“Makes More Sense Than Critics Admit”: The Brave Politics Of Clinton’s Medicare Buy-In Proposal
Predictably, much of the commentary about Hillary Clinton’s newly expressed interest in making a Medicare buy-in option available to people near retirement age is treating it as another calibrated “move to the left” to head off Bernie Sanders or placate his supporters. The unstated assumption is that anything other than a full-on single-payer system (the only creditable progressive proposal, you see) is a half measure reflecting either political cowardice or corrupt kowtowing to private insurance interests.
Here’s the thing, though. People who love to cite polls showing the popularity of “Medicare for all” (the favored buzz-phrase for single-payer) should be aware that the popularity of the venerable retirement program is based on its current characteristics as an “earned entitlement” program for which working Americans pay payroll taxes and then, after becoming beneficiaries, premiums. The “buy-in” proposal, by targeting people who have (a) presumably been paying those same payroll taxes and will continue to do so until retirement if they are employed, and (b) will immediately pay relatively steep premiums (though not as steep, in most cases, as private insurance premiums), does minimal violence to the structure, financing and original purpose of Medicare. “Medicare for all,” once it is a tangible proposal rather than a bumper-sticker slogan, changes Medicare in all these respects, and might make it unrecognizable. The financing challenge alone for a single-payer system — which never much gets mentioned in the polling — makes the incremental approach, via a combination of Medicare, “Obamacare”-subsidized private insurance, and Medicaid, a much easier reach financially and politically.
Perhaps I’m wrong and perhaps Hillary Clinton is wrong in feeling this way. But one thing’s for sure: Expanding Medicare and providing a “public option” under Obamacare are not popular ideas in the private insurance industry. That’s certainly not the constituency Clinton is representing here. And anyone who doubts the political courage it takes to achieve universal health coverage incrementally, instead of just intoning “Medicare for all” until the walls fall down like Jericho’s, hasn’t been paying much attention the last quarter-century.
By: Ed Kilgore, Daily Intelligencer, New York Magazine, May 11, 2016
“It’s About His Vision For America’s Future”: Why Ben Carson’s Problem With The Truth Really Matters
Ben Carson’s campaign turned into a kaleidoscope of oddities last week: The retired neurosurgeon made fanciful claims about the purpose of Egyptian pyramids and the political experience of the Founding Fathers. He insisted that he was, in fact, a violent youth, but admitted that he wasn’t, in fact, offered admission to West Point—both key highlights of his autobiography. But amid all the attention being paid to his personal background, it’s easy to overlook what Carson is actually running on. Of all the GOP candidates, Carson has put forward the most radical ideas for overhauling country’s entitlement programs. And while he’s lately begun to clumsily retreat to more moderate alternatives, they don’t add up any more than his attempts to explain the factual holes in his autobiography. While his past will surely provide rich fodder for Tuesday night’s third GOP debate, it’s what Carson proposes for America’s future that truly needs more critical attention.
Carson originally proposed to scrap Medicare and Medicaid entirely—a genuinely radical idea, and one with massive policy and political risks. Under his plan, every American would receive a cradle-to-grave health savings account with an annual $2,000 government subsidy, which family members could share. But after the third debate two weeks ago, Carson began running away from that old idea, which had been coming under increasing attack by fellow Republicans, particularly Donald Trump. “Ben wants to get rid of Medicare, Trump said last week. “You can’t get rid of Medicare. It would be a horrible thing to get rid of.”
Carson has begun to roll out an alternative that avoids the political liabilities of blowing up the entire system. But his account of the changes he’s made has been as confusing as the West Point saga. A few days before the last debate, Carson was already claiming on Fox News Sunday that his original plan for entitlement reform had been “gone for several months now.” That confused host Chris Wallace, who—like most of those watching—had definitely not been under that impression. Though he remains hazy on the details, Carson’s new scheme could also be massively disruptive, not only undermining care but also running up costs for the government.
Under Carson’s new plan—at least, from what can be sussed out from his statements—the traditional government programs would stay in place, but people would have the alternative to opt out with private Health Savings Accounts they could use to purchase their own coverage. Unlike his original plan, however, not everyone would get a subsidy in this one. Many of the details remain murky, and Carson’s campaign says a full-blown proposal is forthcoming. But based on his remarks so far, Carson seems to be suggesting that if you qualify for Medicare or Medicaid, you could choose to have the government money that would have paid for your health care to go directly to a private savings account instead. “I would never get rid of the programs. I would provide people with an alternative,” Carson said on Fox News Sunday. “I think they will see that the alternative that we’re going to outline is so much better than anything else that they will flock to it.”
But Carson’s alternative could create a whole host of problems. Those who pick HSAs would likely face very high deductibles and co-pays, which could lead them to forgo necessary care. At the same time, the cost of government health programs could end up rising as well. Healthier people would likely opt out if they could receive cash in private accounts, while sicker people would probably stick with traditional Medicare and Medicaid. “The new plan runs the risk of costing the government more than the current system, since people could game a two-choice system, sticking with a savings account when their spending is low, and switching to a government program once their medical costs rise,” writes The New York Times’s Margot Sanger-Katz.
If Carson’s original plan took a sledgehammer to Medicare and Medicaid, his alternative risks seriously weakening the programs. Despite his medical credentials, Carson seems confused about the very basics of the health care system. In a recent interview, he said that Medicare and Medicaid fraud was costing taxpayers “half a trillion dollars,” a truly astonishing estimate given that the total cost of both programs is $980 billion, as Mother Jones’s Kevin Drum points out. (Experts estimate that the real cost of Medicare and Medicaid fraud could be about $98 billion.)
In previous Republican debates, candidates have treated questions about the factual reality of their policy ideas as an inconvenience to be brushed aside—or as evidence of a media conspiracy to smear conservatives. But it wouldn’t be surprising on Tuesday night, given Carson’s standing in the polls and the scent of his blood in the water, if other Republican candidates go after him on Medicare and Medicaid far more aggressively. Carson won’t be the only likely target: Former Florida Governor Jeb Bush and Senator Marco Rubio have both embraced House Speaker Paul Ryan’s contentious “premium support” proposal, which would give seniors a set amount of money to buy private insurance or traditional Medicare.
Carson’s original idea to overhaul Medicare was far more comprehensive, however, and his new idea is significantly more confusing than his rivals’. Though he’ll likely spend much of Tuesday night defending himself on other scores, his credibility is also on the line when it comes to his policy proposals. We had a preview of what’s to come in the last debate, when Carson was pressed to explain his wild-eyed idea to scrap the current tax code in favor of a ten-percent flat tax. He responded by denying that this was ever his position to begin with, then refused to accept the basic facts behind the idea.
He’s already started to use the same cop-outs when it comes to his health-care ideas, acting as if he had never proposed to get rid of Medicare. This, ultimately, is why Carson’s trouble with truth-telling really does matter: His fuzzy relationship with the facts doesn’t stop with his youth.
By: Suzy Khimm, Senior Editor at The New Republic; November 9, 2015
“Skeletal Descriptions Of Planlike Concepts”: How The Presidential Race Is Making The GOP’s Health Care Ideas Even Worse
Every major national Republican is sure that they want to repeal the Affordable Care Act. They are much less clear about what, if anything, they would do after stripping insurance from millions of people. Two plausible Republican nominees for president — Scott Walker and Marco Rubio — issued health care plans this week. And…let’s just say there’s a reason Republicans spend a lot more time on the “repeal” part of the “repeal and replace” equation.
Indeed, to call these positions “plans,” as opposed to gestures in the direction of having a policy alternative, is probably too generous. As Jon Chait of New York puts it, they are “not so much plans as skeletal descriptions of planlike concepts.” Still, even in larval form, Walker’s plan contains several elements that are common to most Republican health care proposals, and that if enacted would result in horribly unpopular policy disasters. Here are the main features:
End the individual mandate
Most individual components of the Affordable Care Act are popular; the requirement that people carry insurance or pay a tax penalty is not. And since the mandate was very nearly the lever that gave a conservative Supreme Court majority a pretext to declare the ACA unconstitutional, Republicans have also convinced themselves that it is one of the greatest threats to liberty ever seen. So it is inevitable that any Republican proposal will advocate eliminating it, as Walker’s does.
The problem is that the popular parts of the ACA can’t be divorced from the mandate. If people are permitted to free-ride, the health insurance market can’t work. Multiple states tried to initiate ACA-like reforms without a mandate, and it was a disaster — young and healthy people decline to buy insurance knowing they can get it if they fall sick, premiums increase, more people drop out, and the market collapses. This is why President Obama — who pandered during the 2008 primaries by putting forward a plan without a mandate — recanted as soon as he was in a position to actually try to get a law passed.
Make state regulations ineffective
Whenever conservatives have a policy they would prefer not to defend on the merits, the language of federalism comes in handy. In health care, virtually all Republican plans argue for permitting the purchase of insurance across state lines. Walker’s is no exception: “My plan would allow individuals to shop in any state to find health insurance that covers the services they need at a price that fits the family budget.”
In the abstract, a policy of permitting people to shop for insurance across state lines sounds attractive. In practice, it would be a regulatory race to the bottom. Insurance companies would gravitate to the states that place the fewest regulations on insurance industries. It would therefore become easier for insurance companies to deny claims, rescind insurance (or refuse to give it in the first place), and impose hidden costs. If you think credit card companies should be a model for health insurance companies, then Walker’s plan might sound like a good idea. If you’re thinking more clearly, it’s obviously a terrible one.
Make it easier to sell junk insurance
Walker’s plan would reduce federal regulations as well. The Affordable Care Act’s requirement that insurance actually cover things would be eliminated, as would other provisions such as the popular requirement that children be allowed to stay on their parents’ plan until age 26. Other provisions of the ACA, like the ban on discrimination based on pre-existing conditions, would be seriously weakened. So at the same time as Walker’s plan would effectively eliminate many state regulations, it would also leave the insurance companies mostly unsupervised by federal regulations as well.
Conservatives would defend this awful idea by posing a choice between “regulation” and “competition.” But the problem is that health care simply lacks the features of a competitive market. There’s a reason why other liberal democracies have more state intervention into health care than the United States, not less. And by the way, they all cover more people for significantly less money.
Attack the poor
Walker’s politics are not about small government. After all, he thinks that abortion should be illegal even when necessary to save a woman’s life, and he just approved a $250 million gift of taxpayer money to hedge fund billionaires to build a basketball stadium. Rather, his politics are about assisting the rich and powerful at the expense of the poorer and less powerful.
His health care plan is no exception. Like the ACA, Walker’s plan would offer tax credits to allow people to purchase insurance. But Walker’s tax credits would be distributed on the basis of age, not income. The result, as Jeffrey Young and Jon Cohn demonstrate, would be a disaster for the non-affluent, as insurance would become unaffordable for many people at any age. And in addition, Walker also advocates savage cuts to Medicaid. The callousness Walker showed in refusing the ACA’s Medicaid expansion in Wisconsin is reflected in his health care plans.
So Walker’s plan would be an utter disaster if implemented. But it’s not just about Walker. Amazingly, some conservative candidates and pundits attacked Walker’s plan from the right. A spokesman for also-ran candidate Bobby Jindal accused Walker of collaborating with Bernie Sanders to create a plan that would make health care far less accessible to the non-rich.
Essentially, Republicans look at the state of health care circa 2009 — in which more than 16 percent of Americans were uninsured, and in which insurance companies could abuse consumers in a number of ways — and argue that even fewer Americans should have insurance and the quality of the insurance should be much worse. This is one of the many reasons that the contemporary Republican Party is simply unfit to govern at the national level.
By: Scott Lemieux, The Week, August 21, 2015
“They Show That They Still Have No Answer”: Scott Walker, Marco Rubio Propose ‘Plans’ To Replace Obamacare
Today, Scott Walker and Marco Rubio have published plans — really, not so much plans as skeletal descriptions of planlike concepts — to replace Obamacare. Their fundamental dilemma is that Obamacare provides a popular benefit to millions of voters. Appealing to the conservative base demands they eliminate the program that provides this benefit. Appealing to the general election requires them to promise something to compensate the victims of repeal. How will they fund that something? This is the basic problem that for decades has prevented Republicans from offering a health-care plan. Rubio and Walker show that they still have no answer.
The usual pattern in politics is for politicians to turn complex problems into simple ones. But covering the uninsured is a simple problem they want to make complex. The main reason people lacked insurance before Obamacare is that they did not have enough money to afford it. Some of those uninsured people had unusually high health costs. Some of them had unusually low incomes. Boiled down, Obamacare transferred resources from people who are rich and healthy to people who are poor and sick, so the poor and sick people can afford insurance.
It cuts funds, but not benefits, from Medicare. And it transfers resources to sick people through regulations. The individual insurance market is reorganized so that insurers can’t deny essential health services or jack up prices to people with preexisting conditions. This means people with expensive medical needs pay less, and people with cheap medical needs have to pay more. Repealing Obamacare means eliminating all these forms of redistribution from the rich and healthy to the poor and sick. And replacing them with … what?
Walker and Rubio are fairly clear about their plans for regulating the insurance market. They want to go back to the pre-Obamacare, deregulated system. They’d eliminate the requirements that insurance plans cover essential benefits, and let them charge higher prices to sicker customers. That’s good for people who have very limited medical needs (as long as they never obtain a serious medical condition, or have a family with somebody with a serious medical condition). It’s bad for people who have, or ever will have, higher medical needs.
Both Walker and Rubio promise to take care of people with preexisting conditions by creating separate “high-risk pools.” That is a special kind of insurance market for people with expensive medical conditions. As you may have guessed, insurance for people with expensive medical needs is, well, expensive. Making that insurance affordable therefore requires lots of subsidies from the government. Where would Walker and Rubio get the money for that? They don’t say.
Both the Rubio and Walker planlike concepts share a basic structure and an extreme lack of detail. Walker’s document is a few pages padded out with ample white space. Rubio’s op-ed, which repeats the talking points of another op-ed from a few months ago, contains even less information. And the lack of detail is not a matter of filling in the fine print. Both Walker and Rubio have signed the Grover Norquist pledge to never raise a single penny of tax revenue ever, under any circumstances.
Both Walker and Rubio propose to cut funding for Medicaid, but this doesn’t create much room to subsidize coverage, since Medicaid is already much cheaper than Medicare or private insurance. Indeed, the main conservative complaint about Medicaid is that it is so cheap that many doctors refuse to see its patients. Republicans are willing to cut Medicaid because they’re generally willing to cut programs that focus on the very poor, but there’s not much blood to be drawn from this stone.
It is tempting to treat the lack of specifics in the Republican health-care plans as a problem of details to be filled in. But it is not a side problem. It is the entire problem. They will not finance real insurance for the people who have gotten it under Obamacare, nor will they face up to the actual costs they’re willing to impose on people. The party is doctrinally opposed to every available method to make insurance available to people who can’t afford it. They have spent six years promising to come up with an alternative plan, and they haven’t done it, because they can’t.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, August 18, 2015
“Demand A Higher Wage, People!”: The Status Quo Of Wage Injustice And Greed-Driven Inequality Relies On Our Complicity
Chasten Florence was on his lunch break when he decided to join a protest outside a McDonald’s in New York City on Wednesday. To be honest, Florence wasn’t really sure what he was helping protest. But as he lay his body down on the sidewalk at a die-in of low-wage workers demanding a $15 wage and a union, Florence simply explained, “These are my people.”
Didn’t Florence need to eat lunch? Sure, but he could spare five minutes. Working concrete on construction jobs, Florence earns more than $15 an hour and thinks everyone else should, too. “I don’t know how you can raise a household on less,” said Florence. And he’s right. You can’t.
On April 15, workers from McDonald’s, Walmart and other low-wage employers were joined by college students and adjunct faculty, domestic workers and leaders from the Black Lives Matter movement. In all, tens of thousands participated in protests in 200 cities across the United States to demand a $15 minimum wage and a union. The #FightFor15 is unconventional in that, instead of focusing on Congress to raise wages, workers and advocates are pressuring employers and also the general public—trying to foster awareness about dismal wages and working conditions and create a groundswell of support for change.
The nationwide protests were organized on Tax Day, April 15, because 4/15 is a short-hand for the campaign’s wage demands. But it was also meant to highlight the fact that the poverty wages paid by fast food restaurants and employers are so low that many low-wage workers are forced to rely on public assistance benefits to get by. In fact, almost three-quarters of Americans who depend on public assistance programs like food stamps and Medicaid are members of a family headed by someone who has a job.
In other words, in America today, many people are poor not because they don’t have a job but because they have a job that pays poverty wages. If the minimum wage had grown at the same rate as overall productivity since 1968, then the minimum wage would now be $18.50 an hour—instead of $7.25, the current federal minimum wage. In fact, adjusted for inflation, the federal minimum wage has actually dropped. In 2014 dollars, the 1968 minimum wage was equal to $9.54 an hour.
The stagnation of working class wages cannot be explained by a lack of hard work or skills. Low-wage workers have more education than their 1968 counterparts—and yet are still being paid less. And as this graph from Mother Jones shows, while worker productivity has steadily risen over the past several decades, overall wages have not grown at the same pace—even though the income of the top 1% has spiked dramatically.
As taxpayers, we foot the bill for greedy employers who pay poverty wages. For instance, because McDonald’s won’t pay its workers a living wage, taxpayers are paying $1.2 billion per year in food stamp costs and other public assistance just for McDonald’s workers alone. That’s like our tax dollars subsidizing McDonald’s profit—and greed.
Recently McDonald’s announced it would raise wages by $1.00 an hour for workers in its corporate-owned stores, which since most McDonald’s are franchise operations, means the raise will affect less than 10 percent of McDonald’s workers. Beth Schaffer, who works at a McDonald’s in Charleston, South Carolina, and came to New York for the protests, shrugged her shoulders about the raise. After all, every single McDonald’s in South Carolina is a franchise not covered by the $1.00-an-hour increase. “My customers show me more respect than my employer,” said Schaffer. As her tone made clear, that’s not saying much.
As I left the Fight for $15 protest, one of several staged throughout New York on Wednesday, Chasten Florence walked one way back to his construction site and I walked the other way. I passed the tony restaurants of New York’s Upper West Side, on what seemed like one of the first real days of spring, men and women in business suits sitting at tables on the sidewalk, taking in the sun. Most were probably spending more on lunch than the workers at the protest earn in a week. Myself included.
And there’s nothing wrong with that, with wealth and success and enjoying what comes with it. The question is, are we paying enough attention to the costs? I wondered whether the people eating their expensive lunches knew that the bussers taking their plates can barely afford to feed their own families, that the workers at their children’s daycares don’t have health insurance, that the cheap stuff they order conveniently on Amazon.com is definitely comes at a high cost to the workers who make and ship those goods.
The construction worker who joined the Fight for $15 protest didn’t know that much about the issues or the protest demands, either. But he was going out of his way to learn, and to be supportive. “These are my people,” he said. Yes, they’re all of our people. It’s time we all wake up, pay attention, be angry and stand with our fellow human beings to do something about it. The status quo of wage injustice and greed-driven inequality relies on our complicity, whether by silence or ignorance. But it cannot survive if we all stand up together and fight.
By: Sally Kohn,
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