“A Ridiculous Argument”: The GOP’s Emergency-Room Argument Never Dies
CBS’s “60 Minutes” ran fairly long interviews last night with both President Obama and Mitt Romney, and the latter made some news with answers on tax policy. While they’re likely to have a political impact, substantively, the Republican’s answers on health care were even more striking.
Following up on Friday’s release of 2011 tax returns, Scott Pelley asked whether it’s fair that Romney pays a lower federal income tax rate than “the guy who makes $50,000.” The Republican conceded it’s a “low rate,” but nevertheless said it’s fair — the reduced rate is the “right way to encourage economic growth — to get people to invest, to start businesses, to put people to work.”
This is no small admission. The multi-millionaire candidate pays a lower tax rate than most of the middle class — and the rate would have been even lower had Romney not artificially inflated it purely for political reasons — and if elected, he’ll fight to keep it that way.
But this exchange on health care struck me as every bit as interesting.
Pelley: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?
Romney: Well, we do provide care for people who don’t have insurance, people — we — if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.
Pelley: That’s the most expensive way to do it.
Romney: Well the–
Pelley: In an emergency room.
When it comes to health care policy, this might be one of the more important moments of the presidential race. Romney doesn’t believe the United States has a responsibility to provide health care coverage to its own citizens — the Republican Party is the only major political party in any democracy on the planet to hold this position — but he does see emergency rooms as an avenue for caring for the uninsured.
And as a policy matter, that’s deeply absurd.
Long time readers may recall this is a long-time focus of mine, but so long as it keeps coming up, it’s worth setting the record straight from time to time.
It’s true that under the preferred Republican system — American health care before the Affordable Care Act passed — if you’re uninsured and get sick, there are public hospitals that will treat you. As Romney noted on camera, if you have a heart attack, you can call 911 and medical professionals will come get you and give you care.
But it’s extremely expensive to treat patients this way, and it would be far cheaper, and more medically effective, to pay for preventative care so that people don’t have to wait for a medical emergency to seek treatment.
For that matter, when sick people with no insurance go to the E.R. for care, they often can’t pay their bills. Since hospitals can’t treat sick patients for free, the bills can still bankrupt those who get sick, and the costs are still passed on to everyone else.
In other words, it’s the most inefficient system of socialized medicine ever devised.
And in the bigger picture, it’s worse than that. For those with chronic ailments, this position is a pathetic joke — is anyone going to stop by the emergency room for chemotherapy or diabetes treatments?
Romney’s argument isn’t a responsible approach to American health care in the 21st century; Romney’s argument is ridiculous.
By: Steve Benen, The Maddow Blog, September 24, 2012
“Terror Management Theory”: The Republicans’ Foreign Policy Problem
Pop quiz: if you had to describe the Obama foreign policy in one sentence, what would you say? Not easy, is it? Back in 2008, it was pretty simple: “Not Bush.” Now back then, there was something called the “Bush doctrine,” which may have had a subtle meaning to those working in the administration, but as far as the public was concerned mostly meant “invading lots of countries and making everyone in the world hate us.” So it was easy to imagine Obama as a breath of foreign policy fresh air. He’d use a less-bumbling combination of diplomacy, “soft power,” and carefully restrained force. He’d get us out of Iraq. Things would change for the better.
But now that Obama has been president for four years, “Not Bush” has lost its relevance. Obama’s actual foreign policy is too complicated to sum up easily, and probably therefore too complicated for most voters to understand. We did get out of Iraq, but things don’t seem to be going too well in Afghanistan; Obama has dramatically increased the use of drone strikes, which have solved some problems and created others; though opinions of America are somewhat better, lots of people still don’t like us. It’s a complex picture, and in the context of an election, the Obama campaign is going to react to most foreign policy questions with, “Remember that guy Osama bin Laden? He’s dead.”
True enough, but this complexity has left Republicans seemingly unable to critique the Obama foreign policy. As Conor Friedersdorf points out, Republicans can’t figure out what to say:
President Obama’s foreign policy is vulnerable to all sorts of accurate attacks. But Mitt Romney, the Republican Party, and the conservative movement are totally unable to exploit them. This is partly because the last four years have been spent advancing critiques so self-evidently implausible to anyone outside the movement that calling attention to them seems impolite. There is no factual basis for the assertion that Obama rejects American exceptionalism; or that he embarked on an apology tour; or that he is allied with our Islamist enemy in a “grand jihad” against America; or that his every action is motivated by Kenyan anti-colonialism. And while those critiques are especially inane, they aren’t cherry-picked to discredit conservatives. They’re actually all critiques advanced by prominent people, publications, and/or Republican politicians.
I’d say they have two problems. First, their impulse is to just say that their foreign policy is “Not Obama,” and that just doesn’t have the same persuasive power as “Not Bush” did four years ago, because American foreign policy doesn’t look like a disaster. For instance, when Mitt Romney criticizes Obama for getting out of Iraq too fast—since if Obama did it, it had to be wrong—most people are going to respond, “Are you crazy?” Second, the closest thing to an articulation of their own foreign policy vision they can come up with is “Obama weak! America should be strong! Grrr!” And voters don’t actually think Obama is weak.
That’s partly because of his own actions, and partly because in 2012, Americans aren’t actually fearing for their lives. They did during the Cold War, and they did in the aftermath of 9/11, but that feeling has faded. There have actually been some experiments showing that when you remind people of the possibility of their own deaths, they’re more likely to support conservative candidates (it’s called “Terror Management Theory”). I’ve heard pollsters say that one of the key moments of the 2004 campaign was the horrific Beslan school massacre that September in which 330 people were killed, over half of them children. It brought terrorism and fear back on to the front pages, to George W. Bush’s advantage.
But today, for all the world’s problems, Americans aren’t feeling like they might be killed tomorrow. That’s a good thing. But it leaves the Republicans without much of a coherent foreign policy critique.
By: Paul Waldman, Contributing Editor, The American Prospect, September 24, 2012
“Promoting Untrue Choice”: Paul Ryan’s Health Care Proposal Would Shrink The Medicare Doctor Pool
The federal budget proposed by Representative Paul Ryan, the Republican vice-presidential nominee, extols the benefits of “promoting true choice” for Medicare beneficiaries.
In truth, though, the Ryan plan would substantially reduce choice for many people on Medicare — by cutting them off from their current doctors.
Doctors see Medicare patients, despite the relatively low payments they receive for doing so, partly because Medicare represents such a large share of the health-care market.
If a substantial number of beneficiaries moved out of Medicare and into private plans, as Ryan proposes, doctors would have much less incentive to see Medicare patients. And the elderly who want to remain in traditional Medicare would risk being stranded.
The evidence suggests that, in time, this problem could well affect a large share of Medicare beneficiaries. To put that evidence in context, though, it helps to first review the history of the Ryan plan.
The proposal has changed since it was presented in 2011. In the original version, traditional Medicare was eventually to be replaced in its entirety by private plans. The Congressional Budget Office found that this shift would raise health-care costs drastically because the private plans wouldn’t be large enough to enjoy Medicare’s leverage in negotiating prices with hospitals and other large providers. The savings that private plans could achieve because beneficiaries would share more of the costs, and therefore economize more, would be more than offset by that loss of leverage — and by the private plans’ higher overhead and need to turn a profit.
Ryan Revision
In response to the devastating CBO report, Ryan revised his proposal. Under Ryan 2.0, private plans would co-exist with traditional Medicare. (The CBO hasn’t fully evaluated the revised plan yet.)
Many supporters argue that the new plan can’t be as big a problem as the old one, since beneficiaries could always choose to remain in traditional Medicare. In health care, however, choice isn’t always innocuous — and can sometimes be harmful.
I have previously described two downsides to expanding private plans in Medicare. First, it would undercut Medicare’s ability to help move the payment system away from fee-for- service reimbursement and toward payments based on value, because no private plan is large enough to accomplish that shift by itself. Second, the mechanism for adjusting premiums to even out the health risks of individual beneficiaries is far from perfect, so plans can easily game the system, raising total costs. In effect, the plans would end up being overpaid.
The reduced choice of doctors for those who remain in traditional Medicare is a third adverse consequence of moving beneficiaries out of the program.
Currently, Medicare beneficiaries almost universally enjoy excellent access to doctors. And the great majority of beneficiaries never have to wait long for a routine appointment, the Medicare Payment Advisory Commission has found. Roughly 90 percent of doctors accept new Medicare patients.
Doctors provide this access even though they are reimbursed by Medicare at rates that are only about 80 percent of commercial rates — partly because Medicare is such a large share of the market. Which brings us to the concern about the Ryan plan.
Medicare Doctors
How important is Medicare’s market share in influencing physician participation? The evidence is limited, but the best study to date suggests it is significant. In the 1990s, Peter Damiano, Elizabeth Momany, Jean Willard and Gerald Jogerst, all associated with the University of Iowa, surveyed Iowa physicians and examined variation among counties. They found that for each percentage-point increase in the share of Medicare beneficiaries in a county’s population, doctors were 16 percent more likely to accept patients on Medicare. The only other study I know of on this topic, an unpublished analysis by Matthew Eisenberg of Carnegie Mellon University, also found an effect from Medicare’s market share, albeit one that was substantially smaller than the one Damiano and his colleagues found.
About 10 percent of the U.S. population is now enrolled in traditional Medicare, and an additional 5 percent has private Medicare plans. Let’s assume, for the sake of argument, that the Ryan plan would cause another 5 percent of the population to shift, and to be conservative let’s cut in half the Damiano estimate of the impact from that reduction in Medicare’s market share. Then the chance that a doctor is willing to see traditional Medicare patients would be expected to decline by a whopping 40 percent. The share of doctors accepting Medicare would fall from about 90 percent to 54 percent.
To be even more conservative, let’s average the reduced Damiano estimate (already been cut in half and applied only to today’s market share rather than the higher one that will exist in the future when more people are on Medicare) with the Eisenberg estimate. Still, about 20 percent of doctors would be expected to stop accepting Medicare patients.
Supporters of the Ryan approach might argue that fewer people would shift into the private plans, so the impact would not be that great. After all, the existing Medicare program already offers Medicare Advantage plans, so perhaps anyone who wants private insurance already has it. But then, what is the point of Ryan’s Medicare reform?
Another defense might be that the government could simply raise doctor-reimbursement rates to encourage providers to continue treating a shrinking population of traditional Medicare patients. And that’s true. However, Ryan has not included the extra cost in his budget.
So, which is it, Mr. Ryan? Will your plan cause Medicare beneficiaries to lose access to their doctors, or are your budget numbers too rosy because you haven’t counted the extra payments needed to keep doctors in the program?
By: Peter Orszag, Council on Foreign Policy, Business Insider, September 24, 2012
“The Wrong Right Move”: Terrible News For Mitt Romney
Republican presidential candidate Mitt Romney campaigns at D’Evelyn High School in Denver, Colorado over the weekend.
Once it became clear that President Obama received a significant bounce from the Democratic National Convention, the next question was whether this bounce would translate to an enduring advantage for his campaign.
On Friday, polls from National Journal and Reason magazine gave Obama a seven-point lead over Mitt Romney, 50–43 and 52–45, respectively. Saturday was a quiet day for national polling, but Sunday saw the release of two tracking polls by Rasmussen and Gallup. Rasmussen was unchanged from the last few days; Romney and Obama remain tied with 46 percent support, though Obama’s job approval has ticked down: 48 percent approve, 50 percent disapprove.
Obama began last week in a similar position with Gallup, but both his approval—and performance against Romney—improved in yesterday’s tracking poll. He now earns 48 percent support to Romney’s 46 percent, and has a job approval rating of 51 percent, with 43 percent disapproval. This morning, a set of national polls from Zogby and Politico/George Washington University show Obama with a decisive lead in the race. The Politico poll finds Obama leading Romney by 3 points among likely voters, 50 percent to 47 percent, while Zogby has Obama up 8, 49 percent to 41 percent.
These results should be considered with polls released last week—from NBC News and the Pew Research Center—that show Obama above 50 percent against Mitt Romney. Relative to his post-convention bounce, Obama’s position has declined, but overall, he’s unquestionably stronger than he was before the conventions. Here is a chart to illustrate the general change over the last three weeks.
As you can see, Obama’s position has sloped downwards since the beginning of last week, but Romney’s has also declined, leaving them in the same rough position.
If there’s an upside for Romney, it’s that Gallup and Rasmussen show a neck-and-neck race. But that’s the extent of the positive news for the former Massachusetts governor. Indeed, if we move our attention to state-level polling, the picture looks even worse for the Republican nominee. In the most critical state for Romney, Florida, his position has deteriorated. Public Policy Polling gives Obama a four-point lead in Florida, while Mason-Dixon puts him ahead by 1 percent. If you’re unwilling to put Florida in the “leans Obama” column—on account of Romney’s one-point lead in Friday’s Purple Strategies survey—then the most you can say is that Florida is a toss-up that tilts in Obama’s favor.
There’s no way in which this isn’t terrible news for Romney. Without Florida’s 29 electoral votes, there is no way for him to reach 270 without winning two states from the “leans Obama” column, like Wisconsin and Michigan. At most, he gets 256 electoral votes—and that’s if he wins every other swing state on the map.
Here’s where Romney stands: He consistently trails Obama, hasn’t held a lead in national polls, and is nearly five points way from the 50-percent mark in most polling averages. His support is collapsing among core demographics like older voters, and he has lost his advantage on the economy. Doubling-down on conservative positions might build enthusiasm among his base, but it won’t help him catch up with Obama; both sides are winning the vast majority of their respective partisans and partisan leaners.
In other words, unless Romney can win undecideds and convert Obama voters, he simply doesn’t have a path to the victory.
By: Jamelle Bouie, The American Prospect, September 24, 2012
“Romney’s Optimism Cure”: Are You Feeling Reassured By The Confidence Fairy?
Mitt Romney is optimistic about optimism. In fact, it’s pretty much all he’s got. And that fact should make you very pessimistic about his chances of leading an economic recovery.
As many people have noticed, Mr. Romney’s five-point “economic plan” is very nearly substance-free. It vaguely suggests that he will pursue the same goals Republicans always pursue — weaker environmental protection, lower taxes on the wealthy. But it offers neither specifics nor any indication why returning to George W. Bush’s policies would cure a slump that began on Mr. Bush’s watch.
In his Boca Raton meeting with donors, however, Mr. Romney revealed his real plan, which is to rely on magic. “My own view is,” he declared, “if we win on November 6, there will be a great deal of optimism about the future of this country. We’ll see capital come back, and we’ll see — without actually doing anything — we’ll actually get a boost in the economy.”
Are you feeling reassured?
In fairness to Mr. Romney, his assertion that electing him would spontaneously spark an economic boom is consistent with his party’s current economic dogma. Republican leaders have long insisted that the main thing holding the economy back is the “uncertainty” created by President Obama’s statements — roughly speaking, that businesspeople aren’t investing because Mr. Obama has hurt their feelings. If you believe that, it makes sense to argue that changing presidents would, all by itself, cause an economic revival.
There is, however, no evidence supporting this dogma. Our protracted economic weakness isn’t a mystery; it’s what normally happens after a major financial crisis. Furthermore, business investment has actually recovered fairly strongly since the official recession ended. What’s holding us back is mainly the continued weakness of housing combined with a vast overhang of household debt, the legacy of the Bush-era housing bubble.
By the way, in saying that our prolonged slump was predictable, I’m not saying that it was necessary. We could and should have greatly reduced the pain by combining aggressive fiscal and monetary policies with effective relief for highly indebted homeowners; the fact that we didn’t reflects a combination of timidity on the part of both the Obama administration and the Federal Reserve, and scorched-earth opposition on the part of the G.O.P.
But Mr. Romney, as I said, isn’t offering anything substantive to fight the slump, just a reprise of the usual slogans. And he has denounced the Fed’s belated effort to step up to the plate.
Back to the optimism thing: It’s true that some studies suggest a secondary role for uncertainty in depressing the economy — and conservatives have seized on these studies, claiming vindication. But if you actually look at the measures of uncertainty involved, they’ve been driven not by fear of Mr. Obama but by events like the euro crisis and the standoff over the debt ceiling. (O.K., I guess you could argue that electing Mr. Romney might encourage businesses by promising an end to Republican economic sabotage.)
You should also know that efforts to base policy on speculations about business psychology have a track record — and it’s not a good one.
Back in 2010, as European nations began implementing savage austerity programs to placate bond markets, it was common for policy makers to deny that these programs would have a depressing effect. “The idea that austerity measures could trigger stagnation is incorrect,” insisted Jean-Claude Trichet, then the president of the European Central Bank. Why? Because these measures would “increase the confidence of households, firms and investors.”
At the time I ridiculed such claims as belief in the “confidence fairy.” And sure enough, austerity programs actually led to Depression-level economic downturns across much of Europe.
Yet here comes Mitt Romney, declaring, in effect, “I am the confidence fairy!”
Is he? As it happens, Mr. Romney offered a testable proposition in his Boca remarks: “If it looks like I’m going to win, the markets will be happy. If it looks like the president’s going to win, the markets should not be terribly happy.” How’s that going? Not very well. Over the past month conventional wisdom has shifted from the view that the election could easily go either way to the view that Mr. Romney is very likely to lose; yet markets are up, not down, with major stock indexes hitting their highest levels since the economic downturn began.
It’s all kind of sad. Yet the truth is that it all fits together. Mr. Romney’s whole campaign has been based on the premise that he can become president simply by not being Barack Obama. Why shouldn’t he believe that he can fix the economy the same way?
But will he get a chance to put that theory to the test? At the moment, I’m not optimistic.
By: Paul Krugman, Op-Ed Columnist, The New York Times, September 23, 2012
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 