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Paul Ryan’s Moral Barbarism

Karl Rove’s column the other day joined the many conservatives expressing their hurt and anger that President Obama would depict Paul Ryan’s budget as harming sick and vulnerable citizens:

Mr. Obama likes campaigning more than governing. And for this president, campaigning means knocking down straw men and delivering a steady stream of misleading attacks. It means depicting opponents as indecent, heartless people who take special delight in targeting seniors and autistic children.

In fact, Obama has never accused Ryan, or anybody, of having a “special delight” in targetting seniors and autistic children. But he has accused them of pursuing policies that would harm, among others, seniors and autistic children. That’s because it’s incontrovertably true. The Center on Budget and Policy Priorities delves into the details of Ryan’s plan to slash Medicaid by more than a third over the next decade, and in half over the next two decades:

  • Seniors:   An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage.  Because the Ryan plan would require such deep cuts in federal Medicaid funding, it would inevitably result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families.  A sharp reduction in the quality of nursing home care would be virtually inevitable, due to the large reduction that would occur in the resources made available to pay for such care.
  • People with disabilities:   These individuals constitute 15 percent of Medicaid beneficiaries but account for 42 percent of all Medicaid expenditures, mostly because of their extensive health and long-term care needs.  Capping federal Medicaid funding would place significant financial pressure on states to scale back eligibility and coverage for this high-cost population, many of whom would be unable to obtain coverage elsewhere because of their medical conditions.
  • Children:   Currently, state Medicaid programs must provide children with health care services and treatments they need for their healthy development through the Early Periodic Screening, Diagnostic and Treatment (EPSDT) aspect of Medicaid, which provides regular preventive care for children and all follow-up diagnostic and treatment services that children are found to need.  A block grant would likely permit states to drop EPSDT coverage, meaning that children, particularly those with special health care needs, would not be able to access some care that medical professionals find they need (because Medicaid would no longer cover certain health services and treatments for children, and their parents wouldn’t be able to afford to pay for that care on their own).
  • Working parents and pregnant women:   Many state Medicaid programs already have extremely restrictive eligibility criteria for parents.  In the typical state, working parents are ineligible for Medicaid if their income exceeds 64 percent of the poverty line (or $14,304 a year for a family of four), and unemployed parents are ineligible if their income exceeds 37 percent of the poverty line ($8,270 a year for a family of four).  Under a block grant, states could cut these already low eligibility levels even further, cap enrollment, and/or require low-income parents to pay more for health services.  States could do the same for low-income pregnant women who rely on Medicaid for their prenatal care, resulting in them forgoing services that are critical to ensuring a healthy pregnancy.

Now, Rove appears to be a pathological liar, or at least so deeply enmeshed in partisan spin it’s not clear that a distinction exists in his mind between objective truth and claims that are useful to his side. But many other conservatives have likewise expressed what has the ring of genuine outrage that Obama would accuse Ryan of snatching medical care away from people in nursing homes, very poor families, special needs children, and so on. I think it reflects, in part, an inability or lack of desire to think with any specificty about the concrete ramifications of imposing extremely deep cuts to Medicaid. Who do they think is on Medicaid? Prosperous, healthy people?

No, Medicaid is a bare-bones program throwing a lifeline to people who are in bad shape. Cutting Medicaid may be the politically easiest way for Ryan to clear budget room to preserve Bush-era revenue levels, as Medicaid patients have little political clout. But it is, well, deeply immoral. I’m actually surprised that conservatives not only can’t seem to imagine (or care about) the consequences of such policies, but they can’t even imagine that people like Obama would actually feel moral outrage at their plan. They can’t imagine a liberal objection as representing anything other than an attempt to score political points. It’s bizarre. I mean, of course Obama finds it morally objectionable to take away medical care to people in nursing homes and children with special needs. That’s why he’s a Democrat.

By: Jonathan Chait, The New Republic, May 3, 2011

May 3, 2011 Posted by | Conservatives, Democrats, GOP, Governors, Health Care, Health Care Costs, Health Reform, Medicaid, Politics, President Obama, Rep Paul Ryan, Republicans, Seniors, States | , , , , , , , , | Leave a comment

Ludicrous and Cruel: America Is Being Punked By GOP Voodoo Economics

Many commentators swooned earlier this week after House Republicans, led by the Budget Committee chairman, Paul Ryan, unveiled their budget proposals. They lavished praise on Mr. Ryan, asserting that his plan set a new standard of fiscal seriousness.

Well, they should have waited until people who know how to read budget numbers had a chance to study the proposal. For the G.O.P. plan turns out not to be serious at all. Instead, it’s simultaneously ridiculous and heartless.

How ridiculous is it? Let me count the ways — or rather a few of the ways, because there are more howlers in the plan than I can cover in one column.

First, Republicans have once again gone all in for voodoo economics — the claim, refuted by experience, that tax cuts pay for themselves.

Specifically, the Ryan proposal trumpets the results of an economic projection from the Heritage Foundation, which claims that the plan’s tax cuts would set off a gigantic boom. Indeed, the foundation initially predicted that the G.O.P. plan would bring the unemployment rate down to 2.8 percent — a number we haven’t achieved since the Korean War. After widespread jeering, the unemployment projection vanished from the Heritage Foundation’s Web site, but voodoo still permeates the rest of the analysis.

In particular, the original voodoo proposition — the claim that lower taxes mean higher revenue — is still very much there. The Heritage Foundation projection has large tax cuts actually increasing revenue by almost $600 billion over the next 10 years.

A more sober assessment from the nonpartisan Congressional Budget Office tells a different story. It finds that a large part of the supposed savings from spending cuts would go, not to reduce the deficit, but to pay for tax cuts. In fact, the budget office finds that over the next decade the plan would lead to bigger deficits and more debt than current law.

And about those spending cuts: leave health care on one side for a moment and focus on the rest of the proposal. It turns out that Mr. Ryan and his colleagues are assuming drastic cuts in nonhealth spending without explaining how that is supposed to happen.

How drastic? According to the budget office, which analyzed the plan using assumptions dictated by House Republicans, the proposal calls for spending on items other than Social Security, Medicare and Medicaid — but including defense — to fall from 12 percent of G.D.P. last year to 6 percent of G.D.P. in 2022, and just 3.5 percent of G.D.P. in the long run.

That last number is less than we currently spend on defense alone; it’s not much bigger than federal spending when Calvin Coolidge was president, and the United States, among other things, had only a tiny military establishment. How could such a drastic shrinking of government take place without crippling essential public functions? The plan doesn’t say.

And then there’s the much-ballyhooed proposal to abolish Medicare and replace it with vouchers that can be used to buy private health insurance.

The point here is that privatizing Medicare does nothing, in itself, to limit health-care costs. In fact, it almost surely raises them by adding a layer of middlemen. Yet the House plan assumes that we can cut health-care spending as a percentage of G.D.P. despite an aging population and rising health care costs.

The only way that can happen is if those vouchers are worth much less than the cost of health insurance. In fact, the Congressional Budget Office estimates that by 2030 the value of a voucher would cover only a third of the cost of a private insurance policy equivalent to Medicare as we know it. So the plan would deprive many and probably most seniors of adequate health care.

And that neither should nor will happen. Mr. Ryan and his colleagues can write down whatever numbers they like, but seniors vote. And when they find that their health-care vouchers are grossly inadequate, they’ll demand and get bigger vouchers — wiping out the plan’s supposed savings.

In short, this plan isn’t remotely serious; on the contrary, it’s ludicrous.

And it’s also cruel.

In the past, Mr. Ryan has talked a good game about taking care of those in need. But as the Center on Budget and Policy Priorities points out, of the $4 trillion in spending cuts he proposes over the next decade, two-thirds involve cutting programs that mainly serve low-income Americans. And by repealing last year’s health reform, without any replacement, the plan would also deprive an estimated 34 million nonelderly Americans of health insurance.

So the pundits who praised this proposal when it was released were punked. The G.O.P. budget plan isn’t a good-faith effort to put America’s fiscal house in order; it’s voodoo economics, with an extra dose of fantasy, and a large helping of mean-spiritedness.

By: Paul Krugman, Op-Ed Columnist, The New York Times, April 7, 2011

April 8, 2011 Posted by | Budget, Congress, Conservatives, Consumers, Deficits, Democrats, Economic Recovery, Economy, Federal Budget, GOP, Government Shut Down, Health Care Costs, Ideologues, Independents, Journalists, Media, Medicare, Planned Parenthood, Politics, Pundits, Republicans, Right Wing, Senate, Uninsured, Voters | , , , , , , , , , , , , , , | 1 Comment

Senate Democrats Weigh Making Big Mistake On Health-Care Reform

I’m getting some worried e-mails from Hill staffers who think Senate Democrats might rubberstamp a policy House Republicans passed to undermine the Affordable Care Act. It’s the sort of policy decision that won’t get much attention but could have some very big, and very bad, effects, so let’s take a moment and go through it.

If you’ve been paying attention to the debate over the Affordable Care Act, you’ve probably heard about the 1099 provision. Essentially, small businesses manage to avoid paying taxes on a lot of small transactions. The 1099 provision would’ve forced them to report those transactions, raising about $20 billion over 10 years. But it would’ve require a lot of paperwork. So much paperwork, in fact, that Democrats agreed to repeal it.

When the Senate repealed the provision, they paid for it by canceling other spending that Congress had authorized, but that hadn’t yet been put to a particular purpose. House Republicans took a different approach. They’re trying to sharply increase the amount of subsidies that families will have to pay back if their income increases during the course of a year. The Center on Budget and Policy Priorities has a longer explanation of how this would work, but here’s the short version:

Under their proposed policy, a family with income at 225 percent of the poverty line who needed subsidies for the first half of the year but canceled them mid-year when the husband got a better job could get a bill for more than $4,500 at the end of the year.

A more worrying example goes the other way: Imagine a family where the breadwinner makes much more than 400 percent of poverty, but loses his job late in the year. He tries to apply for subsidies so the family can keep getting health insurance but is told that he shouldn’t bother — because his total income that year will still be above 400 percent of poverty, he’ll get a bill at the end of the year forcing him to pay back the money.

The Affordable Care Act, unfortunately, already includes a “payback” policy along these lines — the House Republicans are just proposing to make it much, much worse. This will do two things: make people hate the Affordable Care Act for bait-and-switching them, and keep people from entering the exchanges because they’ve heard horror stories of huge bills. It’s clear why the GOP wouldn’t mind that outcome, but there’s no reason for Democrats to accept it. The Senate should stick with the 1099 repeal that the Senate has passed.

By: Ezra Klein, Columnist-The Washington Post, March 8, 2011

March 8, 2011 Posted by | Affordable Care Act, Health Reform | , , , , , , , , , | Leave a comment

   

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