“The Real Deficit Argument”: Only Politics Of A Very Degraded Kind Can Keep Us From Moving Forward
Should our politicians dedicate themselves to solving the problems we face now? Or should they spend their time constructing largely theoretical deficit solutions for years far in the future to satisfy certain ideological and aesthetic urges?
This is one of the two central choices the country faces at the beginning of President Obama’s second term. The other is related: Will the establishment, including business leaders and middle-of-the-road journalistic opinion, stand by silently as one side in the coming argument risks cratering the economy in an effort to reverse the verdict of the 2012 election? Yes, I am talking about using the debt ceiling as a political tool, something that was never done until the disaster of 2011.
My first questions are, admittedly, loaded. They refer to a difference of opinion we need to face squarely.
It is entirely true that in the wake of two budget agreements, in 2011 and the just-passed deal on the “fiscal cliff,” we have not reduced the deficit enough. The issue is: How much is enough?
Contrary to all the scare talk you keep hearing, Robert Greenstein, president of the Center on Budget and Policy Priorities, notes that we could put the deficit on a sustainable path for the next 10 years with one more deficit-reduction package equal to about $1.2 trillion, plus the resulting interest savings.
By sustainable, I mean keeping the debt from growing as a share of gross domestic product and holding it at around 73 percent of GDP for the next decade. This is a more than reasonable number by international standards. To put it in perspective: According to the International Monetary Fund, in 2011 Canada’s debt was at 85 percent of GDP, Germany’s was at 81.5 percent — and Greece’s was at 163.3 percent.
Holding the debt ratio in the low 70s is well within our sights. It could be achieved through a combination of $600 billion in cuts and $600 billion in additional revenue through tax reform — or through modest taxes on carbon or on financial transactions. (Okay, for now, I am dreaming on the last two, but they are still good ideas.) The cuts could be made without wrecking Medicare, Medicaid or Social Security, and without eviscerating government’s capacity to invest in the future.
We could then shelve our deficit obsession for a while and confront the problems that should be center-stage over the next few years: restoring shared economic growth, spurring the creation of good jobs, dealing with gun violence, reforming immigration laws, improving our education system, and taking steps on climate change.
But there is the other side of this debate, pushed not only by conservatives but also by a deficit-reduction industry that sees the only test of seriousness as a willingness to slash Medicare, Medicaid and Social Security for those who will retire 10, 20 or 30 years from now. They want to be able to admire nice predictions on a computer screen that show the debt dropping to 60 percent of GDP.
There is no objection in principle to discussing the modest changes that could improve the long-term stability of Social Security. But when it comes to health-care cost projections, there is so much we don’t know that it is truly foolish to make decisions now for, say, 2040.
Health-care cost inflation has been dropping. We can’t be sure how sustainable this trend is, but economists who study the matter think the cost curve may be bending downward for the longer run. The Affordable Care Act contains measures that could further restrain health expenditures.
Is it either sensible or humane to decide in 2013 on the basis of such limited knowledge to toss future seniors and low-income Medicaid recipients under the bus? Health-care costs are something we must keep working on. We can buy time for this difficult undertaking by getting the deficit down to a sustainable level.
And that brings us to the debt ceiling. The central weakness of a largely helpful fiscal cliff deal is that it did not save us from a debt-ceiling fight. It would be colossally stupid — there is no other word — to derail an economic recovery that is slowly but steadily taking hold with another battle over a silly provision in our law. Will all the respectable people who know this sit on the sidelines and let it happen, or will they speak out now?
We are finally on a promising path. Only politics of a very degraded kind can keep us from moving forward.
By: E. J. Dionne Jr., Opinion Writer, The Washington Post, January 6, 2013
“Just Another Shell Game”: John Boehner’s Medicare Proposal Is Sleight Of Hand, Not Cost Control
Denying Medicare to seniors until they reach age 67 will shift costs to seniors, states, and employers without reducing the actual cost of healthcare by one penny. It’s a shell game, and it should not be an option in the fiscal showdown talks.
While it would reduce Medicare expenditures, those costs won’t vanish. Yes, the federal government would save $5.7 billion in 2014, but that would be offset by an additional $11.4 billion spent by states, employers, and seniors, according to the Kaiser Family Foundation. That’s a cost shift and a cost increase.
The Congressional Budget Office assumes that half of 65- and 66-year-old seniors would continue employer-sponsored coverage at a cost of about $4.5 billion in 2014. That would likely accelerate the long-term decline in corporate benefits for retirees.
States would also pay because low-income uninsured seniors would be eligible for Medicaid. Even if the federal government would pay 100 percent of the cost of the new beneficiaries, states would still be on the hook for an additional $700 million in 2014 alone.
And, of course, seniors lose in the deal. Two thirds of those ages 65 and 66 would each average $2,200 more in out-of-pocket costs ($3.7 billion total) in 2014, even when accounting for subsidies to buy a plan on a health insurance exchange.
There’s another significant but less obvious cost shift through increased premiums in Medicare and in the exchange. Seniors ages 65 and 66 are the healthiest and least expensive Medicare beneficiaries, and they help lower premiums for all enrollees. Moving them to private coverage, where they would be the least healthy and most expensive health plan members, would drive up premiums for everyone else in the exchanges.
Boehner’s proposal seems more sleight of hand than legitimate cost control. It’s about weakening Medicare, not strengthening the program for future generations.
If we really want to think big about Medicare reform, let’s consider lowering the age of eligibility. Letting people as young as 55 buy into Medicare would improve the risk pool for seniors and strengthen Medicare’s bargaining power without raising program costs.
By: Ethan Rome, Executive Director of Health Care for America Now, U. S. News and World Report, December 6, 2012
“Medicaid On The Ballot”: Unfortunately Mr. Romney, A Lack Of Insurance Does Kill People
There’s a lot we don’t know about what Mitt Romney would do if he won. He refuses to say which tax loopholes he would close to make up for $5 trillion in tax cuts; his economic “plan” is an empty shell.
But one thing is clear: If he wins, Medicaid — which now covers more than 50 million Americans, and which President Obama would expand further as part of his health reform — will face savage cuts. Estimates suggest that a Romney victory would deny health insurance to about 45 million people who would have coverage if he lost, with two-thirds of that difference due to the assault on Medicaid.
So this election is, to an important degree, really about Medicaid. And this, in turn, means that you need to know something more about the program.
For while Medicaid is generally viewed as health care for the nonelderly poor, that’s only part of the story. And focusing solely on who Medicaid covers can obscure an equally important fact: Medicaid has been more successful at controlling costs than any other major part of the nation’s health care system.
So, about coverage: most Medicaid beneficiaries are indeed relatively young (because older people are covered by Medicare) and relatively poor (because eligibility for Medicaid, unlike Medicare, is determined by need). But more than nine million Americans benefit from both Medicare and Medicaid, and elderly or disabled beneficiaries account for the majority of Medicaid’s costs. And contrary to what you may have heard, the great majority of Medicaid beneficiaries are in working families.
For those who get coverage through the program, Medicaid is a much-needed form of financial aid. It is also, quite literally, a lifesaver. Mr. Romney has said that a lack of health insurance doesn’t kill people in America; oh yes, it does, and states that expand Medicaid coverage show striking drops in mortality.
So Medicaid does a vast amount of good. But at what cost? There’s a widespread perception, gleefully fed by right-wing politicians and propagandists, that Medicaid has “runaway” costs. But the truth is just the opposite. While costs grew rapidly in 2009-10, as a depressed economy made more Americans eligible for the program, the longer-term reality is that Medicaid is significantly better at controlling costs than the rest of our health care system.
How much better? According to the best available estimates, the average cost of health care for adult Medicaid recipients is about 20 percent less than it would be if they had private insurance. The gap for children is even larger.
And the gap has been widening over time: Medicaid costs have consistently risen a bit less rapidly than Medicare costs, and much less rapidly than premiums on private insurance.
How does Medicaid achieve these lower costs? Partly by having much lower administrative costs than private insurers. It’s always worth remembering that when it comes to health care, it’s the private sector, not government programs, that suffers from stifling, costly bureaucracy.
Also, Medicaid is much more effective at bargaining with the medical-industrial complex.
Consider, for example, drug prices. Last year a government study compared the prices that Medicaid paid for brand-name drugs with those paid by Medicare Part D — also a government program, but one run through private insurance companies, and explicitly forbidden from using its power in the market to bargain for lower prices. The conclusion: Medicaid pays almost a third less on average. That’s a lot of money.
Is Medicaid perfect? Of course not. Most notably, the hard bargain it drives with health providers means that quite a few doctors are reluctant to see Medicaid patients. Yet given the problems facing American health care — sharply rising costs and declining private-sector coverage — Medicaid has to be regarded as a highly successful program. It provides good if not great coverage to tens of millions of people who would otherwise be left out in the cold, and as I said, it does much right to keep costs down.
By any reasonable standard, this is a program that should be expanded, not slashed — and a major expansion of Medicaid is part of the Affordable Care Act.
Why, then, are Republicans so determined to do the reverse, and kill this success story? You know the answers. Partly it’s their general hostility to anything that helps the 47 percent — those Americans whom they consider moochers who need to be taught self-reliance. Partly it’s the fact that Medicaid’s success is a reproach to their antigovernment ideology.
The question — and it’s a question the American people will answer very soon — is whether they’ll get to indulge these prejudices at the expense of tens of millions of their fellow citizens.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 28, 2012
“Affordable Care Act For The Wealthy”: The Rest Of You Can Have Vouchers
It’s not uncommon for the über-wealthy to equip their mega-mansions with pricey private home theaters, spa-worthy washrooms, and palatial pools. Now an increasing number of the super-rich are setting aside space in their homes for another purpose: top-notch medical care.
According to Bloomberg, more well-off families are paying up to install at-home emergency rooms, which can cost upwards of $1 million, and forking over as much as $30,000 a year for “concierge care,” which puts the best-of-the-best physicians at their disposal anytime, anywhere.
“Wealthy people want to have a little exclusivity and want better service than they can get at their normal healthcare facility, and they’re willing to pay for it,” Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, told Bloomberg.
Guardian 24/7, a Virginia-based medical care company founded by former White House physician Sean O’Mara, charges as much as $12,000 a month for its ReadyRooms, Bloomberg reported, which feature discreetly installed medical equipment available at the touch of a button.
If a medical emergency arises, homeowners can immediately contact an on-call emergency physician—a much faster response than waiting for an ambulance to arrive and transport the ailing homeowner to the hospital, the company’s website notes.
“Before Guardian, this kind of medical protection was only available to one person,” the company’s website says. “Now, presidential-level care can be yours—on your schedule and your terms.”
And if you thought for a minute the super-rich might have to be without immediate access to medical care outside the confines of their estates, think again. Guardian 24/7 installs any number of medical apparatuses from X-ray machines to CT scanners on yachts, motor coaches, and aircraft.
By: Meg Handley, Washington Whispers, U. S. News and World Report, March 16, 2012
Chris Christie’s Big Problem
Whether or not he lets himself be persuaded to run for president, Chris Christie needs to find some way to lose weight. Like everyone else, elected officials perform best when they are in optimal health. Christie obviously is not.
You could argue that this is none of my business, but I disagree. Christie’s problem with weight ceased being a private matter when he stepped into the public arena — and it’s not something you can fail to notice. Obesity is a national epidemic whose costs are measured not just in dollars and cents but also in lives. Christie’s weight is as legitimate an issue as the smoking habit that President Obama says he has finally kicked.
On rare occasions, Christie speaks candidly about his weight. “I’m really struggling, been struggling for a long time with it,” he told CNN’s Piers Morgan in June. “And I know that it would be better for my kids if I got it more under control, and so I do feel a sense of guilt at times about that.”
Six weeks later, the New Jersey governor was briefly hospitalized for asthma — a condition that he has had for most of his life. Researchers say that many respiratory problems, including asthma, are worsened by obesity.
As he left the hospital, Christie acknowledged the connection. He described himself as “relatively healthy by all objective indicators,” but added that “if I weighed less, I’d be healthier.”
“The weight exacerbates everything,” he said.
And it does. According to the National Institutes of Health, obesity puts people at greater risk for Type 2 diabetes, coronary heart disease and stroke, certain types of cancer, sleep apnea, osteoarthritis, and gallbladder and liver disease.
The NIH estimates that nearly 34 percent of U.S. adults can be classified as “obese,” meaning they have a body mass index of more than 30. By this standard, a man who stands 5-foot-11 — Christie’s reported height — would be obese if his weight reached 215 pounds. While Christie does not disclose his weight, it appears to exceed the 286 pounds that would place him among the 5.7 percent of American adults whom NIH classifies as “extremely obese.”
I refer to obesity as an epidemic because the percentage of obese adults has doubled in the past 40 years — and childhood obesity is increasing even more rapidly. Again according to the NIH, “obesity is associated with over 112,000 excess deaths due to cardiovascular disease, over 15,000 excess deaths due to cancer, and over 35,000 excess deaths due to non-cancer, non-cardiovascular disease causes per year.”
On average, health-care costs for obese persons are 42 percent higher than costs for individuals whose weight falls into the “normal” range. It costs Medicare $1,723 more a year for an obese beneficiary than a non-obese one. For Medicaid the differential is $1,021, and for private insurers it’s $1,140. In other words, obesity is helping propel the rise in health-care costs, which are fueling the long-term rise in the national debt.
My intention is not to blame Christie for the federal government’s deficit spending — or, in fact, to blame him for his own obesity. Blame is not the point. Christie is just 49 and has four young children; politics aside, I’m sure he wants to be around to share the milestones in their lives. He prides himself on bullheaded determination and speaks often about the need for officials to display leadership. Well, Gov. Christie, lead thyself.
“I weigh too much because I eat too much,” he said after his hospitalization this summer, “and I eat some bad things, too.”
If only it were that simple. Yes, the basic arithmetic of calories ingested vs. calories expended is inescapable. But the science of weight control now takes into account the role that genetics might play, along with psychological factors that lie outside our conscious control. There are new options, including gastric surgery, beyond the dieting roller coaster — lose 40 pounds, gain it all back — that Christie says he has been riding for years.
Those who have lost weight and kept it off for extended periods, including former Arkansas governor Mike Huckabee, say they have succeeded by making proper diet and exercise part of their lives — not just unpleasant chores that have to be endured.
Politically, I disagree with Christie on almost everything. I’ll have plenty of opportunities to tell him why. Today, I’d just like to offer him a bit of unsolicited, nonpartisan, sincere advice: Eat a salad and take a walk.
By: Eugene Robinson, Opinion Writer, The Washington Post, September 29, 2011
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 