“The Obamacare Referendum”: Paul Ryan Is Using Shorthand Again In Selling Changes To Medicare
Did you know that on November 6, 2012, in conjunction with the national election, the United States also had a referendum on Obamacare that Republicans won? No, I didn’t, either, until Paul Ryan informed me of this, via this Think Progress report:
On Sunday morning, Rep. Paul Ryan (R-WI) stopped by Fox News Sunday to preview his new budget, which will be released in full on Tuesday. As it had the past two years, this year’s version will call for massive cuts to social service programs, including food stamps, job training, Medicaid, and Medicare. Host Chris Wallace challenged Ryan on the viability of his plan, pointing out that he wants to repeal and replace Obamacare, and, “that’s not going to happen.”
Still, Ryan insisted that he and then-running mate Mitt Romney won the election on this issue because they “won the senior vote.”
Now I think we all understand that Ryan is using some shorthand here: many Democrats hoped, and Republicans feared, that Ryan’s budget, by proposing to change Medicare from an entitlement to publicly-provided health insurance into a premium-support system, would make his party vulnerable to losses it could not manage in its old-white-folks electoral base. Instead, by a variety of means (including over two years of insanely mendacious “death-panel” demagoguery about the impact of Obamacare on Medicare, and the systematic “grandfathering” of seniors from Ryan’s proposed Medicare changes), the GOP ticket managed to promote a health care message that nicely meshed with its overall pitch to old white folks that those people along with their atheist hippie allies were threatening to take away everything good virtuous retirees had worked so hard to secure for themselves, including Medicare (which they tend to regard as an earned benefit as opposed to Obamacare’s “welfare”).
I suppose it’s understandable that Ryan would view any success in selling big changes in Medicare to old folks would represent a political ten-strike, even if he’s now having to incorporate into his budget the same Medicare savings he implicitly attacked during the campaign as a token of Obamacare’s ultimate goal of sending seniors off to euthanasia camps. But it’s still bizarre that he’s touting an incumbent president’s re-election victory as a repudiation of his most important legislative accomplishment. It’s enough to give Dick Morris hope he can come back from ridicule and disgrace and claim he was right all along in predicting a big Romney-Ryan win.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, March 11, 2013
“Mooching Off Medicaid”: Conservatives Like Big Government Just Fine When It Lines Their Pockets
Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible. And no doubt there are individual conservatives who really have such idealistic motives.
When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — namely, that it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid.
Some background: Medicaid, which provides health insurance to lower-income Americans, is a highly successful program that’s about to get bigger, because an expansion of Medicaid is one key piece of the Affordable Care Act, a k a Obamacare.
There is, however, a catch. Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured.
Now, in the end most states will probably go along with the expansion because of the huge financial incentives: the federal government will pay the full cost of the expansion for the first three years, and the additional spending will benefit hospitals and doctors as well as patients. Still, some of the states grudgingly allowing the federal government to help their neediest citizens are placing a condition on this aid, insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want.
Consider the case of Florida, whose governor, Rick Scott, made his personal fortune in the health industry. At one point, by the way, the company he built pleaded guilty to criminal charges, and paid $1.7 billion in fines related to Medicare fraud. Anyway, Mr. Scott got elected as a fierce opponent of Obamacare, and Florida participated in the suit asking the Supreme Court to declare the whole plan unconstitutional. Nonetheless, Mr. Scott recently shocked Tea Party activists by announcing his support for the Medicaid expansion.
But his support came with a condition: he was willing to cover more of the uninsured only after receiving a waiver that would let him run Medicaid through private insurance companies. Now, why would he want to do that?
Don’t tell me about free markets. This is all about spending taxpayer money, and the question is whether that money should be spent directly to help people or run through a set of private middlemen.
And despite some feeble claims to the contrary, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. Partly this reflects lower administrative costs, because Medicaid neither advertises nor spends money trying to avoid covering people. But a lot of it reflects the government’s bargaining power, its ability to prevent price gouging by hospitals, drug companies and other parts of the medical-industrial complex.
For there is a lot of price-gouging in health care — a fact long known to health care economists but documented especially graphically in a recent article in Time magazine. As Steven Brill, the article’s author, points out, individuals seeking health care can face incredible costs, and even large private insurance companies have limited ability to control profiteering by providers. Medicare does much better, and although Mr. Brill doesn’t point this out, Medicaid — which has greater ability to say no — seems to do better still.
You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying.
But why would you insist on privatizing a health program that is already public, and that does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits.
So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 3, 2013
“Let’s Take Healthcare Away”: Lindsey Graham Struggles With Fiscal Basics
There was an exchange yesterday between Fox News’ Chris Wallace and Sen. Lindsey Graham (R-S.C.) that was hard to watch, but nevertheless illustrative of a larger point.
WALLACE: You know that if we go into the sequester the president is going to hammer Republicans. The White House has already put out a list of all the things, terrible things that will happen if a sequester kicks in: 70,000 children losing Head Start, 2,100 fewer food inspectors, small business will lose $900 million in loan guarantees. And, you know, Senator, the president is going to say your party is forcing this to protect tax cuts for the wealthy.
GRAHAM: Well, all I can say is the Commander-In-Chief thought — came up with the idea of sequestration, destroying the military and putting a lot of good programs at risk. Here’s my belief: let’s take “Obamacare” and put it on the table…. If you want to look at ways to find $1.2 trillion in savings over the next decade, let’s look at “Obamacare”. Let’s don’t destroy the military and just cut blindly across the board.
Now, the first point is obviously ridiculous. Republicans are heavily invested in the idea that automatic sequestration cuts were something President Obama “came up with,” but reality shows otherwise. It’s trivia anyway — what matters is resolving the threat, not imagining who created it — but what Graham chooses to overlook is every relevant detail: the sequester was part of the ransom paid to the Republican Party when it took the nation’s full faith and credit hostage for the first time in American history. GOP leaders, at time, bragged that this policy was their idea, not Obama’s.
If Graham doesn’t like the sequester — and he clearly seems to agree that it’s a serious problem — he can support scrapping the policy or coming up with a bipartisan alternative. For now, he’s opposed to both of those options, making his whining yesterday rather unpersuasive.
But Graham turning his focus to the Affordable Care Act serves as a reminder of just how unserious he is about public policy.
Let’s be clear about what the South Carolinian is saying here. About $1.2 trillion in automatic cuts are set to kick in, doing real harm to the economy, the military, and the country overall. Lawmakers could cancel or delay the policy, though Republicans aren’t interested in either of these options, or they can come up with a bipartisan alternative that replaces the sequester with something else.
With 11 days to go, Lindsey Graham’s contribution to the discussion, in effect, is, “I know! Let’s take health care benefits away from millions of Americans!”
It’s worth noting that even the most reflexive partisans should realize their anti-“Obamacare” preoccupation is quickly becoming laughable. Republican governors are implementing the law; House Speaker John Boehner (R-Ohio) recently conceded the Affordable Care Act is “the law of the land“; public support for repeal is evaporating; and when folks like Orrin Hatch and Michele Bachmann unveil repeal bills, even most GOP lawmakers ignore them.
Graham, in other words, really needs to get over it.
But more important from a substantive perspective is that the South Carolina Republican still doesn’t understand the basics of the fiscal debate. The point of looking for a sequester alternative is to find a new policy on debt-reduction. If policymakers scrapped the Affordable Care Act, it would make the debt worse, not better.
In other words, Graham thinks Washington can produce smaller deficits by producing larger deficits. That doesn’t make any sense.
By: Steve Benen, The Maddow Blog, February 18, 2013
“Warmed Over Pablum”: Marco Rubio’s Lies About Healthcare Reform
Marco Rubio’s rebuttal to the State of the Union address was remarkable for being unremarkable—it contained much of the same warmed-over pablum we heard from the stage in Tampa Bay at the Republican National Convention six months ago. President Obama “believes [the government] the cause of our problems” and that “More government isn’t going to help you get ahead. It’s going to hold you back.” There was even a Solyndra reference.
But the most interesting and substantive part of Rubio’s speech was the attack he leveled against healthcare reform. The Affordable Care Act will be implemented over the next—wait, sorry. I’m incredibly thirsty. I need some water before I finish this post.
Okay, back. In any case, as the ACA is implemented over the next few years, Republicans must continue to launch rhetorical bombs at it, because a negative public perception of the law would create cover for Republican governors to deny Medicaid expansion in their state, and might also blunt “Obamacare” as a powerful Democratic talking point in 2014 and 2016.
So here’s what Rubio said about the ACA:
[M]any government programs that claim to help the middle class, often end up hurting them instead.
For example, Obamacare was supposed to help middle-class Americans afford health insurance. But now, some people are losing the health insurance they were happy with. And because Obamacare created expensive requirements for companies with more than fifty employees, now many of these businesses aren’t hiring. Not only that; they’re being forced to lay people off and switch from full-time employees to part-time workers.
Rubio is explicitly trying to scare people into thinking they’re about to either lose their health insurance or get fired because of Obamacare. But none of this is true.
Let’s start with the first claim: that “some people are losing the health insurance they were happy with.” Rubio is eliding the fact that in the final telling, ACA is projected to insure 30 million Americans who otherwise don’t have health insurance. It’s not immediately clear who Rubio thinks is losing their policies, because after all, insurance companies can no longer just drop people from coverage because of pre-existing conditions.
Rubio goes on to say that “because Obamacare created expensive requirements for companies with more than 50 employees, now many of these businesses aren’t hiring” and others are switching from full-time to part-time workers because of the ACA. But that’s just not the case.
A study this summer from the Midwest Business Group on Health found that “there is little indication that employers plan to drop healthcare coverage.” The “expensive requirements” Rubio alludes to will be about 2.3 percent, according to one international consulting firm, and other studies show that healthcare reform might ultimately help small businesses because of the subsidies they receive and the fact they are offering a more attractive compensation package for employees. That’s what happened in Massachussets under Romneycare.
Sure, some right-wing business titans who run places like Applebee’s and Denny’s may say they’re going to cut back hours because of the dread of Obamacare, but they are the exceptions to the rule. Moreover, their actions are just one small part of a disturbing trend of large companies shifting healthcare costs onto low-wage workers—as would be any employer who cuts his full-time employees to part-time so he is not responsible for increased coverage requirements under the ACA.
And this gets to the real problem with Rubio’s speech. His case here is that Obamacare is hurting middle-class Americans—but then he specifically describes companies who would cut workers’ hours so they aren’t entitled to health insurance. It’s these vicissitudes of the free market that the ACA was trying to address, like when insurance companies drop people from coverage because they once took heartburn pills. Rubio’s larger case—his whole case in this speech—is that the government is hurtful, not harmful. But he was simply unable to prove it.
By: George Zornick, The Nation, February 13, 2013
“Scottie’s Star Trek Tricks”: Rick Scott’s Parallel Universe Of Ideological “Facts”
Via Think Progress, another item from the ever-increasing database of “facts” Republicans use to buttress ideologically dictated positions comes from everybody’s favorite health care expert, Florida Gov. Rick Scott.
Scott has been bruiting it about that his refusal to implement the Medicaid expansion provided for in the Affordable Care Act, which would have supplied health insurance to a cool million residents of that steamy state, was based on its vast cost: $26 billion over ten years in new state costs!
Them’s a lot of dollars, to be sure. But turns out Scott just kinda made the number up, or more accurately, didn’t bother to share the preposterous assumptions needed to generate it. Health News Florida explains:
The state’s chief economist has warned the staff of Gov. Rick Scott that his Medicaid cost estimates are wrong, but Scott keeps using them anyway, according to a series of e-mails obtained by Health News Florida.
Scott says he opposes expanding Florida Medicaid because it would cost too much: $63 billion over 10 years, he says, with the state paying $26 billion of that.
But those numbers are based on a flawed report, according to a legislative budget analyst and State Economist Amy Baker. A series of e-mails obtained by Health News Florida shows the analysts warned Scott’s office the numbers were wrong weeks ago, but he is still using them. He cited them in a Tampa Bay Times op-ed on Sunday and at at a Washington press conference on Monday.
The trumped-up number, it seems, comes from assuming the federal super-match for the expanded Medicaid coverage provided for in the ACA will never actually materialize. Why? Here’s the response from Scott’s “health policy coordinator,” Michael Anway:
Anway said he doesn’t believe the federal funds will come through. “The federal government has a $16 trillion national debt, must borrow 46 cents of every dollar it spends, and in 2011 had its credit rating downgraded for the first time in history,” he wrote in explanation.
So Scott is assuming the feds will renege on their statutory obligation to provide the Medicaid match. That’s a new one, and is particularly ironic since the only threat to the federal government defaulting on its spending obligations comes from Scott’s conservative buddies in Congress.
Truth is, the most authoritative estimate of state costs associated with the Medicaid expansion, from the Kaiser Family Foundation, put Florida’s costs at $1 billion over ten years, and that doesn’t even include potential savings from costs currently incurred by the state in uncompensated care for the uninsured.
So Scott’s costs estimates are off a mere 96%, at least. But what are facts when it comes to the ontological necessity of thwarting Obamacare and saving a million Floridians from the slavery of dependence on government?
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, January 8, 2013
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