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“Has Dr. Ben Finally Stepped In It?”: “We Don’t Need A Department Of Veterans Affairs”

In my TPMCafe column on Ben Carson earlier this week, I noted that he had been pretty vague on a lot of issues even as he had wrapped his extremist philosophy in dog whistles. That’s quite the successful formula, for a while at least, for a stealth wingnut with a powerful biography and a charming manner.

Could be, though, he’s just stepped in a great big cow patty, per Military Times‘ Leo Shane III:

Presidential hopeful Ben Carson’s comments suggesting the Veterans Affairs Department should be eliminated drew quick condemnation from multiple veterans groups, who called the idea short-sighted and ill-informed.

On a national radio show Thursday, Carson said that the country need to re-examine how it cares for veterans but also how to cut back on government bureaucracy.

“There is a lot of stuff we’re doing that doesn’t make any sense,” he said. “We don’t need a Department of Veterans Affairs. Veterans Affairs should be folded in under the Department of Defense.”

Carson said he wants to provide all veterans with health savings accounts to pay for private-sector medical care and reserve defense-run veterans clinics for highly specialized care, like traumatic brain injury treatment and limb replacements.

Ah, yes, the HSA pet rock. But it’s not a welcome idea to the quite conservative VFW:

“To suggest that disabled veterans could be sent out into the economy with a health savings account card overlooks the fact that civilian health care has waiting lists of their own … and presupposes that civilian doctors have the same skill sets as VA doctors, who see veterans of every age and malady every day,” VFW National Commander John Biedrzyck said in a statement.

“(VA) provides an irreplaceable service to the nation’s wounded, ill and injured veterans, and my organization will not let any candidate for any office suggest anything otherwise.”

Them’s fighting words, and other vet groups seem even less pleased:

In a lengthy online essay, Paralyzed Veterans of America Deputy Executive Director Sherman Gillums Jr. called the plan “a misguided notion born from ignorance of what each department does.”

“Those who insist ‘we don’t need a Department of Veterans Affairs’ are likely people who in fact do not need VA care because of good health or cannot access VA care due to ineligibility, as is the case with Dr. Carson,” he wrote.

“However, frustration in reaction to problems in VA combined with ignorance about what VA does and how it works are not the ingredients for a recipe of success where fixing the department is concerned.”

And here’s the thing: this involves the one issue area where Carson can’t say he’s still playing catch-up because he’s been off saving lives for decades. As a physician, health care policy is the one thing he definitely will be expected to “get.”

Politics aside, abolishing the VA health system to shunt veterans (or at least those not picked up by the DoD, which could create another whole set of problems) into the private system is pretty close to the opposite of what we should be doing. As WaMo’s own Phil Longman explained back in 2007, we ought to be making the rest of the health care system more like the VA. No, it’s not perfect; the eligibility system has problems, as well all know; but the actual care it provides at a limited cost remains the best available in the country. And Ben Carson ought to realize that.


By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, September 4, 2015

September 6, 2015 Posted by | Ben Carson, Department of Veteran Affairs, Veterans | , , , , , | 1 Comment

“Jeb Once Again Turns To His Apple Watch”: A Wrist Gadget As Part Of His Vision For A Replacement Healthcare System

Jeb Bush caused a bit of a stir last week, telling an audience that he intends to destroy the Affordable Care Act, replacing it with a “consumer-driven” system, part of which includes his new Apple Watch.

“On this device in five years will be applications that will allow me to manage my health care in ways that five years ago were not even possible,” he said. “I’ll have the ability, someone will, you know, because of my blood sugar, there’ll be a wireless, there’ll be, someone will send me a signal…. We’ll be able to guide our own health care decisions in a way that will make us healthy.”

Yesterday, campaigning in New Hampshire, the Florida Republican returned to the same subject:

“We’re on the verge of a revolution in this regard, where we’ll be able to know all sorts of things with, you know, devices like this. I got beat up by the left because I showed my, you know, Apple Phone – this device will have the ability to measure your sugar content, to measure your heartbeat, to measure whether you’re taking your drugs in the proper way. And you’ll be able to wirelessly send text messages to your health care provider or to your loved one, or whatever, so that you can get back on track.”

It seems the former governor isn’t entirely clear on why he “got beat up.”

The point isn’t that wearable tech is irrelevant (he said “phone” yesterday, but I assume he meant “watch”). It’s easy to imagine devices that can help people manage chronic conditions like diabetes. Indeed, the Florida Republican makes it sound as if these advancements are on the horizon, but in many instances, the technology already exists.

That’s not the problem. Rather, the area of concern is that Bush intends to scrap the Affordable Care Act, which would eliminate health security for millions of families, and he included a wrist gadget as part of his vision for a replacement system. Sarah Kliff added last week:

Bush endorses the idea of “someone” sending him a signal on his Apple Watch when his blood sugar is low. I like that idea, too! It would help diabetic patients, like Bush, better manage their care.

But here’s the challenge: there is not some army of benevolent people out there monitoring blood sugar. There are health-care providers who do this, and to get signed up for their blood sugar monitoring programs, you typically need health insurance. In this way, the type of consumer-powered health market that Bush describes is one that relies on Americans having access to health services – and using that access to make better decisions about their health care.

Jeb Bush didn’t get “beat up” because he pointed to his fancy gizmo; he got “beat up” because he pointed to his fancy gizmo while making the case against the existing U.S. health care system.


By: Steve Benen, The Maddow Blog, May 22, 2015

May 26, 2015 Posted by | Affordable Care Act, Health Insurance, Jeb Bush | , , , , , , | 2 Comments

“Are ‘Death Panels’ Coming To Scott Walker’s Wisconsin?”: A Scheme To Make Middle-Class Workers Pay Even More For Health Care

Scott Walker could be on the verge of giving Infowars some great conspiracy theory fodder. A move by Wisconsin’s Group Insurance Board to substantially increase how much state employees pay for their health insurance is drawing unqualified and sharp opposition from labor leaders but could once have drawn criticism from Sarah Palin, as well. That’s because the proposal includes “consultations about end-of-life care, which some called ‘death panels,’” as the Wisconsin State Journal put it.

Death panels?! In the great Badger State? Putting Badger Staters to death? How could this be? One may have asked, as some on the right did during the debate over the Affordable Care Act. But here we are, with the Wisconsin state government overseeing what’s set to be the controversy-free implementation of new policies designed to save the state money through its employees’ end-of-life decisions.

Quick background: The Wisconsin state government is having some tough fiscal times, and Walker’s budget proposal suggested substantial cuts in a number of areas, including to the University of Wisconsin system and to K-12 education. The governor’s budget proposal also called for savings of $81 million on the state employees’ group health insurance program. (Remember that in 2011 the governor oversaw the passage of Act 10, which virtually ended collective bargaining for most of the state’s public sector unions.) But the budget wasn’t too specific about how to save that $81 million. Instead, Walker’s proposal directed the state’s Group Insurance Board to work with Atlanta-based Segal Consulting to figure it out.

The most buzzed-about change, the Wisconsin State Journal reported, will require public sector employees to pay twice as much out of pocket for their health care than they do now. These changes are projected to save the state $85 million over the next two years (Wisconsin passes budgets biennially), and most of the savings “will come from increasing out-of-pocket limits and introducing deductibles for the vast majority of state workers who don’t have them,” according to the paper. Individual employees will have new $250 deductibles, and family deductibles will be $500.

The Group Insurance Board voted for the changes on May 19, and unless the legislature’s Joint Finance Committee moves to require legislative approval for the changes, they will go into effect Jan. 1, 2016, according to Mark Lamkins, communications director for the state’s Department of Employee Trust Funds. The board that approved the changes has 11 members, some of whom are Walker appointees. The majority of the Walker appointees on the board voted in favor.

And the change has labor leaders irate.

“What the group insurance board did today is unconscionable,” said Wisconsin AFSCME executive Marty Beil, according to THOnline. “I’d also call it evil that they’re treating state employees at that level. It’s incredible.”

But Walker’s critics on the left aren’t just going after him for increasing public sector employees’ expenditures for their health care. They’ve also targeted him for a tiny provision the board approved that seeks to save a bit of money through end-of-life care. The memo laying out the cost-cutting health-care proposal doesn’t detail how these changes would work, and the State Journal reported that “[e]nd-of-life care consultations, also called advanced care planning or palliative care, would save $292,500.” That’s hardly a hefty sum. Lamkins said the changes would involve “keeping people out of institutions near the end of life, giving them more opportunities to manage their care-treatment plan.”

He added that the change is designed “to ensure that members facing serious illness and survival of less than six months are informed of care options and are able to make treatment decisions based on their individual values and goals of care.”

Reached for comment, Laurel Patrick, a spokeswoman for the governor, pointed out that the phrase “death panels” is nowhere to be found in any of the health care change proposals. But that hasn’t defused liberal ire about the panel’s move.

That’s because Walker has been one of the most outspoken conservative opponents of the Affordable Care Act.

“When Sarah Palin was trying to derail Obamacare over ‘death panels,’ Scott Walker didn’t say a word defending the need for people to have end-of-life counseling and instead on his first day as governor wasted taxpayer dollars suing the federal government over Obamacare,” said Scot Ross, executive director of One Wisconsin Now. “But wrapped in a scheme that would make cash-strapped middle-class workers in Wisconsin pay even more for health care, Team Walker quietly slides this into the mix. The inclusion of the palliative counseling is critical, but Scott Walker would have saved families a lot of grief if he would have stood up to the Tea Party in 2010 instead of this backdoor deal now.”

Robert Kraig, executive director of Citizen Action of Wisconsin, voiced support for Walker’s so-called death panels but said he was frustrated the governor didn’t do more to defend the Affordable Care Act.

“The right, using Sarah Palin, shamelessly tried to call simple voluntary end-of-life consultation a ‘death panel’ early in the debate over Obamacare,” he said. “There’s obviously a great irony that the Walker administration would now come forward with an end-of-life consultation provision. I still have to say that it’s good policy, most likely, it’s just incredible hypocrisy for them to come out with that after Walker has been one of the most disingenuous critics of the ACA.”

It’s doubtful, of course, that any of this will be a problem for Walker’s 2016 ambitions. Nobody ever did poorly with Iowa Republican caucus-goers because critics on the left were too noisy. But the debate highlights one of the tricky aspects of running for president as a governor: that the tiniest provisions in uncontroversial policies can easily become flashpoints for controversy.


By: Betsy Woodruff, The Daily Beast, May 21, 2015

May 22, 2015 Posted by | Death Panels, Public Employees, Scott Walker | , , , , , , | 1 Comment

“Sympathy For The Speaker” GOP Leaders Appear To Know They Have A Credibility Problem

I have sympathy (not much, but some) for John Boehner.

When it comes to the Affordable Care Act, the Republican House Speaker is nearly always between a rock and a hard place.

On one hand, he and the GOP leadership must stand against President Barack Obama’s health care law, because the longer it remains on the books, the more likely those who receive its benefits are going to support Democrats, not Republicans.

On the other hand, if someday the Republicans repeal the law, after having returned to the White House with congressional majorities, they will be forced to devise an alternative — an impossibility given the reactionary impulses of today’s GOP.

In the former scenario, Republicans lose.

In the latter scenario, they lose.

So Boehner must thread the needle while hoping his credibility as a GOP leader isn’t badly tarnished, even as rank-and-file Republicans discover through their experience that Obamacare isn’t actually a harbinger of North Korean-style totalitarianism.

Of course, that’s easier said than done. Boehner reiterated the Republican position on health care on the May 3 broadcast of Meet the Press, saying that Obamacare wasn’t working.

“Obamacare made it harder for employers to hire people,” he said. “You can ask any employer in America, ask them whether Obamacare has made it harder for them to hire employees, and they’ll tell you yes.”

When asked why none of the Republican Party’s dire predictions about health care came true, Boehner responded: “You know why there’s more people insured? Because a lot more people are on Medicaid.” He continued, “Giving people Medicaid insurance is almost like giving them nothing, because you can’t find a doctor that will see Medicaid patients. So where do they end up? The same place they used to end up: the emergency room.”

Events later in the week suggested, however, that something wasn’t right about Boehner’s claims. On Wednesday, the largest independent study of its kind was released. It found that nearly 17 million Americans are now covered under the Affordable Care Act.

Some lost coverage (about 6 million), according to the RAND Corporation study, but many more found coverage, with a net gain of 16.9 million. The evidence also contravenes those who say Obamacare encumbers hiring. For one thing, the largest gains (nearly 10 million) were made in employer-run insurance plans. For another, some 80 percent of the working population under the age of 65 saw no change at all in their health care coverage.

That wasn’t the only reason to look askance at Boehner’s claims. Last Friday’s monthly jobs report showed the unemployment rate had dropped to 5.4 percent, the lowest it’s been since May 2008, before Obama won the presidency. Even wages, which have not typically kept pace with inflation, rose by 2.2 percent in the past year.

So something’s wrong with the picture Boehner is painting. If most employers are offering insurance, and if the job market is expanding, why is Boehner saying that the Affordable Care Act has led to less insurance coverage and more unemployment?

GOP leaders appear to know they have a credibility problem. They are shifting their stance against Obamacare from quantity to quality. According to a report in The Hill published after Boehner’s appearance on Meet the Press, the Republicans now concede that Obamacare has covered more Americans but argue that the coverage is inferior. Hence, Boehner’s comment about Medicaid: Doctors don’t take Medicaid, and having it is like having nothing.

Such a shift raises its own question of credibility. Why would a Republican Party that equates tyranny with the presence of government in the lives of individuals be worried about the government’s role in providing quality health care to individuals?

Some might judge this as hypocrisy and thus dismiss the new Republican position as entirely unworthy of scrutiny. There’s merit to that, as Washington wallows in hypocrisy. But hypocrisy can prevent us from seeing what’s really going on. In this case, I wonder if Boehner and the leadership are worried about holding their ranks, as the temptation to defect grows from within.

Over time, the Affordable Care Act will penetrate deeper into the population. The millions of Americans who will benefit from the law will have an incentive to maintain the status quo. They’ll likely support the Democratic Party as long as the Republicans demand repeal of the law. So, as of now, a vote for a Republican, from the point of someone covered by the Affordable Care Act, is a self-destructive vote. And among those millions are conservatives.

Some might argue that in saying things about Obamacare that just aren’t true, Boehner risks alienating conservatives that make up the base of the Republican Party. Why would they trust the House Speaker if he is so consistently wrong? There’s something to that, but a likelier explanation for the GOP’s continued, and shifting, stance against the health care law is that opposition, no matter how contorted, is the best way to keep the conservatives in line.

Given time, more conservatives are going to benefit from the law. And the more they do, they more they will vote their self-interests. And that’s why I have (a little) sympathy for John Boehner.


By: John Stoehr, The National Memo, May 16, 2015

May 17, 2015 Posted by | Affordable Care Act, John Boehner, Obamacare | , , , , , , , | 1 Comment

“Praise The Lord, Mom’s Alive”: Rick Scott’s Stunning Health Care ‘Ruse’ In Florida

In early 2013, Florida Gov. Rick Scott (R) surprised nearly everyone by announcing he’d changed his mind about Medicaid expansion through the Affordable Care Act. The Republican governor had long condemned the idea, but he apparently had a change of heart.

“I cannot, in good conscience, deny the uninsured access to care,” he said at the time. Scott added that Medicaid expansion is “a compassionate, common sense step forward.” The governor even referenced the death of his mother when explaining his rationale.

“A few months ago, my mother passed away, and I lost one of the only constants in my life,” Scott said. “Losing someone so close to you puts everything in new perspective … especially the big decisions…. As I wrestled with this decision, I thought about my Mom’s struggles raising five kids with very little money.”

That was February 2013. In April 2015, Scott reversed course again, announcing his renewed opposition to the policy he’d endorsed. And today, the local CBS affiliate in Miami reports that the governor offered an unexpected explanation for his posture two years ago.

Scott conceded this week that was all a ruse. He now says his support for Medicaid expansion was a calculated move designed to win support from the Obama administration for the state’s proposal to hand over control of Medicaid to private insurance companies. At the time, he denied that his support was tied to a deal with the federal government.

Now that he’s succeeded in privatizing Medicaid, Scott is again railing against Medicaid expansion and is suing the federal government for allegedly forcing it on him.

Oh my.

Of course, if you notice that CBS/Associated Press excerpt, you’ll notice that it’s missing something: a quote. The entire report appears to be a paraphrase of Scott’s comments, and the exact wording always matters.

Indeed, the governor’s office this afternoon pushed back against the AP’s reporting, saying the piece “editorialized” Scott’s comments.

So, which is it? On Twitter, Gary Fineout, an AP reporter in Florida, fleshed this out in a little more detail, explaining the argument Scott presented yesterday. As Fineout described it, the governor may have claimed at the time that his mother’s death inspired him to change his perspective, but in reality – according to Scott’s comments yesterday – the Florida Republican only supported Medicaid expansion as part of “a quid pro quo” to get a waiver from the Obama administration for Medicaid privatization.

Scott may have publicly claimed in 2013 that his position was about his “conscience” and deceased mother, but according to the governor’s new version of events, the rhetoric wasn’t actually sincere – his previous position was a calculated move to gain approval for his privatization plan.

In other words, the governor didn’t literally use the word “ruse” yesterday, so much as he effectively described a scheme in which he told the public something untrue in order to get what he wanted at the time.

I don’t expect much from Florida politics, but when a governor references his deceased mother to make a deliberately misleading argument, the Sunshine State is quite possibly breaking new ground in ugliness.


By: Steve Benen, The Maddow Blog, May 7, 2015

May 10, 2015 Posted by | Medicaid Expansion, Rick Scott, Uninsured | , , , , , | 4 Comments


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