“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
“All The Explanation You Need”: Mitt Romney, The Most Mysterious Man In The Election
It’s often said that the way a candidate runs his campaign gives insight into the way he’ll run the government, but unfortunately it usually isn’t true. A campaign has a few similarities to a government, but not many; likewise, while there are similarities between running for president and being president (lots of speeches, for instance), most of the really important things couldn’t be more different.
As the presidential election nears its end—a vote of tremendous consequence preceded by a campaign of unusual triviality—is there anything left to learn about Barack Obama and Mitt Romney? Despite the fervid hopes of those on the extreme right that there is some secret revelation waiting to be unearthed about Obama, we know most of what we need to know about his potential second term just by taking stock of his first. We know that domestically, where he needs Congress’s cooperation he’ll pursue the policies his party supports, just as Mitt Romney will. In foreign policy and national security, we know that he’ll continue to distress the progressives who care to think about it, with a continuation of the drone war in Pakistan and Afghanistan and a vision of presidential power that is little different from George W. Bush’s. The bulk of his policy initiatives will merely continue what he has already done; whether you think that’s a good idea depends almost entirely on your party affiliation.
If you had particular foresight, you might have seen in Obama’s pre-presidential political career some of the characteristics that produced his greatest successes as president. In particular, he combines a carefulness and methodical planning with extremely bold action when he believes circumstances have produced the perfect moment. The most obvious example was his decision to run for president in the first place. Let’s not forget that at the time, nearly every sage observer said Obama was being presumptuous and premature. When his run began he was a mere two years removed from the Illinois state senate, an electrifying presence but hardly possessed of the seasoning that a president needed. But Obama saw that the end of the Bush years provided an opportunity he might not see again, when the thirst for someone new and different made the election of the nation’s first black president a possibility, even one who had only occupied high office for only a brief time.
There have been plenty of times when Obama could have gone farther than he did, or would have done better forcing a confrontation instead of settling for conciliation. But that boldness could be seen at most of the key moments of his first term: ignoring advisers like Rahm Emanuel who counseled abandoning the Affordable Care Act when it was in jeopardy; bailing out the auto industry when many thought it was a dying elephant; and yes, ordering the operation that killed Osama bin Laden despite all the risks it entailed.
Like Obama, Mitt Romney is known as a careful planner. But unlike Obama, Romney has shown an aversion to risk-taking that is nearly absolute. That isn’t always a bad thing; though many of Obama’s risks have worked out well, there’s nothing inherently wrong with caution. But Romney’s caution is extreme, so much so that it’s impossible to think of a single risk he’s ever taken—political, personal, or otherwise. When he was working at Bain & Co. and the firm’s founder asked him to run the new venture of Bain Capital, Romney negotiated a deal that guaranteed him his old job back if the private equity firm failed. When he went to run the Olympics in Salt Lake, he negotiated a similar deal with Bain Capital. And the private equity business that he helped pioneer is all about risking borrowed money and making sure to charge huge management fees, so even if the company you buy goes under, you still wind up making a profit.
In politics, Romney’s aversion to risk is all the explanation you need for his reinventions: When the next electorate to be wooed didn’t look favorably inclined to the last iteration of Mitt, rather than risk being rejected because of what he stood for, he sought out the path of least ideological resistance. The problem is that if he becomes president, Romney will face decisions in which there is no safe choice. I don’t doubt that if a natural disaster hit, Romney could effectively manage the government’s response, since it would be an administrative challenge with clear goals. But what about some international crisis where all paths pose tremendous risks? What if, say, fundamentalists staged a coup in Pakistan? Can anyone say how Romney would respond, or even what in his character or experience might give us some idea? He might handle such crises brilliantly or disastrously. We have no idea.
Nevertheless, for all Romney’s ideological revisions and reimaginings, we can be fairly sure about many of the things he’ll do. Just like Obama, he’ll be a creature of his party. He’ll stock the executive branch with the same Republicans who would arrive with any GOP president. He can’t enact his tax cut plan as he has presented it during this campaign, but he’ll attempt to cut income tax rates in some fashion, and probably try to cut capital gains and inheritance taxes to boot. He’ll appoint judges (and Supreme Court justices if he gets the chance) who are hostile to reproductive rights and friendly to corporate power and privilege. When he promises to cut regulations that limit business’s ability to pollute or harm consumers, he means it. While he may not achieve his utterly arbitrary goal of increasing military spending to 4 percent of GDP, he’ll certainly try to increase it. He might get cold feet on voucherizing Medicare, but he’ll be happy to go after Medicaid; doing so is less risky since the latter’s constituency is poor people.
Finally, if we’re trying to imagine the next four years, it’s as important to ask what each candidate doesn’t care about as what he does care about. A president won’t take a political risk or invest in a long-term effort to accomplish a goal he can live without achieving. Obama wouldn’t have undertaken the monumental struggle required to pass the Affordable Care Act if he didn’t care about the goal of health care reform. On the other hand, he clearly doesn’t care much about the proliferation of guns.
As for Mitt Romney, it’s so hard to determine what he cares about that it’s equally difficult to say what he doesn’t care about. His campaign recently informed reporters that he will be giving no more interviews between now and Election Day, lest he be subjected to the risk of an uncomfortable question or another cringe-inducing gaffe. So whatever voters don’t know about Mitt Romney they aren’t going to find out unless he becomes president.
By: Paul Waldman, Contributing Editor, The American Prospect, October 29, 2012
“It’s Not Flexibility”: What Women Really Want In The Workplace
What do women want? And why do they act the way they do?
These are not difficult or rational questions. The true question is, why is it that we’re in the 21st century and politicians and so-called scientific researchers are still pondering these questions as though women are some exotic, mute species that must be diagnosed?
The most recent offense comes from a CNN story—quickly scrubbed—reporting on a University of Texas San Antonio study on how women’s menstrual cycles affect the way they vote. Said the now-removed CNN post:
While the campaigns eagerly pursue female voters, there’s something that may raise the chances for both presidential candidates that’s totally out of their control: women’s ovulation cycles. Here’s how [researcher] Durante explains this: When women are ovulating, they “feel sexier,” and therefore lean more toward liberal attitudes on abortion and marriage equality. Married women have the same hormones firing, but tend to take the opposite viewpoint on these issues, she says.
It’s absurd to think that women universally “feel sexier” during ovulation (and if they do, it’s probably more because that’s the point where most women feel thinnest), but even more ridiculous to suggest this has anything to do with voting. Even if the statistics were true, there’s no cause-and-effect relationship established. If anything, it’s a mere statistical correlation, and one driven by a (wrong and offensive) default view that men are the control group of rationality, and whatever women do that deviates from that must be explained away as some sort of irrational deviation. The underlying assumption in many of these so-called studies—including all the ones about how women dress more attractively during ovulation to attract a mate during peak baby-making time (again, gentlemen, not so much—women I know dress for the occasion, for themselves, and for other women before they dress for men)—is that a woman’s real job is to find a mate and produce children. How convenient that the insulting thesis supports de facto policies that keep women in less prestigious jobs, paying them less for their work.
Then we have Mitt Romney, observing during a debate that one of the things he learned when he was staffing his gubernatorial office was that he needed to be “flexible” for the females. Said Romney:
I recognized that if you’re going to have women in the workforce that sometimes you need to be more flexible. My chief of staff, for instance, had two kids that were still in school.
She said, I can’t be here until 7 or 8 o’clock at night. I need to be able to get home at 5 o’clock so I can be there for making dinner for my kids and being with them when they get home from school. So we said fine. Let’s have a flexible schedule so you can have hours that work for you.
This is what Romney thinks women want in the workplace—”flexibility?” We all want flexibility—men and women—but it obscures an important point. Here’s what women want first in the workplace: money and power. The same as the men. Really, it’s a pretty simple equation. Opining that women are some special class needing “flexibility” so they can be home in time to make dinner for their husbands and kids is just another way of saying that home-making is a woman’s real job, even if it’s another thing she does in addition to working. It puts her husband’s job above hers, and gives license to every employer to treat women as less valuable—and thus, less compensated and promoted—in the workforce. And what about all those women who aren’t married and presumably don’t have wifely tasks? Well, they’re ruled by their hormones instead, if we are to believe the utter piece of garbage produced by the University of Texas.
It’s been quite some time since one of the original misogynist scientists, Sigmund Freud, asked, “What do women want?” It’s the 21st century. Candidates and researchers could just ask—and maybe listen to the answer.
By: Susan Milligan, U. S. News and World report, October 29, 2012
“The Heartland Election”: Ultimately Determined By “Makers” Quite Different From The Ones In Paul Ryan’s Speeches
When Mayor Bobby J. Hopewell talks about the importance of manufacturing to this friendly Michigan town with a name that lends itself to song, he doesn’t reel off the usual list of heavy industries typically associated with the word “factory.”
He speaks of Kalsec, the Kalamazoo Spice Extraction Company founded in 1958 that produces and markets natural herbs and spices for food manufacturers. He mentions Fabri-Kal, a 62-year-old packaging company that describes itself as “the seventh-largest plastic thermoformer in North America.” Think of products in drug stores encased in heavy plastic. And he doesn’t leave out the pharmaceutical industry, long vital to his city’s economy.
Yes, we still make a lot of stuff in the United States of America, and one of the good things about this election is that it is likely to be decided in the nation’s industrial heartland — in the towns and cities of Ohio above all, but also in Michigan, Pennsylvania and Wisconsin.
President Obama almost certainly needs these states to win reelection, and if he does, manufacturing is destined for a larger role in the American economic conversation. Many promises have been made this year to the people and the communities whose ability to thrive has long depended upon manufacturing. The campaign’s thrust should move them to the heart of our efforts to seek a path up from the financial catastrophe that engulfed the country in 2008.
For two decades now, we have acted as if nearly all of us are destined to work in the tech industry or health care — or to survive on money that trickles our way courtesy of the world of finance. But while Hopewell is proud of the part played in his city by universities and those engaged in work involving what he calls “intellectual property,” he adds: “We are major makers in the region.”
When Hopewell is asked if he used the term “makers” in the way Paul Ryan does in drawing a distinction between “makers” and “takers” — between those who produce and those who get government aid — this Democrat laughs heartily. No, he says, his views have little in common with Ryan’s. The mayor is talking about manufacturing, pure and simple.
Leaders of traditional factory towns are by no means interested in a stagnant world in which members of each generation follows their parents into the same old factory job. On the contrary, this city is proud of “The Kalamazoo Promise,” the remarkable initiative of anonymous local donors who have established a fund that pays for a college education for every graduate of the city’s schools.
In Parma, Ohio, the industrial suburb of Cleveland where both Bruce Springsteen and Bill Clinton recently campaigned on Obama’s behalf, Mayor Tim DeGeeter said the top priority of the city’s blue-collar workers is a college education for their children. Parma and places like it, he adds, also want the sort of economic development that creates higher-end jobs so graduates can stay in the area, “and not have to move to Phoenix or Charlotte.”
What both mayors are saying (there are many like them) is that they want the market system to work for their communities, but do not want to leave their citizens utterly at the mercy of decisions made by economic actors far away, or of economic forces that no one controls.
This is why the rescue of the auto industry has been such a defining campaign issue in the Midwest. In Parma, DeGeeter notes that the auto revival means that GM recently made a $20 million investment in its stamping plant in the city. “That helps me sleep at night,” he says.
Hopewell says that even though the auto industry is not as important to Kalamazoo as it is in the Detroit area, “you can’t be a Michigander and not understand the importance of the auto industry, and not understand what it has done for our state.” The Republican sweep in Michigan in 2010 suggested it might be open to the GOP’s presidential candidate this year. But so far, it has remained anchored in Obama’s camp.
More broadly, white voters without college educations are voting for Obama at nearly twice the rate in the Midwest as in the South. In the Midwest, Obama is drawing 41 percent of their votes, according to a recent Washington Post/ABC News Poll, compared with only 24 percent in the South. If Obama prevails, “makers” of a sort quite different from the ones in Ryan’s speeches will have played a central role.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, October 28, 2012
“Logic, Fairness, And Common Sense”: The Final Days, The Biggest Issue, And The Clearest Choice
As we go into the final days of a dismal presidential campaign where too many issues have been fudged or eluded — and the media only want to talk about is who’s up and who’s down — the biggest issue on which the candidates have given us the clearest choice is whether the rich should pay more in taxes.
President Obama says emphatically yes. He proposes ending the Bush tax cut for people earning more than $250,000 a year, and requiring that the richest 1 percent pay no less than a third of their income in taxes, the so-called “Buffett Rule.”
Mitt Romney says emphatically no. He proposes cutting tax rates on the rich by 20 percent, extending the Bush tax cut for the wealthy, and reducing or eliminating taxes on dividends and capital gains.
Romney says he’ll close loopholes and eliminate deductions used by the rich so that their share of total taxes remains the same as it is now, although he refuses to specify what loopholes or deductions. But even if we take him at his word, under no circumstances would he increase the amount of taxes they pay.
Obama is right.
America faces a huge budget deficit. And just about everyone who’s looked at how to reduce it — the non-partisan Congressional Budget Office, the bi-partisan Simpson-Bowles Commission, and almost all independent economists and analysts — have come up with some combination of spending cuts and tax increases that raise revenue.
Just last Thursday, executives of more than eighty large American corporations called for tax reform that “raises revenues and reduces the deficit.”
The practical question is who pays for those additional revenues. If Romney’s view prevails and the rich don’t pay more, everyone else has to.
That’s nonsensical. The rich are far richer than they used to be, while most of the rest of us are poorer. The latest data show the top 1 percent garnering 93 percent of all the gains from the recovery so far. But median family income is 8 percent lower than it was in 2000, adjusted for inflation.
The gap has been widening for three decades. Since 1980 the top 1 percent has doubled its share of the nation’s total income — from 10 percent to 20 percent. The share of the top one-tenth of 1 percent has tripled. The share of the top-most one-one hundredth of 1 percent — 16,000 families — has quadrupled. The richest 400 Americans now have more wealth than the bottom 150 million of us put together.
Meanwhile, the tax rates paid by the wealthy have dropped precipitously. Before 1981 the top marginal tax rate was never lower than 70 percent. Under President Dwight Eisenhower it was 93 percent. Even after taking all the deductions and tax credits available to them, the rich paid around 54 percent.
The top tax rate is now only 35 percent and the tax on capital gains (increases in the value of investments) is only 15 percent. Since so much of what they earn is from capital gains, many of the super-rich, like Mitt Romney himself, pay 14 percent or less. That’s a lower tax rate than many middle-class Americans pay.
In fact, if you add up all the taxes paid — not just on income and capital gains but also payroll taxes (which don’t apply to income above incomes of $110,100), and sales taxes — most of us are paying a higher percent of our income in taxes than are those at the top.
So how can anyone argue against raising taxes on the rich? Easy. They say it will slow the economy because the rich are “job creators.”
In the immortal words of Joe Biden, that’s malarky.
The economy did just fine during the three decades after World War II, when the top tax rate never fell below 70 percent. Average yearly economic growth was higher in those years than it’s been since, when taxes on the rich have been far lower.
Bill Clinton raised taxes on the rich and the economy did wonderfully well. George W. Bush cut them and the economy slowed.
The real job creators are America’s vast middle class, whose spending encourages businesses to expand and hire — and whose lack of spending has the opposite effect.
That’s why the recovery has been painfully slow. So much income and wealth have gone to the top that the vast majority of Americans in the middle don’t have the purchasing power to get the economy moving again. The rich save most of what they earn, and their savings go anywhere around the world where they can get the highest return.
It would be insane to compound the damage by raising taxes on the middle class and not on the rich.
Logic, fairness, and common sense dictate that the rich pay more in taxes. It’s the key to avoiding January’s fiscal cliff and coming up with a “grand bargain” on taming the budget deficit. And it’s central to getting the economy back on track.
By: Robert Reich, Robert Reich Blog, October 28, 2012
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