Health Reform in Massachusetts: Self-Serving For Mitt But Also True
Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.
Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.
Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.
Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.
Other significant accomplishments:
The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.
The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.
The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.
Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.
There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.
Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.
What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.
Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.
The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.
By: Editorial, The New York Times, May 20, 2011
The Republican “Need for Greed” Meets the Fockers
The bet was audacious from the beginning, and given the miserable, low-down tenor of contemporary politics, not unfathomable: Could you divide the country between greedy geezers and everyone else as a way to radically alter the social contract?
But in order for the Republican plan to turn Medicare, one of most popular government programs in history, into a much-diminished voucher system, the greed card had to work.
The plan’s architect, Representative Paul Ryan of Wisconsin, drew a line in the actuarial sand: Anyone born before 1957 would not be affected. They could enjoy the single-payer, socialized medical care program that has allowed millions of people to live extended lives of dignity and decent health care.
And their kids and grandkids? Sorry, they would have to take their little voucher and pay some private insurer nearly twice as much as a senior pays for basic government coverage today. In essence, Republicans would break up the population between an I’ve Got Mine segment and The Left Behinds.
Again, not a bad political calculation. Altruism is a squishy notion, hard to sustain in an election. Ryan himself has made a naked play for greed in defending the plan. “Seniors, as soon as they realize this doesn’t affect them, they are not so opposed,” he has said.
Well, the early verdict is in, and it looks as though the better angels have prevailed: seniors are opposed. Republicans: Meet the Fockers. Already, there is considerable anxiety — and some guilt — among older folks about leaving their children worse off financially than they are. To burden them with a much costlier, privatized elderly health insurance program is a lead weight for the golden years.
This plan is toast. Newt Gingrich is in deep trouble with the Republican base for stating the obvious on Sunday, when he called the signature Medicare proposal of his party “right-wing social engineering.” But that’s exactly what it is: a blueprint for downward mobility.
Look at the special Congressional election of next Tuesday. What was supposed to be a shoo-in for Republicans in a very safe district of upstate New York is now a tossup. For that, you can blame the Medicare radicals now running the House.
And a raft of recent polls show that seniors, who voted overwhelmingly Republican in the 2010 elections, are retreating in droves. Democratic pollster Geoffrey Garin says the Ryan plan is a “watershed event,” putting older voters in play for next year’s presidential election.
Beyond the political calculations, all of this is encouraging news because it shows that people are starting to think much harder about what kind of country they want to live in. Give the Republicans credit for honesty and showing their true colors. And their plan is at least a starting point compared with those Tea Party political illiterates who waved signs urging government to keep its hands off their government health care.
When the House of Representatives voted to end Medicare as we know it last month, it was sold as a way to save the program. Medicare now covers 47.5 million Americans, but it won’t have sufficient funds to pay full benefits by 2024, according to the most recent trustee report. Something has to be done.
Many Republicans want to kill it. They hate Medicare because it represents everything they are philosophically opposed to: a government-run program that works and is popular across the political board. It’s tough to shout about the dangers of universal health care when the two greatest protectors (if not creators) of the elderly middle class are those pillars of 20th-century progressive change, Social Security and Medicare.
For next year’s election, all but a handful of Republicans in the House are stuck with the Scarlet Letter of the Ryan Plan on their record. Soon, there will be a similar vote in the Senate. It will not pass, but it will show which side of the argument politicians are on.
There is a very simple way to make Medicare whole through the end of this century, far less complicated, and more of a bargain in the long run than the bizarre Ryan plan. Raise taxes. It hasn’t sunk in yet, but most American pay less taxes now than anytime in the last 50 years, according to a number of measurements. And a majority of the public now seems willing to pay a little extra (or force somebody else to pay a little extra) to keep a good thing going. Both Ronald Reagan and George H.W. Bush raised taxes, by the way.
Given a choice between self-interest and the greater good, voters will usually watch out for themselves — unless that greater good is their own family. For Republicans intent on killing Medicare, it was a monumental miscalculation to miss that logical leap.
By: Timothy Egan, Opinion Writer, The New York Times, May 17, 2011
Newt Gingrich And “The Food Stamp President”
Newt Gingrich doubled down on his clever new slur against President Obama as “the food stamp president.” He tried the line in a Friday speech to the Georgia Republican convention, and he used it again on “Meet the Press Sunday.” It’s a short hop from Gingrich’s slur to Ronald Reagan’s attacks on “strapping young bucks” buying “T-bone steaks” with food stamps. Blaming our first black president for the sharp rise in food-stamp reliance (which resulted from the economic crash that happened on the watch of our most recent white president) is just the latest version of Rush Limbaugh suggesting that Obama’s social policy amounts to “reparations” for black people.
But when host David Gregory suggested the term had racial overtones, Gingrich replied “That’s bizarre,” and added, “I have never said anything about President Obama which is racist.” That’s not quite as extreme or silly as Donald Trump declaring “I am the least racist person there is,” but it’s up there. He also told Georgia Republicans Friday that 2012 will be the most momentous election “since 1860,” which happens to be the year we elected the anti-slavery Abraham Lincoln president, and he suggested the U.S. bring back a “voting standard” that requires voters to prove they know American history — which sounds a lot like the “poll tests” outlawed by the Voting Rights Act.
Just last week Gingrich said Obama “knows how to get the whole country to resemble Detroit,” which just happens to be home to many black people. And last year Gingrich accused Obama of “Kenyan anti-colonialist behavior” that made him “outside our comprehension” as Americans, spreading Dinesh D’Souza’s idiocy that Obama inherited angry African anti-colonialism from the Kenyan father he never knew. “This is a person who is fundamentally out of touch with how the world works, who happened to have played a wonderful con, as a result of which he is now president,” Gingrich told the National Review Online last year.
All this from the guy who’s supposed to be the “smart” candidate for the GOP nomination?
Republicans have done well with their quest to stigmatize social welfare programs as handouts to the undeserving, and to pretend that most of the undeserving are black people. But it may not be working as well today. Paul Ryan’s class-war budget is going down in flames, largely because seniors are up in arms over Ryan’s attacks on Medicare. Ryan and his GOP allies tried to be clever, making sure his plans to phase out Medicare wouldn’t apply to today’s seniors, who happen to be disproportionately white and disproportionately Republican. But seniors are seeing through the ruse, telling Ryan and the GOP that they want to protect Medicare for their children, too. Even Gingrich is now backing away from the Ryan budget, telling Gregory it’s too “radical” and “too big a jump.” A jump off a political cliff for Republicans, that is.
Let’s hope Gingrich’s attacks on our “food stamp president” backfire, too. I learned about the ex-GOP speaker’s latest use of the term from the group Catholic Democrats, which Tweeted Sunday morning that the twice-divorced Catholic convert ought to have a look at Catholic social teaching if he’s going to call himself a Catholic. The American bishops have lately been trying to remind Americans (and themselves, perhaps) that Catholic social teaching is about more than abortion. The church has long been a force on behalf of the poor and powerless, going back to Pope Leo XIII’s encyclical Rerum Novarum (On the Condition of Labor) at the height of the Gilded Age in 1891, which put the church on the side of labor organizing, through Pope Benedict’s “Caritas in Veritate” (Charity in Truth) of 2009, which restated the church’s commitment to support for workers and the poor worldwide, in the wake of the greed-driven financial crisis of 2008.
House Speaker John Boehner got a taste of the rising Catholic concern for social justice when 83 Catholic scholars wrote to Boehner protesting his attacks on programs for the poor, after Boehner was chosen as Catholic University’s commencement speaker. They didn’t call on the university to cancel Boehner’s address, unlike Catholic conservatives who protested Obama’s commencement address at Notre Dame in 2009). They wrote:
Your voting record is at variance from one of the church’s most ancient moral teachings. From the apostles to the present, the Magisterium of the Church has insisted that those in power are morally obliged to preference the needs of the poor. Your record in support of legislation to address the desperate needs of the poor is among the worst in Congress. This fundamental concern should have great urgency for Catholic policymakers. Yet, even now, you work in opposition to it.
The scholars also noted that the U.S. Conference of Catholic Bishops called Boehner-promoted Ryan budget as “anti-life” for its cuts to programs for pregnant women and children. Boehner’s commencement address went on Saturday with a quiet protest from students who wore green placards reading “Where’s the compassion, Speaker Boehner?” over their graduation gowns. Of course the Catholic Boehner didn’t address the controversy; instead he shed tears remembering how his high school football coach called him the morning he became speaker to tell him “you can do it,” which he considered an answer to his prayers.
Boehner may have been crying about what his support of the Ryan budget is doing to House GOP re-election chances. Gingrich could find that his racially coded attacks on Obama backfire as well. Both the poverty rate and the unemployment rate for white Americans have doubled since the start of this recession. Maybe Republican policies will succeed in uniting Americans across racial lines for a change, as more people see them as favoring one minority — the super-rich — over the rest of us.
By: Joan Walsh, Editor at Large, Salon, May 15, 2011
A “No New Taxes” Pledge Is A Death Trap For Seniors
This has to be one of the funniest political stories of recent weeks: On Tuesday, 42 freshmen Republican members of Congress sent a letter urging President Obama to stop Democrats from engaging in “Mediscare” tactics — that is, to stop saying that the Republican budget plan released early last month, which would end Medicare as we know it, is a plan to end Medicare as we know it.
Now, you may recall that the people who signed that letter got their current jobs largely by engaging in “Mediscare” tactics of their own. And bear in mind that what Democrats are saying now is entirely true, while what Republicans were saying last year was completely false. Death panels!
Well, it’s time, said the signatories, to “wipe the slate clean.” How very convenient — and how very pathetic.
Anyway, the truth is that older Americans really should fear Republican budget ideas — and not just because of that plan to dismantle Medicare. Given the realities of the federal budget, a party insisting that tax increases of any kind are off the table — as John Boehner, the speaker of the House, says they are — is, necessarily, a party demanding savage cuts in programs that serve older Americans.
To explain why, let me answer a rhetorical question posed by Professor John Taylor of Stanford University in a recent op-ed article in The Wall Street Journal. He asked, “If government agencies and programs functioned with 19% to 20% of G.D.P. in 2007” — that is, just before the Great Recession — “why is it so hard for them to function with that percentage in 2021?”
Mr. Taylor thought he was making the case for not increasing spending. But if you know anything about the federal budget, you know that there’s a very good answer to his question — an answer that clearly demonstrates just how extremist that no-tax-increase pledge really is. For here’s the quick-and-dirty summary of what the federal government does: It’s a giant insurance company, mainly serving older people, that also has an army.
The great bulk of federal spending that isn’t either defense-related or interest on the debt goes to Social Security, Medicare and Medicaid. The first two programs specifically serve seniors. And while Medicaid is often thought of as a poverty program, these days it’s largely about providing nursing care, with about two-thirds of its spending now going to the elderly and/or disabled. By my rough count, in 2007, seniors accounted, one way or another, for about half of federal spending.
And in case you hadn’t noticed, there will soon be a lot more seniors around because the baby boomers have started reaching retirement age.
Here are the numbers: In 2007, there were 20.9 Americans 65 and older for every 100 Americans between the ages of 20 and 64 — that is, the people of normal working age who essentially provide the tax base that supports federal spending. The Social Security Administration expects that number to rise to 27.5 by 2020, and 31.7 by 2025. That’s a lot more people relying on federal social insurance programs.
Nor is demography the whole story. Over the long term, health care spending has consistently grown faster than the economy, raising the costs of Medicare and Medicaid as a share of G.D.P. Cost-control measures — the very kind of measures Republicans demonized last year, with their cries of death panels — can help slow the rise, but few experts believe that we can avoid some “excess cost growth” over the next decade.
Between an aging population and rising health costs, then, preserving anything like the programs for seniors we now have will require a significant increase in spending on these programs as a percentage of G.D.P. And unless we offset that rise with drastic cuts in defense spending — which Republicans, needless to say, oppose — this means a substantial rise in overall spending, which we can afford only if taxes rise.
So when people like Mr. Boehner reject out of hand any increase in taxes, they are, in effect, declaring that they won’t preserve programs benefiting older Americans in anything like their current form. It’s just a matter of arithmetic.
Which brings me back to those Republican freshmen. Last year, older voters, who split their vote almost evenly between the parties in 2008, swung overwhelmingly to the G.O.P., as Republicans posed successfully as defenders of Medicare. Now Democrats are pointing out that the G.O.P., far from defending Medicare, is actually trying to dismantle the program. So you can see why those Republican freshmen are nervous.
But the Democrats aren’t engaging in scare tactics, they’re simply telling the truth. Policy details aside, the G.O.P.’s rigid anti-tax position also makes it, necessarily, the enemy of the senior-oriented programs that account for much of federal spending. And that’s something voters ought to know.
By: Paul Krugman, Op-Ed Columnist, The New York Times, May 12, 2011
Pandering To The Extremists: Mitt Romney In A Time Warp
There was something almost quaint about Mitt Romney’s speech on health careThursday, as if we were watching early sound footage of Theodore Roosevelt.
Republicans no longer talk about the virtues of government social programs, especially if they intend to run for president in a party that now considers Medicare the first cousin of socialism. Yet there was Mr. Romney defending a mandate to buy health insurance as passionately as in any similar speech by President Obama.
When he was governor of Massachusetts, of course, Mr. Romney created a health care system very similar to the one championed by the president. He could have walked away from it, as he did in the 2008 presidential race, or fecklessly repudiated it, as Tim Pawlenty, the former governor of Minnesota, did in the Republican debate last week regarding his earlier support for a cap-and-trade system to reduce greenhouse gases.
This time, to his credit, Mr. Romney is standing by his record, perhaps hoping there might still be a few primary voters who appreciate candor — assuming he doesn’t pivot again in the heat of the right-dominated primaries.
Tearing it down might help him politically, he said, but “it wouldn’t be honest.” He said he did what he “thought would be right for the people of my state.” A mandate to buy insurance, he said, makes sense to prevent people from becoming free riders, getting emergency care at enormous cost to everyone else.
Where he went off the rails, however, was in not acknowledging that that same logic applies to the nation. Mr. Romney tried desperately to pivot from praising his handiwork in Massachusetts to trashing the very same idea as adapted by Mr. Obama. His was an efficient and effective state policy; Mr. Obama’s was “a power grab by the federal government.”
He tried to justify this with a history lesson on federalism and state experimentation, but, in fact, said nothing about what makes Massachusetts different from its neighbors or any other state. And why would he immediately repeal the Obama mandate if elected president? Because Mr. Obama wants a “government takeover of health care,” while all he wanted was to insure the uninsured.
That distinction makes no sense, and the disconnect undermines the foundation of Mr. Romney’s candidacy. At heart, he is still the kind of old-fashioned northeastern Republican who believes in government’s role while trying to conceal it under a thin, inauthentic coating of conservative outrage. But in its blind abhorrence of President Obama, the party has also left behind former centrists like Mr. Romney, and it is unlikely that any amount of frantic pandering about the free market will change that. He is trapped not only between the poles of his party but between eras, a candidate caught in an electoral time warp.
By: The New York Times, Editorial, May 12, 2011
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 