“Ending Medicare As We Know It”: Here’s Why There Won’t Be A Republican Alternative To Obamacare
Republicans are sick of people saying they don’t have an alternative to Obamacare.
They have plenty!
And not just, “Don’t get sick! And if you do get sick, die quickly,” as Rep. Alan Grayson (D-FL) said in 2009.
The Republican-controlled House of Representatives just hasn’t voted on even one Obamacare alternative because it’s hard to fit stuff in when you only work 28 hours a week and have to squeeze in all those Obamacare repeals.
But they’re going to fix that problem in 2014, says Rep. Tom Price (R-GA).
The congressman has introduced his Obamacare alternative — the Empowering Patients First Act — three times since 2009. Price’s bill has never been given a vote, even though it has 50 co-sponsors, including the eminent Rep. Michele Bachmann (R-MN).
Price told Fox News that after the first of the year, Republican leaders are going to bring forth a bill that will “unite Republicans around health care issues” because “you can’t beat something with nothing.”
This logic runs contrary to Town Hall‘s Conn Carroll, who believes the House GOP won’t coalesce around one plan or, as he calls it, “a villain to run against.”
This has been the GOP strategy since 2010, and don’t expect it to change, despite the assurances the leadership has given to Rep. Price.
Price’s bill has never been scored by the Congressional Budget Office (CBO). But a former Republican head of the CBO scored it independently and found that it saves trillions of dollars over 10 years and will reduce the uninsured population by 29 percent by 2016.
If this is true, why haven’t Republicans even put it up for a vote?
A quick look at H.R. 2300, the current version of Price’s bill, shows you why the GOP likely won’t propose an alternative to Obamacare — ever.
The bill starts off with Republicans’ favorite health care distractions — tort reform and selling across state lines.
If you eliminated every malpractice claim in America, that would only reduce the costs of our health care system by 1 to 1.5 percent – far less than implementing a public option.
Selling insurance over state lines would just give insurers the chance to sell plans from the state with the fewest regulations. The Washington Post‘s Ezra Klein looked at a CBO report on a bill from 2005 that would have made national sales of state insurance plans possible and found “the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance.”
The real goal of Price’s bill and just about every Republican reform of the health care system is to end the employer-provided health insurance dynamic that most Americans rely upon. Employers get a generous tax break for providing health coverage that Price would then extend to individuals. The 2009 version of his bill did this in a way that would actually have resulted in a huge tax increase.
But the bigger problem with Price’s plan to sever the employer-employee health insurance relationship and create plans that stay with an individual for life is that it would end up in cancelations of current plans — tens of millions of cancelations.
Republicans could argue that these new plans would be better than the existing plans for various reasons — but that’s an argument they know doesn’t work, because they crushed it when Democrats used it to defend the cancelations that happened after the implementation Obamacare.
Price says his plan would cover people with pre-existing conditions, though it doesn’t include an individual mandate or any incentive to prevent insurers from cherry-picking the healthiest consumers.
“In other words, this looks much like the reforms that collapsed in Texas, and in California,” Klein noted. ”Price isn’t learning from past policy mistakes, and so he means to repeat them.”
The biggest problem with Price’s bill is how it reforms existing public health care programs.
If H.R. 2300 became law, anyone could opt out of Medicare or Medicaid and receive a voucher to purchase private insurance.
We have no idea how many people would opt out of Medicare given the fact that few private insurers see people over 65 as the path to prosperity for their business. But when the growth of Medicare costs is far below that of private insurers, all that voucher would end up being is a ticket to pay far more for health care at the time of your life when it will cost you the most.
And if too many beneficiaries opted out, the entire system of dictating costs to providers in exchange for volume could collapse with devastating effects to our deficit and debt.
The worst part for Republicans is the facet of the law that allows Democrats to make a pretty simple case against the GOP’s Obamacare alternative: It ends Medicare as we know it. The GOP could rebut that assertion by saying that Medicare will still exist for those who want it, but a party that has been shedding senior support all year doesn’t want to have that argument.
Any alternative the GOP proposes to replace Obamacare is going to spark negative headlines — even if the GOP manages to evade the tax increases, cancelations and potential problems for Medicare that exist in Price’s bill.
If the Republican leadership makes the mistake of offering an alternative, they’ll dull the sting of their attacks on Obamacare by having to defend some version of a plan they were wise enough to sit on for years.
By: Jason Sattler, The National Memo, December 16, 2013
“And The Shootings Continue”: 2013, The Year We Learned Gun Reform Is Impossible
Nothing in 2013 matched the horror of Sandy Hook or Aurora, but the year proved to be a dispiriting one for gun-control crusaders hoping to capitalize on the intense outpouring of grief wrought by 2012’s shooting massacres.
After Newtown, President Obama gave an impassioned speech promising to do everything in his power to prevent “more tragedies like this.” We’d watched these scenes of public mourning before—after Tucson, after Aurora—but it was different this time. Obama’s bold declaration that “we are not doing enough and we will have to change” seemed more forceful than before. And coming just six weeks after his reelection, it seemed more possible.
But once the National Rifle Association and others got a whiff of any serious threat to firearm freedoms, they moneyed up. Although gun-control groups spent five times as much on federal lobbying in 2013 as they did in 2012, according to data compiled by the Sunlight Foundation, gun-rights groups outpaced them by more than 7-to-1.
As usual, the NRA’s efforts paid off. Watered-down legislation that would have expanded background checks failed in the Senate this past spring, and the issue retook its place in Congress as a perennial nonstarter.
And the shootings continued.
But Congress delivered gun-reform advocates one final 2013 disappointment this week. The Senate on Monday voted to renew the Undetectable Firearms Act just hours before the 25-year-old law was set to expire. The 10-year extension, which even the National Rifle Association endorsed, is largely genteel. It keeps on the books a ban on firearms that can sneak through metal detectors, but efforts by Sen. Chuck Schumer, D-N.Y., to close what he called a “dangerous loophole” allowing a person to use 3-D printing technology to craft a plastic gun failed to get off the ground. Schumer wanted to amend the law to require that firearms have permanent metal pieces in them.
Gun-control advocates have seen some movement outside of Congress. In September, Starbucks CEO Howard Schultz declared guns unwelcome in his stores, even in states with open-carry laws. Colorado’s State House passed stricter gun laws, though members did so at great political peril. Connecticut adopted some of the strictest in the nation, despite being home to several gun manufacturers. And Obama did pass a number of executive orders that make small inroads, such as restricting the import of military surplus weapons and ordering federal agencies to share more data with the background-check system.
But national lawmakers in 2013 did what they do every year when it comes to tightening gun restrictions: nothing.
“It should be a source of great embarrassment to the U.S. Senate and House of Representatives that we have not moved the ball forward one inch when it comes to the issue of protecting the thousands of people all across this country who are killed by guns every year,” said Sen. Chris Murphy, D-Conn., before Monday’s vote of the Undetectable Firearms Act, which passed by unanimous consent.
2012’s gun violence brought us unprecedented grief. But 2013 reminded us just how impossible it is to move that ball forward. If a deranged man killing 20 kids and six teachers at an elementary school won’t prompt meaningful gun reform, it’s hard to imagine what will.
By: Dustin Volz, The National Journal, December 10, 2013
“A Pill For Every Ill”: Consumer Drug Advertising Should Be Banned
Consumer advertising of prescription drugs is a massive public health experiment in which billions of dollars are spent each year. But this advertising is a blunt instrument where a sharp edge is needed.
Drugs have harms as well as benefits, and the harms are greater when drugs are indiscriminately prescribed. Consumer advertising, delivered to the masses as a shotgun blast, rather than as specific information to concerned patients or caregivers, results in more prescriptions and less appropriate prescribing.
There is no evidence that consumer ads improve treatment quality or result in earlier provision of needed care. Research has shown that the ads convey an unbalanced picture, with benefits and emotional appeals given far greater weight than risks. Clinicians can work to override these miscues, but this steals precious time from activities that can provide real benefit to patients. In the packed agenda of the patient visit, in which so many real concerns and evidence-based care are available to make a difference in people’s lives, the intrusion of marketing risks harm.
Advertising also provokes a subtle shift in our culture — toward seeking a pill for every ill. While there are many for whom stimulants and other medications can be a godsend, the case of attention deficit hyperactivity disorder is a prime example of how, too often, a pill substitutes for more human responses to distress. U.S. clinicians prescribe stimulant medication for A.D.H.D. at a rate 25 times that of their European counterparts. The complex decision to start a long-term medication should be motivated by the observations of teachers and parents and children, in the context of a relationship with a caring clinician − not stimulated by rosy ads.
Consumer drug advertising is banned in most of the world, although pharmaceutical companies are making a full-court press on the European Union, even while violating the limited guidelines for that advertising in the United States.
In the information age, in which more balanced sources of information on drugs should be widely available, biased pill-pushing messages are a public health menace. To advance the health of the public, the United States should follow the lead of the vast majority of countries, and ban direct-to-consumer pharmaceutical advertising.
By: Kurt C. Strange, Room for Debate, The New York Times, December 15, 2013
“Why Inequality Matters”: Rising Inequality Is By Far The Most Important Single Factor Behind Lagging Middle-Class Incomes
Rising inequality isn’t a new concern. Oliver Stone’s movie “Wall Street,” with its portrayal of a rising plutocracy insisting that greed is good, was released in 1987. But politicians, intimidated by cries of “class warfare,” have shied away from making a major issue out of the ever-growing gap between the rich and the rest.
That may, however, be changing. We can argue about the significance of Bill de Blasio’s victory in the New York mayoral race or of Elizabeth Warren’s endorsement of Social Security expansion. And we have yet to see whether President Obama’s declaration that inequality is “the defining challenge of our age” will translate into policy changes. Still, the discussion has shifted enough to produce a backlash from pundits arguing that inequality isn’t that big a deal.
They’re wrong.
The best argument for putting inequality on the back burner is the depressed state of the economy. Isn’t it more important to restore economic growth than to worry about how the gains from growth are distributed?
Well, no. First of all, even if you look only at the direct impact of rising inequality on middle-class Americans, it is indeed a very big deal. Beyond that, inequality probably played an important role in creating our economic mess, and has played a crucial role in our failure to clean it up.
Start with the numbers. On average, Americans remain a lot poorer today than they were before the economic crisis. For the bottom 90 percent of families, this impoverishment reflects both a shrinking economic pie and a declining share of that pie. Which mattered more? The answer, amazingly, is that they’re more or less comparable — that is, inequality is rising so fast that over the past six years it has been as big a drag on ordinary American incomes as poor economic performance, even though those years include the worst economic slump since the 1930s.
And if you take a longer perspective, rising inequality becomes by far the most important single factor behind lagging middle-class incomes.
Beyond that, when you try to understand both the Great Recession and the not-so-great recovery that followed, the economic and above all political impacts of inequality loom large.
It’s now widely accepted that rising household debt helped set the stage for our economic crisis; this debt surge coincided with rising inequality, and the two are probably related (although the case isn’t ironclad). After the crisis struck, the continuing shift of income away from the middle class toward a small elite was a drag on consumer demand, so that inequality is linked to both the economic crisis and the weakness of the recovery that followed.
In my view, however, the really crucial role of inequality in economic calamity has been political.
In the years before the crisis, there was a remarkable bipartisan consensus in Washington in favor of financial deregulation — a consensus justified by neither theory nor history. When crisis struck, there was a rush to rescue the banks. But as soon as that was done, a new consensus emerged, one that involved turning away from job creation and focusing on the alleged threat from budget deficits.
What do the pre- and postcrisis consensuses have in common? Both were economically destructive: Deregulation helped make the crisis possible, and the premature turn to fiscal austerity has done more than anything else to hobble recovery. Both consensuses, however, corresponded to the interests and prejudices of an economic elite whose political influence had surged along with its wealth.
This is especially clear if we try to understand why Washington, in the midst of a continuing jobs crisis, somehow became obsessed with the supposed need for cuts in Social Security and Medicare. This obsession never made economic sense: In a depressed economy with record low interest rates, the government should be spending more, not less, and an era of mass unemployment is no time to be focusing on potential fiscal problems decades in the future. Nor did the attack on these programs reflect public demands.
Surveys of the very wealthy have, however, shown that they — unlike the general public — consider budget deficits a crucial issue and favor big cuts in safety-net programs. And sure enough, those elite priorities took over our policy discourse.
Which brings me to my final point. Underlying some of the backlash against inequality talk, I believe, is the desire of some pundits to depoliticize our economic discourse, to make it technocratic and nonpartisan. But that’s a pipe dream. Even on what may look like purely technocratic issues, class and inequality end up shaping — and distorting — the debate.
So the president was right. Inequality is, indeed, the defining challenge of our time. Will we do anything to meet that challenge?
By: Paul Krugman, Op-Ed Contributor, The New York Times, December 15, 2013
“Family Values Hypocrisy”: We Need To Think More About “Positive Liberty”, The Ability To Realize Certain Goals In Our Lives
Politicians talk about family values but do almost nothing to help families. They talk about parental responsibility but do almost nothing to help parents. They talk about self-sufficiency but do precious little to make self-sufficiency a reality for those who must struggle hardest to achieve it.
How often can we hear that government should be more responsive to the problems Americans face now? But the vogue for simply assuming that government cannot — or should not — do much of anything about those problems leads to paralysis. This, in turn, further increases disaffection from government.
For all these reasons, it was exciting last week to see Sen. Kirsten Gillibrand of New York and Rep. Rosa DeLauro of Connecticut introduce the FAMILY Act, the acronym standing for their Family and Medical Insurance Leave Act. The bill would provide partial income for up to 12 weeks of leave for new parents and for other family demands, such as care for a sick family member, including a domestic partner.
How far behind the rest of the world is our country on this quintessential family values matter? The Post’s Amy Joyce cited a Harvard University study in 2004 noting that of 168 countries it examined, 163 had some form of paid maternity leave. We weren’t one of the 163. Joyce observed that “the U.S. is on par with places like Papua New Guinea and Swaziland when it comes to paid family leave.”
The usual knock on proposals of this sort is that they would put an excessive economic burden on employers — or cost the federal government money it doesn’t have. Gillibrand and DeLauro, both Democrats, solve this problem by establishing FAMILY as an insurance program. Premiums would range from about $72 to $227 a year, depending on a person’s income. The maximum benefit is capped at $4,000 a month. They expect the average monthly benefit to be less than half that.
There is nothing revolutionary about this proposal. It builds on the existing (and highly popular) Family and Medical Leave Act, which requires unpaid leave and was enacted two decades ago. It is modest in comparison with leave policies in other well-off countries.
Yet in light of Congress’s dismal record since the Republican takeover of the House in 2010, it would be revolutionary to see any law passed that empowered individuals and families to ease their everyday difficulties.
Our current discussion of what constitutes “freedom” is shaped far too much by a deeply flawed right-wing notion that every action by government is a threat to personal liberty and that the one and only priority of those who care about keeping people free is for government to do less than it does.
This perspective ignores the many ways over the course of our history in which government has expanded the autonomy of our citizens. Consider how much less freedom so many of us would have without civil rights or voting rights laws, without government student loans, without labor laws, without public schools and without Medicare, Medicaid and Social Security. (And we don’t take seriously enough the implications of a most basic fact of our national story: that it took big government in Washington to outlaw slavery.)
Gillibrand’s role in championing this proposal also deserves attention. She is known nationally for her battle on behalf of victims of sexual assault in the military. But she has put forward five bills labeled as an “American Opportunity Agenda.” All of them involve ideas that have won broad support over many years. Besides pressing for paid family leave, she is calling for a minimum wage increase, affordable child care, universal pre-kindergarten programs and equal pay for equal work.
At a time when the political news is dominated by a debate between do-little conservatism and do-nothing conservatism — which is to say, between a right-tilting Republican establishment and the radical tea party — Gillibrand’s package includes building blocks for a broader counter-vision inspired by the idea of an Empowering Government.
Yes, we need to protect what the philosophers call “negative liberty.” There are, indeed, many things that government should never be able to do to us. But we need to think more about “positive liberty,” the ability to realize certain goals in our lives. Democratic government can create the framework in which we have more power to reach those ends.
And surely a country that honors the devotion of family members to each other should want to make it at least a little easier for them to do their jobs.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, December 15, 2013
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