“Medicaid Is the Real Target”: Mitt Romney’s Priorities, Aid For The Rich, Paid For By The Poor
Since August, when Mitt Romney chose Paul Ryan as his running mate, the two campaigns have fought a fierce battle over who is the most stalwart protector of Medicare. In the first presidential debate, Romney assailed President Obama for his $716 billion in Medicare cuts, and Ryan did the same in last week’s vice presidential face-off. Likewise, the Obama campaign has hit Team Romney for the Ryan plan and its Medicare “premium support”—which, if implemented, would gradually replace traditional Medicare with subsidized, regulated private insurance.
The irony is that—in the short term, at least—Medicare will stay unchanged, regardless of who wins the election. Seniors are among the most mobilized voters in the electorate, and there’s too much political risk involved in making big, immediate changes to Medicare. For that reason, Medicare reform plans on both sides are backloaded and will take time to unfold.
The same isn’t true of Medicaid, the other major federal health-care program. The primary constituency for Medicaid—poor and working-class families—lacks the clout and influence of seniors. And while the Obama administration expanded the program in the Affordable Care Act, it has also made Medicaid a ripe target for conservative cuts to social insurance.
This means that, as Mother Jones’ Kevin Drum pointed out last week, Medicaid, not Medicare, is the actual flashpoint in this election. Romney has promised to “block grant” the program, giving states more flexibility in dealing with eligibility and benefits. Some states would use this as an opportunity to innovate. But as Drum notes, just as many would use it as an excuse to drop health coverage for poor people:
Lots of states, especially poor states in the South, don’t have much interest in experimenting. They just want to slash eligibility for Medicaid. Given the freedom to do it, they’d adopt what Ed Kilgore calls the “Mississippi model,” cutting off coverage for a family of three earning anything over $8,200. For all the talk of fresh thinking and new solutions, what they really want to do is simple: They want to stop providing medical care for poor people.
Admittedly, this is a little speculative. It’s possible—albeit, unlikely—that a future governor of South Carolina or Alabama might want to use the new flexibility to improve services for lower-income people. With that in mind, it’s also worth noting the extent to which Romney’s block-grant plan involves a massive cut to overall Medicaid spending. The Center on Budget and Policy Priorities finds that with a Paul Ryan-style block grant in place, overall Medicaid spending would decline by one-third over the next decade. When you put this in the context of Romney’s budget proposals—which include new defense spending and a promise to protect Medicare—and his promise to repeal the Affordable Care Act, the result is a $1.5 trillion reduction in Medicaid spending by 2022. These cuts would add an additional 14 to 19 million people to the ranks of the uninsured, on top of the 30 million people who would lose coverage as a result of full Obamacare repeal.
It’s his approach to Medicaid, more than anything else, that reveals Mitt Romney’s priorities—aid for the rich, paid for by taking relief from the poor.
By: Jamelle Bouie, The American Prospect, October 15, 2012
“Wrong Again Mitt”: Romney Says People Don’t Die Because They Lack Insurance
In an interview with the Columbus Dispatch in Ohio published Thursday, Mitt Romney repeated a claim that already got him in trouble once this cycle and has reflects an enduring belief among Republicans: that people in the U.S. don’t die because they lack health insurance.
“[Y]ou go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital,” Romney said. “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”
It’s eerily reminiscent of a statement President George W. Bush made in 2007 that haunted Republicans during the 2008 campaign — “[P]eople have access to health care in America. After all, you just go to an emergency room.”
There’s just one problem: It’s not true.
Numerous studies over the past 10 years conclude that tens of thousands of Americans die each year because they lack insurance.
A 2009 study conducted at Harvard Medical School and Cambridge Health Alliance, and published in the American Journal of Public Health concluded that “[l]ack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease. … The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance.”
A 2012 report by the health care reform advocacy group Families USA concluded that 26,100 people died prematurely in America in 2010 due to lack of insurance. That report extrapolated from a 2002 Institute of Medicine study — conducted when the uninsurance rate was lower — which concluded that 18,000 people died prematurely because they weren’t covered.
In a 2009 update, the IOM concluded that uninsured patients are at higher risk of mortality or poor health outcomes in the aftermath of both acute medical issues (heart attacks, serious injury, stroke) and chronic ones (cancer, diabetes).
In 2008, the Urban Institute’s Stan Dorn concluded that “[b]ased on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006. Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.”
Conservatives have attacked these findings and methods and argued that, controlling for health status, there’s no difference in survival probabilities between insured and uninsured people. When the Families USA report came out, Avik Roy, a Romney health adviser, called its findings “statistical hogwash.”
To buttress his argument, he cited a thorough study by Richard Kronick — a University of Rochester health policy expert who served in the Obama administration and was a senior adviser to Bill Clinton during his push for health care reform. His conclusion? “[I]f two people are otherwise similar at baseline … but one is insured and the other uninsured, their likelihood of survival over a 2-16-year follow-up period is nearly identical.”
Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.
However, Kronick conceded that “[g]iven the inherent uncertainties in inferring causality from the results of observational analyses, the results presented here are not able to provide a definitive answer to the question, ‘How many fewer deaths would there be in the United States if all residents were continuously covered by health insurance?’”
In an interview, Urban’s Stan Dorn praised Kronick but defended his and his colleagues’ conclusion.
“I’m aware of Rick’s study and he’s a great researcher. And I guess what I’d say is it’s an outlier,” Dorn said in an interview. “There’s a lot of research that goes beyond what we did, and it’s an outlier.”
Dorn noted that other studies focusing on particular ailments make the link between uninsurance and death quite clear. “We know that women with cervical cancer who are uninsured get their cancer detected later…. We know that people with heart disease don’t take their medicine because they can’t afford it…and sometimes die.”
And as Boston University health economist Austin Frakt noted when he engaged this same controversy in February 2010, “among recent studies in this area the evidence is greater than three-to-one in favor of an insurance-health outcome link, including mortality.”
In 2006, then-Massachusetts governor Romney himself agreed — at least to an extent. Though he did not address the mortality issue specifically, in an April 2006 presentation before the Chamber of Commerce he conceded that uninsured people who seek health care at emergency rooms experience worse outcomes.
“There ought to be enough money to help people get insurance because an insured individual has a better chance of having an excellent medical experience than the one who has not. An insured individual is more likely to go to a primary care physician or a clinic to get evaluated for their conditions and to get early treatment, to get pharmaceutical treatment, as opposed to showing up in the emergency room where the treatment is more expensive and less effective than if they got preventive and primary care.”
By: Brian Beutler, Talking Points Memo, October 12, 2012
“Truth-Telling As Fascism”: Is There A Better Way To Describe What Romney’s Been Doing In This Election Cycle?
It’s getting a lot of derisive attention today, but let me add my own hilarity to the general reaction to Daniel Henninger’s Wall Street Journal column today suggesting that people in politics should never, ever, call each other “liars.” Here’s the passage being quoted most:
The Obama campaign’s resurrection of “liar” as a political tool is odious because it has such a repellent pedigree. It dates to the sleazy world of fascist and totalitarian propaganda in the 1930s. It was part of the milieu of stooges, show trials and dupes. These were people willing to say anything to defeat their opposition. Denouncing people as liars was at the center of it. The idea was never to elevate political debate but to debauch it.
The purpose of calling someone a liar then was not merely to refute their ideas or arguments. It was to nullify them, to eliminate them from participation in politics.
Um, no. The habit of 1930s totalitarians was to either (a) ignore everything enemies say and simply exclude them because of who they are, or (b) force them to confess their perfidies, the more lurid the better. The only people I know of in U.S. politics with those unsavory characteristics are typically Republicans who have been calling their opponents “un-American” for years, and/or suggesting that anyone who doesn’t accept “constitutional conservative” policy prescriptions hates the country and God Almighty. Nobody’s trying to “eliminate” Mitt Romney “from participation in politics.” The people, myself included, who have called him a “liar” have done so because he’s, you know, on a factual basis, “lied.” It’s hard to call the massive ad campaign run by Romney accusing the Obama administration of abolishing work requirements for welfare anything other than a “lie.” Since it’s not very likely that Mitt Romney fails to grasp elementary arithmetic, his repeated assertions that there are no contradictions built into his tax proposals have risen to the level of a “lie,” as well. And as readers of Brother Steve Benen know, you can go on and on and on and on.
Sometimes people on the left accuse Romney of lying when it would be possible to accuse him of “misrepresentations” or “fudging the truth” or “serial exaggeration” and so forth. But you know what? Romney’s habit of using lies to reinforce even bigger lies (e.g., his preposterous claim that his “health care plan” would take care of the uninsured just as much as Obamacare would, or his alleged interest in governing in a bipartisan manner, or his supposed independence from the Cultural Right) kind of makes me lose interest in cutting the guy any slack in theoretically close cases. And in complaining (as his running mate did earlier this week) about Democratic attacks on his integrity, Romney hardly comes into the political court of equity with clean hands, having run hatefully negative ads on both his primary and general election opponents whenever it seemed helpful to his candidacy.
But the clincher to me is that it’s not just “liberals” who think there’s something specially mendacious about Romney’s campaign: it’s what conservatives said for months when they were searching high and low for any plausible alternative to the man, and then what they said about his general-election campaign until very, very recently. Why can’t Mitt be loud and proud about his conservative agenda? they asked over and over about the policy positions he continues to hide and distort with every breath.
If Henninger or anyone else can come up with a better way of describing what Romney’s been doing in this election cycle again and again, I’m all ears. For a while I thought about calling him “Nixonian” in his byzantine twists and turns. But after a while, this became an insult to the memory of the Tricky One. In any event, don’t call those of us who have the responsibility of truth-telling about Romney and his vast, dishonest Potemkin Village of a campaign “fascist.” Nobody’s trying to silence Mitt Romney; we’d just prefer he’d unfork his tongue a lot more often. It’s exhausting just keeping up with the man’s mendacity, or whatever you choose to call his aversion to anything like straight talk.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 11, 2012
“A Stark Election Choice”: Study Measures Mitt Romney’s Plan To Screw The Poor And Sick
The largest and clearest point of distinction in the presidential race is universal access to health insurance. If President Obama wins reelection, his law to provide access to the uninsured will go forward. If Mitt Romney is elected, it will be gutted, and Medicaid — the bare-bones coverage plan for the most desperately poor and sick — will face enormous additional cuts.
Commonwealth Fund has released a report comparing the stark choice. Estimating conservatively, Romney’s plan — to the extent that the report was able to piece it together — would increase the uninsured population to about 72 million, while Obama’s would cut it to 26 million (his plan does not cover illegal immigrants.) Probably more telling is Romney’s official campaign reaction:
“Under ObamaCare, Americans have seen their insurance premiums increase, small businesses are facing massive tax increases, and seniors will have reduced access to Medicare services,” Ryan Williams, a Romney spokesman, wrote in an email to POLITICO. “The American people did not want this law, our country cannot afford this law, and when Mitt Romney becomes president he will repeal it and replace it with common-sense, patient-centered reforms that strengthen our health care system.”
Note that the statement is almost entirely an attack on Obamacare, with a brief clause at the end vaguely promising something good will take its place. But that something requires resources. Most people lacking insurance are either sick or have a sick family member or they’re poor. If you want to cover them, you need to cough up some money. Obamacare undertook the massive political heavy lift of providing those resources, and that’s what Romney attacks — he included higher taxes on “small businesses” (i.e., people making more than $250,000 a year) and “reduced access to Medicare services” (i.e., cuts in reimbursements to Medicare providers, as a trade-off for providing them with 30 million new paying customers.)
Romney’s budget is premised on denying the government enough resources to fund any kind of universal health insurance program. His promise to cut tax rates by 20 percent would reduce tax revenue well below current levels. But even if you accept Romney’s arithmetically impossible claim that he can cut tax rates by 20 percent and raise the same tax revenue as the tax code does right now (and without raising taxes on the middle class), merely holding revenue at current, Bush-set levels would make any kind of universal coverage impossible.
Both campaigns describe the election as a stark choice, and this is correct. It’s a choice between universal health coverage for legal citizens and preserving the Bush tax cuts.
By: Jonathan Chait, Daily Intel, October 2, 2012
“RomneyUseToCare”: Mitt’s New “I Care” Message Makes A Pretty Good Case For Obamacare
Mitt Romney, slipping in the polls after his bizarre dismissal of 47 percent of the American people as a “dependent” class with which he would not concern himself, has come up with a new tactic to revive his ailing campaign: compassion.
His message: “I care.”
“There are so many people in our country who are hurting right now,” says the Republican nominee for president. “I want to help them.”
And how does Mitt confirm his concern?
By embracing healthcare reforms that use the power of government to assure that Americans who have no insurance protection—or inadequate insurance—are provided with access to the coverage and the care they need.
“Don’t forget—I got everybody in my state insured,” Romney told NBC News while campaigning in Toledo, Ohio. “One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”
Give Mitt his due.
As governor of Massachusetts, he did indeed establish a statewide program to expand access to healthcare. He was so associated with the program that it’s come to be known as “Romneycare.”
Just like President Obama’s association with the reasonably similar Affordable Care Act at the federal level led to it being dubbed “Obamacare.”
Both programs are imperfect, especially in the eyes of supporters of broader reform, such as the “Medicare for All” proposals advanced by Senator Bernie Sanders and other progressives.
But let’s accept that working to enact them qualifies as evidence of at least some degree of empathy.
So Romney cares—or, at the least, he cared.
And Obama cares.
The political question that remains to be resolved is this: How does Mitt Romney argue that Americans should vote for him because he cared about those who needed healthcare in Massachusetts while Romney is, at the same time, arguing that Americans should not vote for Barack Obama because he cared about those who needed healthcare in the other forty-nine states?
By: John Nichols, The Nation, September 27, 2012
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