Tag: ACA

We have a plan. It’s called Medicare.

Nancy Pelosi, once and future Speaker of the House, reprising her prior quote on Social Security.
This is exactly where the Democrats need to be: stating clearly that there will be no significant benefit cuts to Medicare. We will achieve cuts and reduce costs through implementation of the ACA and reforms to existing money-holes like Medicare Part D; this is, in fact, the only durable way to deliver spending reduction: by lowering the overall per-person cost of medical care in the United States.
The next nearest developed country spends about ⅕th what we do per person on healthcare and gets better results by almost any metric you care to use. You control costs by controlling costs and the rate of their growth, not by setting an arbitrary benefits value that you will pay forevermore.
Note to the MSM: healthcare costs and the rate of cost growth are the issues in federal deficit and debt discussions. Why are these never, ever mentioned or asked after? If you’re truly a Serious Person when it comes to deficits, this is where you should be starting and finishing.
Source: Washington Post

Beating a Dead Hobby Horse

jeffmiller:

[…]Challenged to produce an actual plan, Obama produced rhetoric.  

As opposed to Ryan’s plan and its magical unicorns based solutions? Honestly and specifically please detail exactly which programs and federal initiatives Ryan is specifically cutting to get spending to 3% of GDP? Are you aware that current military spending is all on its own consuming about 3% GDP? It’s no coincidence that the only specifics in Ryan’s plans are the tax cuts to the wealthy and the functional elimination of Medicare and Medicaid. That’s all he cares about. Deficits don’t even enter into it; that’s why the plan so brazenly doesn’t even bother to pretend it’s really lowering deficits. Only the math addled beltway media seems to think it will do anything but increase deficits. Instead, Ryan’s plan is all about undoing a social contract that’s been in place for nearly a century. Anything else that happens, any outcome for good or ill is simply window dressing and utterly unintentional. The elder poor will kindly go die in the streets, as the plutocrats need that money.

[…]

Obama is different president than I expected him to be.  I expected him to be a pragmatic crusader, but he’s not really that.  Were he a crusader, he’d better exploit his bully pulpit.  

Clinton, I think, was driven by power.  Obama doesn’t seem that interested in power … he’s more interested in importance.  Or rather, I think Obama wants to feel important. Wielding power is one way to feel important, but so is talking about wielding power.  And lest you think that talk isn’t important, remember that our warmongering President won a Nobel Peace prize as a result of his talking.  I think that prize was terrible psychologically for our President, in the same way that our election was terrible for him too.  He was elected without actual achievement, and he was given a Nobel Prize without actual achievement … naturally, he’s learned that actual achievement isn’t that important.  That’s not a good lesson for a President to learn.  

Sorry, but this is simply horseshit. Obama won a Peace Prize because of his talking? I’m fully aware that he has no negro dialect, but Barack Hussein Obama won a Peace Prize because he’s a black man who was elected President of the United States of America, which only 150 years ago fought a war over the “states’ rights” to allow its citizens to own other human beings who just so happen to share an ethnic background with Obama. He furthermore won that election by means of the first non-plurality (e.g. true majority election) that’s occurred in this country in decades. This apparent non-achievement was deemed utterly impossible and was the subject of utter “no Serious Person can believe this is possible” derision as recently as 20 years ago when Jesse Jackson was running regularly. But, yeah, total non-event.
And, oh my stars, a Peace Prize recipient is presiding over killing and wars! To the fainting couch! I’m sure they’ll get around to the W Bush statues in our new and wonderful Peace Spring Eternal Middle East any day now.

All that aside, maybe it’s escaped your memory that Obama was also elected a United States Senator. Now that’s suddenly not an actual achievement? I guess ACORN rigged it up for him then too. But which high national office did George W. Bush hold before being elected President? Clinton? Jimmy Carter? Gerald Ford? I must be forgetting all their reams of national-level elected experience before landing the top job.

Finally, and most importantly, anything Obama proposes as “deficit policy” is actually unnecessary. While his plan includes specifics, why even bother? Leaving aside that the GOP House will simply shitcan his stated preferences as a starting point (even if said stated preferences are/were the GOP priorities of that morning), please do recall that doing nothing at all will largely solve this issue in short order. Thus Obama can sit back, veto extensions of the Bush tax cuts and watch the budget come into balance. Period. Or, using parts of the Bush tax cuts as leverage, he can perhaps shape some sort of policy compromise that suits his desired outcome.

And that’s the key. His desired outcome. If we’ve learned anything about this President, it’s that Obama is interested in outcomes. He could care less about tilting at preferred policy windmills, plaudits, power, and most problematic of all: the credit for any of it. For example, Obama has lowered taxes and reduced the size of government, but seems to be going out of his way not to tell anyone. Most polls show people believe the opposite is true on both counts. Even more importantly, though, his administration managed to pass the ACA, which likely will prove to be the single most important legislative achievement of my lifetime when all is said and done.

But, yeah. He’s not achieved anything.

I’d advise you to get some new hobby horses. These are very tired indeed. Maybe try “where’s the long form!?!” on for size.

Medicare and the Overton Window

This Pelosi post got me thinking about just what a Democratic response to a Ryan-style plan on Medicare should even be. After all, if you work from Ryan’s far right starting point and counter with “well, let’s just privatize x% of Medicare for this set of individuals” or some other “sensible middle” type compromise, then you’ve already lost. You’ve advanced the GOP’s idea of the program (which is a bad one) significantly and at the expense of the better solution: Medicare as it stands or Medicare plus substantial improvements.

It is a fact that the real driver of deficits in this country are healthcare expenses. Don’t take it from me, here’s the CBO’s report (PDF link):

Medicare and Medicaid are responsible for 80 percent of the growth in spending on the three largest entitlements over the next 25 years and for 90 percent of that growth by 2080.

But if we could achieve the per patient healthcare cost of most of the other developed nations in the world, we’d be facing yawning surpluses in this country, not deficits, and we’d very likely have better individual health outcomes to boot.

Therefore: the Democratic response to Ryan’s “privatize Medicare” should in fact be: Medicare For All. Period. We don’t want to reduce this program. Like 87% of all Americans, we think it should at the bare minimum stay just as it is. Preferably, we’d like to massively expand it. This has the dual benefit of covering medical expenses for everyone in the country and relieving the number one deficit driver in the economy: everyone’s medical expenses. Plus this means we eliminate the dread ACA and its totalitarian horrors. Everyone wins!

Now, of course, I don’t really think Medicare For All has any particular chance of becoming law; what using this sort of proposal does do is set the limits of the debate more appropriately and in ways that tend to favor outcomes preferable to the Democrats.
On the right: Eliminate Medicare and let the wealthy fend for themselves.
On the left: not only keep Medicare, but make it the healthcare provider for all, with tremendous humanitarian benefit but also knock-on budget benefits.
Then you’d be down to arguing about whose plan actually saves more money long term and how that impacts health outcomes in America. Which is precisely where the debate needs to be.

GOPoison Control

While a single visit to an emergency room can cost hundreds or thousands of dollars (often paid for by the government), a call to a poison center costs the government only $30 or $40. A study in the Journal of Medical Toxicology estimated that the poison centers saved the State of Arizona alone $33 million a year. Louisiana eliminated its centers in the 1980s but restored them when it realized how much money they saved.

Classic GOP: borrow a billion to save a few million and demolish a demonstrably effective government program. The problem is, no government program large or small can be seen to work. Thus it must go, costs be damned.

If the GOP wants it, you can rest assured it is going to create a bad policy outcome. Bad policy outcomes are catnip to the GOP.

GOPoison Control

I’m not optimistic about [Wyden-Brown] going anywhere. The Affordable Care Act has taken on too much symbolism for the Republican base as something that must be destroyed. It doesn’t matter if Wyden-Brown actually gives Republicans what they’re asking for in terms of policy.

Adam Serwer is mostly right here, but the fact is that anything Obama wants has automatically “taken on too much symbolism” for the GOP to allow it to happen. By taking up a position as anything but against Wyden-Brown, Obama has absolutely doomed it.

Obama and his staff are still assuming that the facts matter. That a media exists to notice and discuss his sober position that essentially gives the GOP what they want on a key issue. That the serious people actually care about policy outcomes despite 40 years of evidence to the contrary. That the GOP movers and shakers will be seen doing anything, anything that even remotely agrees with a position the President has taken up. All of this is squarely why Wyden-Brown will fail, no matter how good or bad it might be: Obama wants it, and has signaled as much. It doesn’t stand a chance.

Radical as this seems to Americans, the rest of the world has figured this out and gotten it right. We keep getting it wrong, and we’re paying for it.

Vermont Governor Peter Shumlin, talking to Ezra Klein about his plans to make Vermont the first all single payer healthcare state in the Union.
I eagerly await the “why this instance isn’t actually states’ rights” argument from the GOP.
Source: Washington Post

Defazio Bears Attention

TPM reports:

Rep. Peter Defazio (D-OR) proposes that people be allowed to opt out of the insurance mandate altogether – but if they do, they will not be allowed to free-ride on the new health care system.

Under his plan, a person opting out “must file an ‘affidavit of personal responsibility’ with the state exchange. Such a filing will waive their rights to: 1) Enroll in a health insurance exchange; 2) Enroll in Medicaid if otherwise made eligible; and 3) Discharge health care related debt under Chapter 7 bankruptcy law,” DeFazio wrote in a letter to colleagues Tuesday.

Under his plan, if a person wants back into the system, they’d need to buy insurance on their own, out of pocket, for five years. The idea here, and with other, similar plans, is to moot one of the constitutional complaints about the mandate – that it penalizes “inactivity.”

Exactly. No doubt the legions of “go die in the streets” conservatives who are morally wounded by the very concept of the individual mandate are lining up to cosponsor this. Right? Right?

Defazio Bears Attention

And this is precisely why the Senate should have no other business until the debt ceiling vote. Alright, who wants to vote against the liver? Anyone against the liver? Next, the kidney. One or a pair? How about one lung, one kidney? Can we agree on that civilly?