from the millionaire in the corner office to the mechanic in the local garage, the Trayvon Martin tragedyis personal. It could have been me or one of my sons. It could have been any of us.
How many George Zimmermans are out there cruising the streets? How many guys with chips on their shoulders and itchy fingers on the triggers of loaded handguns? How many self-imagined guardians of the peace who say the words “black male” with a sneer?
We don’t yet know every detail of the encounter between Martin and Zimmerman in Sanford, Fla., that ended with an unarmed 17-year-old high school student being shot dead. But we know enough to conclude that this is an old, familiar story.
We know from tapes of Zimmerman’s 911 call that he initiated the encounter, having decided that Martin’s presence in the neighborhood was suspicious. We know that when Zimmerman told the 911 operator that he was following Martin, the operator responded, “Okay, we don’t need you to do that.” We know that Zimmerman kept following Martin anyway.
“This guy looks like he is up to no good,” Zimmerman said on the 911 tape.
Please tell me, what would be the innocent way to walk down the street with an iced tea and some Skittles? Hint: For black men, that’s a trick question.
Some commentators have sought to liken Martin’s killing to the 1955 murder of Emmett Till, an unspeakable crime that helped galvanize the civil rights movement. To make a facile comparison is a disservice to history — and to the memory of both young men. It is ridiculous to imply that nothing has changed.
When Till was killed in Mississippi at 14 — accused of flirting with a white woman — this was a different country. State-sanctioned terrorism and assassination were official policy throughout the South. Today, the laws and institutions that enforced Jim Crow repression have long since been dismantled. Mississippi, of all places, has more black elected officials than any other state. An African American family lives in the White House.
Black America was never a monolith, but over the past five decades it has become much more diverse — economically, socially, culturally. If you stood on a street corner and chose five black men at random, you might meet a doctor who lives in the high-priced suburbs, an immigrant from Ethiopia who drives a cab, a young aspiring filmmaker with flowing dreadlocks, an unemployed dropout trying to hustle his next meal and a midlevel government worker struggling to put his kids through college.
Those men would have nothing in common, really, except one thing: For each of them, walking down the wrong street at the wrong time could be a fatal mistake.
I hear from people who contend that racism no longer exists in this country. I tell them I wish they were right.
Does it matter that Zimmerman is himself a member of a minority group — he is Hispanic — or that his family says he has black friends? Not in the least. The issue isn’t Zimmerman’s race or ethnicity; it’s the hair-trigger assumption he made that “black male” equals “up to no good.”
This is one thing that hasn’t changed in all the eventful years since Emmett Till’s mutilated body was laid to rest. It is instructive to note that Till grew up in Chicago and just happened to be in Mississippi visiting relatives. Young black men who were born and raised in the South knew where the red lines were drawn, understood the unwritten code of behavior that made the difference between survival and mortal danger. Till didn’t.
Today, young black men grow up in a society where racism is no longer deemed acceptable. Many live in integrated neighborhoods, attend integrated schools, have interracial relationships. They wonder why their parents prattle on so tediously about race, warning about this or that or the other, when their own youthful experience tells them that race doesn’t matter.
What could happen on the way home from the store with some Skittles and an iced tea?
Whether Zimmerman can or should be prosecuted, given Florida’s “stand your ground” law providing broad latitude to claim self-defense, is an important question. But the tragic and essential thing, for me, is the bull’s-eye that black men wear throughout their lives — and the vital imperative to never, ever, be caught on the wrong street at the wrong time.
By: Eugene Robinson, Opinion Writer, The Washington Post, March 22, 2012