Weekly Pulse: GOP Would Privatize Medicare, Gut Medicaid


By Lindsay Beyerstein, Media Consortium blogger

On Tuesday, Rep. Paul Ryan (R-WI) unveiled a draft budget resolution for 2012. Ryan’s program would privatize Medicare and gut Medicaid.

“Rep. Paul Ryan, R-Wisconsin, is waging radical class warfare and ideological privatization schemes and selling it as a debt reduction plan,” writes Karen Dolan in AlterNet. Indeed, Ryan’s plan is larded with tax cuts  for wealthy citizens and profitable corporations, which according to the non-partisan Congressional Budget Office (CBO), would actually increase the national debt over the next decade. The CBO projects that the debt would reach 70% of GDP by 2022 under Ryan’s plan compared to 67% under the status quo.

At TAPPED, Jamelle Bouie predicts that Ryan’s budget plan will become the de facto platform for the GOP in the 2012 elections. Presidential hopeful Tim Pawlenty is already gushing about the plan. He notes the irony in Republicans seizing upon a plan to eliminate Medicare when they campaigned so hard to “protect” the program during the fight over the Affordable Care Act.

Attacking Medicare is politically risky. The conventional wisdom is the program is all but invulnerable because it is so popular with the general public, and especially with senior citizens–who reliably turn out to vote in large numbers.

Suzy Khimm of Mother Jones argues that, in order to win this political fight, the Democrats need to emphasize what they’re doing to grapple with the rising costs of Medicare–such as creating an independent board to regulate the reimbursement rates for all procedures covered under Medicare. Republicans have harshly criticized such a board as an example of health care rationing. Their proposed plan, however, would ration care far more severely, based on ability to pay. Ryan’s plan would give seniors a voucher to defray part of the cost of buying private health insurance. The voucher wouldn’t cover care equivalent to that which is offered under Medicare. So, under Ryan’s plan, care would be rationed based on each person’s ability to pay for extra coverage.

In a separate piece, Khimm notes that the GOP is taking a further political gamble by proposing massive cuts to Medicaid. She cites a recent study by the Kaiser Family Foundation which found that only 13% of respondents favored major cuts to Medicaid. Republicans may be betting that they can cut Medicaid because they associate it with health care for the very poor, a constituency with little political capital and low voter turnout. But while Medicaid does serve the poor, a large percentage of its budget covers nursing home care for middle class retirees and services for adults with major disabilities–care that their families would otherwise have to pay for.

How to save $15 billion in health care costs

New research suggests that the federal government could save $15 billion by reducing unnecessary emergency room visits through investment in community health centers, Dan Peterson of Change.org reports:

This week, new research, from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, pinpoints just how much we stand to lose in health care efficiency savings if the funding is cut as proposed; $15 billion. Put another way, for every $1 invested in CHC expansion, there is a potential savings in health care costs of $11.50.

Peterson reports that money to expand the CHC program may be cut from the budget. The report explains that if the funding is lost, then CHCs will not be able to serve the 10-12 million additional patients who were supposed to get care through expanded CHCs under the Affordable Care Act. If Congress refuses to allot $1.3 billion for cost-effective primary care, $15 billion in projected savings will evaporate.

If Republicans are serious about balancing the budget, they should happily expand the Community Health Center network.

Danish Antibiotic Resistance Education

D.A.R.E. to keep pigs off drugs. The U.S. hog industry is heavily dependent on low-dose antibiotics to keep its swine infection-free. This practice comes at the cost of increased antibiotic resistance. Sixteen years ago, the government of Denmark, the world’s largest exporter of pork, took the bold step of asking its pork industry to reduce the amount of antibiotics given to pigs. Ralph Loglisci of Grist notes that the experiment has been a huge success: The industry has slashed antibiotic use by 37%, antibiotic resistance is down nationwide, and production has held steady or increased.

Gay-bashed, uninsured

Twenty-nine-year-old Barie Shortell’s face was shattered in an apparent anti-gay attack in Williamsburg, Brooklyn in February. Joseph Huff-Hannon reports on AlterNet on an obstacle in Shortell’s already-long road to recovery:

After blacking out, and spending 10 hours in surgery and five days in the hospital, Shortell is now taking another whipping from one of the insidious antagonists of 21st-century American life—the private health-care system. Shortell, like many of his fellow American twentysomethings, is uninsured.

Up to 30% of people in their twenties are uninsured. The Affordable Care Act should reduce the number of uninsured twenty-somethings, but as Huff Hannon notes, the number of uninsured young adults is expected to continue to rise for some time. The ACA allows young people to stay on their parents’ health insurance until age 26, but this reform is of little help to the millions of families who lost job-linked health coverage during the recession.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

 

Weekly Audit: Republicans' Budget Declares War on Medicare

By Lindsay Beyerstein, Media Consortium blogger

The Republicans are poised to unveil a model budget on Tuesday that would effectively end Medicare by privatizing it, Steve Benen reports in the Washington Monthly. House Budget Committee Chair Paul Ryan (R-WI) is touting the budget as a strategy to reduce the national debt.

Ryan’s plan would turn Medicare from a single-payer system to a “premium support” system. “Premium support” is a euphemism for the government giving up to $15,000 per person, per year, to insurance companies to defray the cost of a health insurance policy.

As Benen points out, privatizing Medicare does nothing to contain health care costs. On the contrary, as insurance customers weary of double-digit premium increases can attest, private insurers have a miserable track record of containing costs. They excel at denying care and coverage, but that’s not the same thing.

The only way the government would save money under Ryan’s proposal is by paying a flat rate in vouchers. Medicare covers the full cost of medical treatments, but private insurers are typically much less generous. So, after paying into Medicare all their working lives, Americans currently 55 and younger would get vouchers for part of their health insurance and still have to pay out-of-pocket to approach the level of benefits that Medicare currently provides.

Taking aim at Medicaid

The poor are easy targets for Republican budget-slashing, Jamelle Bouie writes on TAPPED. Ryan’s proposal would also cut $1 trillion over the next 10 years from Medicaid, the joint federal-state health insurance program for the poor, by eliminating federal matching and providing all state funding through block grants. Most of this money would come from repealing the Affordable Care Act’s Medicaid expansion, which is slated to add 15 million people to Medicaid.

Block grants are cuts in disguise. Currently, Medicaid is an entitlement program, which means that states have to enroll everyone who is eligible, regardless of the state’s ability to pay. In return, the states get federal matching funds for each person in the program. Ryan and the Republicans want to change Medicaid into a block grant program where the federal government simply gives each state a lump sum to spend on Medicaid. The states want to use this new found “flexibility” to cut benefits, narrow eligibility criteria, and generally gut the program.

This is incredibly short-sighted. The current structure of Medicaid ensures extra federal funding for every new patient. So when unemployment rises and large numbers of new patients become eligible for Medicaid, the states get extra federal money for each of them. But with a block grant, the states would just have to stretch the existing block grants or find money from somewhere else in their budgets. Medicaid rolls surge during bad economic times, so a block grant system could make state budget crises even worse.

Ryan’s proposal has no chance of becoming law as long as Democrats control the Senate. The main purpose of the document is to lay out a platform for the 2012 elections.

Fake debt crisis

In The Nation, sociologist and activist Frances Fox Piven argues that the Republicans are hyping the debt threat to justify cuts to social programs:

Corporate America’s unprovoked assault on working people has been carried out by manufacturing a need for fiscal austerity. We are told that there is no more money for essential human services, for the care of children, or better public schools, or to help lower the cost of a college education. The fact is that big banks and large corporations are hoarding trillions in cash and using tax loopholes to bankrupt our communities.

She notes that Republican-backed tax cuts for the wealthy are a major contributor to the debt.

Jesus was a non-union carpenter?

Josh Harkinson of Mother Jones reports on the religious right’s crusade against unions. He notes that James Dobson of the socially conservative Family Research Council tweeted: “Pro-family voters should celebrate WI victory b/c public & private sector union bosses have marched lock-step w/liberal social agenda.”

Harkinson reports that the Family Research Council is backing the Republican incumbent, David Prosser, in today’s Wisconsin Supreme Court election–a battle that has become a proxy fight over Gov. Scott Walker’s anti-collective bargaining bill:

The FRC’s new political action committee, the Faith, Family, Freedom Fund, is airing ads on 34 Wisconsin radio stations in an effort to influence the April 5 judicial election that could ultimately decide the fate of the law. The ads target Wisconsin Assistant Attorney General JoAnne Kloppenburg, who’s running against a conservative incumbent, David Prosser, for a seat on the state Supreme Court. If elected, Kloppenburg wouldalter the balance on the court in favor of Democrats, giving them the ability to invalidate the recently enacted ban on public-employee collective bargaining. “Liberals see her as their best hope to advance their political agenda and strike down laws passed by a legislature and governor elected by the people,” say the ads. “A vote for Prosser is a vote to keep politics out of the Supreme Court.”

Roger Bybee of Working In These Times argues that recalling Republican state senators in Wisconsin is not enough to defend workers’ rights from Gov. Scott Walker’s anti-union onslaught.

This post features links to the best independent, progressive reporting about the economy bymembers of The Media Consortium. It is free to reprint. Visit the Audit for a complete list of articles on economic issues, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The MulchThe Pulse and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

 

Weekly Pulse: 911 Is a Joke (Because It’s Broke)

By Lindsay Beyerstein, Media Consortium blogger

As the Great Blizzard of 2010 blanketed New York City, most residents were blissfully unaware that their city’s 911 system was on the brink of collapse. The system fielded 50,000 calls in a single day, and at one point the backlog swelled to 1,300 calls. The mayor was called to account for the slow service and promised that it wouldn’t happen again.

But David Rosen and Bruce Kushnick report in AlterNet that New York’s close call is an example of a much broader and deeper problem. Cash-strapped state and local governments are raiding funds set aside for 911 service, and the system is hurting badly:

Hundreds of millions of dollars are collected annually by states and localities to support 911 services and much of it is diverted to plug state budget holes and meet a host of other demands. Most disturbing, 911 services are technologically bankrupt, held together by duct-tape and workarounds.

States siphoned nearly $400 million earmarked for 911 between 2001 and 2004. The law demands that the money, raised by a tax on every phone line, has to be set aside for 911-related services. Some states fudge the definition of “911-related” to fund things that had nothing to do with emergency services, like raises for courthouse staffers. Others just brazenly redirected the money into their general funds. New York collected $82.1 million in 911 taxes on phone lines in 2007, but only 19 cents out of the $1.20 monthly fee was spent on 911.

At least New York can account for its misdirected funds. South Dakota simply has no idea where its 911 money went, Rosen and Kushnick report.

Walker: Hurry up and die

Seemingly determined to cast himself as a Dickensian villain, Wisconsin Governor Scott Walker presented a budget last week that would slash millions in funding for health care for the poor and the elderly. However, as I reported in Working in These Times, Walker recommended an increase in funding for a program that buries Wisconsinites who die destitute.

Medicaid roulette

Some governors are clamoring for more control over Medicaid, the joint state/federal health insurance program for the poor, Suzy Khimm reports for Mother Jones. Currently, Medicaid funding is allocated primarily by a matching system, with the federal government kicking in a certain number of dollars for every dollar the state spends. The states must abide by federal rules in order to qualify. Now, some Republican governors want to see Medicaid funding doled out in block grants. The states would get a fixed amount of money, which they could spend as they saw fit.

Rep. Cathy McMorris Rodgers (R-Wash.), the fourth highest-ranking Republican in the House, is a leading proponent of this new scheme. She claims it would increase “flexibility” for states. In this case, flexibility is a euphemism for “massive cuts.” Washington’s Democratic governor, Christine Gregoire, has already convinced the Obama administration to exempt her state from certain Medicaid rules. McMorris Rodgers applauds the move.

Crisis Propaganda Centers

New York City City passed a landmark “truth in advertising” bill last Wednesday that would force so-called crisis pregnancy centers (CPCs) to disclose that they are not health care facilities. CPCs are anti-choice ministries posing as reproductive health clinics. Among other things, the law will require city CPCs to inform potential clients that they do not refer for abortions or emergency contraception, Noelle Williams reports for the Ms. Magazine blog.

The logic of our sex laws

The cover story of this month’s Washington Monthly is a provocative analysis of Dan Savage, America’s most influential sex advice columnist, as an ethicist of contemporary sexual mores. The author, Benjamin J. Dueholm, is a Lutheran pastor and a longtime fan of Savage’s syndicated column “Savage Love.” Dueholm does a good job of summarizing some of the core principles of Savage’s ethos: disclosure, autonomy, mutual pleasure, and personal commitment to achieving sexual competence. His central critique is that Savage’s attitude is too consumerist and businesslike.

I would argue that there’s nothing inherently capitalist about Savage’s ethics. Yes, Savage’s ideal sexual world is based on consensual, mutually beneficial exchanges, like an idealized free market–but that doesn’t mean that realizing one’s sexual identity, or finding true love, is on par with picking a brand of laundry detergent. In consumerism, the customer is always right. Savage is constantly urging his readers to be active participants in a mutually satisfying sex life, not passive consumers who expect their partners to cater to them without giving anything in return.

USDA hearts Michael Pollan

Every five years, the U.S. Department of Agriculture issues guidelines for healthy eating. Parke Wilde of Grist explains why this year’s edition is, in many ways, a radical and surprising document:

The new edition has a fascinating chapter on eating patterns, focusing on real foods and not just nutrients. This chapter on eating patterns provides a nice counterpoint to the reductionism — what Michael Pollan calls “nutritionism” — of scientific discussion of diet and health. The guidelines’ healthy eating patterns may or may not include meat. For example, the USDA Food Patterns and the DASH diet each include moderate amounts of meat and plenty of low-fat dairy. At the same time, the guidelines explain clearly that meat is not essential, and near-vegetarian and vegetarian diets are adequate and even “have been associated with improved health outcomes.”

This is a big departure for an agency that has historically been criticized for acting as a propaganda outlet for the livestock and dairy industries. But Wilde notes that, despite its enlightened discussion of the perils of “nutritionism,” the USDA hasn’t broken the habit of referring to nutrients rather than foods. The guidelines still recommend that Americans eat less saturated fat, without dwelling at length on which foods actually contribute most of the saturated fat to the American diet.

As nutritionist Marion Nestle explains in her seminal book, Food Politics, this mealy-mouthed advice is measured to avoid offending any lobby group that might take offense at the suggestion that Americans eat less of their product. There is no saturated fat lobby, but there are plenty of lobby groups representing the interests of industries tied to the major sources of saturated fat in the American diet, which include cheese, pizza, bakery products, ice cream, chicken, and burgers.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

 

Weekly Pulse: The Republicans’ War On Women

By Lindsay Beyerstein, Media Consortium blogger

The entire federal government might shut down over birth control. Yes, birth control. This special edition of the Pulse is about the ongoing war against women being waged in Congress and in state legislatures nationwide.

Cutting birth control

Last Friday, the House voted to amend the continuing resolution to fund the federal government to defund the $317 million Title X Family Planning Program, a major beneficiary of which is Planned Parenthood. None of this money funds abortions. Instead, it goes to birth control, cancer screenings, and other reproductive health services for 5 million low-income Americans.

This kind of preventive care is highly cost-effective. Every federal family planning dollar saves an estimated $4 tax dollars on unintended pregnancy costs alone. Saving money by de-funding contraception is like “saving money” by not paying your rent. It’s not savings if you end up staying in a hotel that costs even more.

As Nick Baumann reports for Mother Jones, Senate Democrats are confident that they can defeat the measure. However, if that happens and the House Republicans won’t pass an acceptable alternative, the federal government will run out of money and shut down until the impasse is resolved.

Julianne Hing, blogging at TAPPED, wrote of last Friday’s House vote to de-fund Planned Parenthood:

I find it difficult to summon the energy to be angered or even shocked by the news anymore. I wouldn’t describe my reaction on Friday as either of those two. It felt like something much deeper — like an attack on women and women’s access to health care. I took it personally.

The vote was just the latest assault on women’s health care by House Republicans. H.R. 3 initially proposed to redefine rape as “forcible rape.” That provision was withdrawn amid public outcry, but the bill would still effectively eliminate private health insurance coverage for abortion. H.R. 358 would give hospitals a loophole to not refer women for abortion, even if their lives are in danger.

The miscarriage mafia

Georgia state Rep. Bobbie Franklin (R) has introduced a bill that would investigate unsupervised miscarriages as potential murders, Robin Marty reports for Care2.

Here’s the relevant text of the bill, H.B.1:

When a spontaneous fetal death required to be reported by this Code section occurs without medical attendance at or immediately after the delivery or when inquiry is required by Article 2 of Chapter 16 of Title 45, the ‘Georgia Death Investigation Act,’ the proper investigating official shall investigate the cause of fetal death and shall prepare and file the report within 30 days[.]

The bill opens with the familiar anti-choice tactic of defining a fetus as a person and declaring abortion to be murder. Even fervent anti-choicers may regard this as something of an overreach on Franklin’s part. Historically, anti-choicers have sought to pass discrete “personhood amendments” while maintaining the polite fiction that these laws have nothing to do with restricting abortion. Franklin is not a fan of the incremental approach. He is seeking to redefine a fetus as a person and abortion as murder in a single piece of legislation.

As Marty notes, one third of all pregnancies end in miscarriages. In early miscarriages, the woman may never even know she was pregnant. So, Franklin essentially wants to criminalize unauthorized vaginal bleeding in Georgia. Setting aside the basic human rights of women, as Franklin is only too happy to do, his miscarriage bill is about as practical as his bid to make Georgians pay their state taxes in gold and silver coins.

State legislatures all over the country are weighing ever more draconian restrictions on abortion. Republican lawmakers in Ohio have proposed legislation to ban abortion of any fetus with a heartbeat, Daniel Tencer of Raw Story reports. South Dakota Republicans were forced to back off a proposed law that appeared to legalize the murder of abortion providers.

Scott Walker’s anti-abortion crusade

You probably know Wisconsin Gov. Scott Walker as the Tea Party favorite who wants to take collective bargaining rights away from the state’s public employees. You may not know that Walker is also a longtime anti-abortion crusader. Andy Kroll of Mother Jones reports that Walker, a former president of his college’s chapter of Students for Life, has a long history of campaigning against abortion, contraception, and sex ed. As a gubernatorial candidate, Walker won the endorsement of the hardline Pro-Life Wisconsin, which even opposes abortion to save the life of the woman.

As I reported in RH Reality Check, Walker’s anti-union “budget repair” bill also contains an all-out attack on a popular and successful Medicaid program to provide birth control to Wisconsinites whose incomes would qualify them for Medicaid if they became pregnant. The program saves Wisconsin an estimated $45 million a year in maternal and infant health costs alone and brings in 9 federal dollars for every on dollar spent by the state.

The Republicans swept to power with promises of limited government and fiscal conservatism. Now that they’re in office, their true agenda appears to be restricting women’s freedom at taxpayers’ expense.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

 

 

Weekly Pulse: End-of-Life Counseling Returns, But Death Panels Still Nonsense

by Lindsay Beyerstein, Media Consortium blogger

A proposed program to cover counseling sessions for seniors on end-of-life care has risen from the ashes of health care reform and found a new life in Medicare regulations, Jason Hancock of the American Independent reports.

In August, former Alaska governor Sarah Palin started a rumor via her Facebook page that the the Obama administration was backing “death panels” that would vote on whether the elderly and infirm had a right to live. In reality, the goal was to have Medicare reimburse doctors for teaching patients how to set up their own advance directives that reflect their wishes on end-of-life care.

Patients can use their advance directives to stipulate their wishes for treatment in the event that they are too sick to make decisions for themselves. They can also use those directives to demand the most aggressive lifesaving interventions.

Waste not, want not

Though end-of-life counseling was ultimately gutted from the Affordable Care Act (ACA), the legislation will eventually ensure health coverage for 32 million more Americans. However, Joanne Kenen in The American Prospect argues it will do comparatively less to curb the high costs of health care. The architects of the ACA had an opportunity to include serious cost-containment measures like a robust public health insurance option to compete with private insurers, but they declined to do so.

Kenen argues that the government should more aggressively target waste within the health care delivery system, especially Medicare and Medicaid. Unchecked and rising health care costs through Medicare and Medicaid are a significantly greater driver of the deficit than Social Security or discretionary spending:

“The waste is enormous,” says Harvard health care economist David Cutler. “You can easily convince yourself that there is 40 to 50 percent to be saved.” Squeezing out every single bit of that inefficient or unnecessary care may not be realistic. But it also isn’t necessary; eliminating even a small fraction of the current waste each year over the next decade would make a huge difference, he added. Health care would finally start acting like “a normal industry.” Productivity would grow, in the one area of the economy where it has not, and with productivity gains, prices could be expected to fall.

The new end-of-life counseling program will help reduce waste in the system, not by pressuring people to forgo treatments they want, but by giving them the tools to refuse treatments they don’t want.

Teen births down, but why?

The teen birth rate has dropped again, according to the latest CDC statistics. Births to women under the age of 20 declined by 6% in 2009 compared to 2008. One hypothesis is that the reduction is an unexpected consequence of the recession, an argument we pointed to in last week’s edition of the Pulse. John Tomasic of the Colorado Independent is skeptical of the recession hypothesis. He writes:

Emily Bridges, director of public information services at Advocates for Youth, agrees with other observers in pointing out that teens aren’t likely to include national economics as a significant factor in pondering whether or not to have unprotected sex. Peer pressure, badly mixed booze, general awkwardness, for example, are much more likely than the jobless recovery to play on the minds of horny high schoolers.

Some states with weak economies actually saw a rise in teen birth rates, Tomasic notes. However, this year’s sharp downturn in teen births parallels a drop in fertility for U.S. women of all ages, which seems best explained by economic uncertainty.

It’s true that prospective teen moms are less likely to have jobs in the first place, and so a bad job market might be less likely to sway their decisions. However, young women who aren’t working are unlikely to have significant resources of their own to draw on, which means that they are heavily dependent upon others for support. If their families and partners are already struggling to make ends meet, then the prospect of another mouth to feed may seem even less appealing than usual.

Abortion is the elephant in the room in this discussion. The CDC numbers only count live births. Logically, fewer live births must be the result of fewer conceptions and/or more terminations. Some skeptics doubt that economic factors have much to do with teens’ decisions about contraception. However, it seems plausible that decisions about abortion would be heavily influenced by the economic health of the whole extended family.

Last year’s decrease was notably sharp, but teen birth rates have been declining steadily for the last 20 years. The Guttmacher Institute, a New York-based non-profit that specializes in research on reproductive choice and health, suggests that successive generations of teens are simply getting savvier about contraception. Births to mothers between the ages of 15 and 17 are down 48% from 1991 levels, and births to mothers ages 18 to 19 are down 30%.

Stupid drug dealer tricks

Martha Rosenberg of AlterNet describes 15 classic dirty tricks deployed by Big Pharma to push drugs. These include phony grassroots patient groups organized by the drug companies to lobby for approval of dubious remedies. Another favorite money-making strategy is to overcharge Medicare and Medicaid. Pharmaceutical companies have paid nearly $15 billion in wrongdoing settlements related to Medicare and Medicaid chicanery over the last five years.

This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.

Diaries

Advertise Blogads