“The Other Mitt”: No Health Insurance? Romney Says “Freeloading” In The ER Is Now All Good
Whether you support the candidacy of Mitt Romney or not, we all should be able to agree that his experience as Governor of Massachusetts—at the time when the first universal healthcare law in the nation was conceived and placed into operation—makes him something of an expert on the subject of health care economics.
And that is precisely what makes his comments during last night’s edition of “60 Minutes” all the more bizarre.
When asked whether the nation has a responsibility to provide health care to the 50 million Americans who do not currently have coverage, the Governor responded;
“Well, we do provide care for people who don’t have insurance. 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.”
Never mind that ‘60 Minutes’ interviewer Scott Pelly was quick to accurately point out that ER care is the most expensive form of treatment that one can access. What is far more interesting is that the remark so clearly puts Governor Romney at odds with the other candidate seeking the presidency—and I don’t mean Barack Obama.
I refer, of course, to the ‘other’ Mitt who seems to come and go at various moments in the campaign, offering up direct contradictions to the positions of the Mitt Romney we watched last night on the CBS news show.
You see, it was the ‘other’ Mitt who said during a 2010 interview over at MSNBC—
“It doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility.”
And it was the ’other’ Mitt who told Glenn Beck in a 2007 interview—
“When they show up at the hospital, they get care. They get free care paid for by you and me. If that’s not a form of socialism, I don’t know what is. ”
Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.
It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.
As noted by the current incarnation of the GOP candidate, when a patient turns up at the ER with severe stomach pain, that patient will be treated until her condition is stabilized. But it is the ‘other’ Mitt Romney who understands that, when the tests administered in the ER reveal that the patient has Stage One stomach cancer, it will not be up to the ER to administer the six months of chemotherapy that will be required to save the patient’s life. For that, the patient better be insured or face a truly precarious situation.
The ‘other’ Romney understands that ER care is insufficient to truly treat many patients and that, even when it was possible to get the desired result via ER care, it is the worst possible way to administer health care.
Here’s a thought—maybe current candidate Romney should consider getting rid of his failing campaign staff and see if he can entice the ‘other’ Mitt Romney to join the campaign as a strategist and adviser.
At the end of the day, I think we’d all be better off for it.
By: Rick Ungar, Contributor, Forbes, September 24, 2012
Not So “Friendly’s”: Tax Avoidance, Government Dependency, And Mitt Romney’s Boca Raton Host
Amid the ongoing uproar over Mitt Romney’s snooty remarks at a Florida fundraiser concerning the “47 percent” who pay no federal income taxes, the party’s high-rolling host hasn’t drawn quite as much attention as he deserves. As the head of private equity firm Sun Capital Partners, Marc Leder is a longtime associate of the Republican nominee – and a practitioner of the same dubious behavior that has smudged Romney’s reputation.
Lately Leder has been dogged by tabloid headlines recounting his nasty divorce and wild partying (replete with reported nudity and public sex around the pool at a summer house he rented on Long Island’s East End for $500,000). What he has in common with Romney, however, isn’t a taste for bacchanalian revels, of course, but a record of business and taxation practices that working Americans might find troubling.
At the moment, Leder is under investigation by New York State Attorney General Eric Schneiderman, who subpoenaed internal records from Sun Capital, Bain Capital, and several other private equity giants last July. Issued by the Attorney General’s taxpayer protection bureau, the subpoenas were evidently designed to probe whether Leder and other executives had misused “carried interest,” a method of reducing tax liability by converting management fees into investment income — which is taxed at the lower capital gains rate of 15 percent that keeps Romney’s taxes lower than the rate paid by many middle-income families. (Tax analysts say that Bain Capital records released last August indicate that the firm may have saved more than $200 million in federal taxes thanks to the carried-interest maneuver.)
If Leder did benefit from such aggressive practices, he would merely be typical of an industry where tax manipulations are not just widespread, but fundamental.
Equally common in private equity is profiting from bankrupted companies in which other stakeholders – especially workers and government – are left to cope with the loss. During the Republican primaries, Romney’s rivals helped to make Bain notorious for such practices – and his fundraiser Leder seems no different.
Although roughly 25 firms held by Sun have gone bankrupt, perhaps the best known example involves Friendly’s, the family restaurant and ice cream chain that went under at the hands of Sun Capital in 2010 after more than 70 years in business. After acquiring Friendly’s in 2007 for a premium price, Sun took the company into bankruptcy only three years later, supposedly due to rising milk prices.
But the Pension Benefit Guaranty Corporation – the federal agency that insures benefits to workers victimized by failed corporate pension plans – accused Sun of sinking Friendly’s to dump pension costs onto the government. By pushing the company’s pension burden onto federal taxpayers, who fund the PBGC, Sun could then reorganize Friendly’s in bankruptcy, get rid of laid-off workers and less profitable restaurants, and – as Romney likes to say – give the company a “turnaround.” So far, that is precisely what Sun appears to doing, and getting away with it.
So there on the videotape shot in Leder’s huge Boca mansion stood Romney, complaining about the income taxes that the working poor don’t pay and their dependence on government assistance, while the host surely nodded in agreement. At $50,000 a plate, the lobster was garnished with a nice helping of irony.
By: Joe Conason, The National Memo, September 24, 2012
“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
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