Category Archives: Medicare

Why Medicare works and Obamacare might not

Picked this up at Andrew Sullivan’s site. More at the link.

Mike Konczal blames Obamacare’s technical problems on the law’s design. He contrasts Obamacare’s form of social insurance, which he labels “Category A,” with previous forms of social insurance, such as Medicare and Social Security, which he labels “Category B”

http://sullydish.files.wordpress.com/2013/10/social_insurance_category.png

He doens’t look so dead to me.

Aha. Jim Inhofe is 78 years old and has been on Medicare, a truly socialized medical insurance plan, for 13 years. inhofe

Good old Ike – he didn’t think anyone would take these guys seriously. He was wrong.

http://i.ebayimg.com/00/s/MjAwWDIwMA==/z/PVMAAMXQ0pNRpPzs/$T2eC16R,!y0E9s2S6cbQBRpPzsNBgg~~60_35.JPG?set_id=8800004005As we approach the start of the GOP’s Annual Hunting Season To Capture and Kill Legislation (Social Security from the 1930’s, Medicare from the 1960’s, and those 21st Century obscenities, Bush’s Medicare Part D Rx plan, and Obama’s nose under the door of universal health care), I like to remember this guy. Here’s then-former President Dwight D. Eisenhower in a 1954 letter to his brother.

Now it is true that I believe this country is following a dangerous trend when it permits too great a degree of centralization of governmental functions. I oppose this–in some instances the fight is a rather desperate one. But to attain any success it is quite clear that the Federal government cannot avoid or escape responsibilities which the mass of the people firmly believe should be undertaken by it. The political processes of our country are such that if a rule of reason is not applied in this effort, we will lose everything–even to a possible and drastic change in the Constitution. This is what I mean by my constant insistence upon “moderation” in government. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history. There is a tiny splinter group, of course, that believes you can do these things. Among them are H. L. Hunt (you possibly know his background), a few other Texas oil millionaires, and an occasional politician or business man from other areas.Their number is negligible and they are stupid.

 

And Ayn Ryan didn’t help

Look at “Age 65 and Older”. That’s a demo where Romney should be doing much better. Perhaps some day, in one of what will be many stories about how the 2012 election played out, this graphic might be resurrected and renamed How Medicare sunk Romney ‘s dreams of the White House. Chart from National Journal where the story is worth a read.

Cool. Help is at hand.

I just learned from Ann Romney that Medicare isn’t the only thing the Republicans are going to save from those black-hearted Democrats. Thank Elvis, they’re gonna save the women too! The GOP has our back girls!

Yeah Mitt!

(IN FAIRNESS: The woman is a terrific speaker.)

Hell-o-o-o . . .

The Republican presidential ticket is planning to save Medicare from the mean Democrats who are trying to take it away.

If this works, we’re toast.

A thought. A scam. A crime.

VOTER ID: I have absolutely no problem with voter ID. My problem is with 1) making it difficult, and 2) rushing it. Voter ID? Not a bad idea. The way they’re doing it? That’s suppression.

NEW STUPID GOP MEME: “In 1962, six percent of Americans got federal entitlements. Now, it’s 35 percent.” Clever. Of course 1962 was before there was Medicare.

CYNICAL MUCH?: Our Congress Critters have made clear once again that they are incapable of acting, even to save  the nation from the bullet they themselves aimed directly at 320 million Americans – the one that requires automatic spending cuts of $900 billion in January 2013.  So, diversion is called for. Time for a shiny new thing. What to do? Why, pass a new bill, The Sequestration Transparency Act. A Nebraska newspaper describes it thusly: “having proven incapable . . . they now indignantly demand to know how the President plans to cut spending.” Not them, the President. Neat.

Solving our nation’s problems: any semblance of rational thought has now left the room

At a fundraiser in Israel, Mitt Romney marveled at how little Israel spends on health care relative to the United States. He was jealous and wished we could find a way to contain our costs like they have. He probably likes the quality of their health care too – Israel ranks #18 in life expectancy; we’re #50.

Israel has had completely socialized health care since they became a nation 65 years ago.

“When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation,” Romney told donors at a fundraiser at the King David Hotel in Jerusalem, speaking of a health care system that is compulsory for Israelis and funded by the government. “We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.

But, but, but  f-r-e-e-d-o-m !  (Or maybe you could just look around you Mitt.)

Anything else you want to ask me?

It’s been an unbloggy week, but I think I managed to say this on Monday:

(I’m staying out on my limb – I think Roberts votes for Obamacare. And if he does, so does Kennedy.)

Yup. That’s what I said. Gotta go. CNN’s calling.

(Whoops. My bad. Kennedy dissented.)

Governor Voldemort has a better idea because he knows all about health care.

My Gov don’t like him none of that Muslim-Keynan Obamacare stuff. He’s no fan of Medicare/Medicaid either (even though his criminal abuse of both made him and his co-conspirators millions). Nevertheless, we the people chose him to run things here in Florida, trusting, I assume, that he’d gotten ethically born-again.

He knows – made it clear on Day One – that Obamacare is not for Florida and so has refused to institute any of the legally mandated reforms. He has a better idea. States, he says:

. . . can do a better job . . . we should have 50 laboratories to see which is the best approach.

Yeah, that’ll work.

Here’s a little summary of his earlier career as head of Columbia/HCA (that’s Health Corporation of America):

On March 19, 1997, investigators from the FBI, the Internal Revenue Service and the Department of Health and Human Services served search warrants at Columbia/HCA facilities in El Paso and on dozens of doctors with suspected ties to the company.[21] The Columbia/HCA board of directors pressured Scott to resign as Chairman and CEO following the inquiry.[22]He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million.[23][24][25] In 1999, Columbia/HCA changed its name back to HCA, Inc.

I always like that getting rewarded with $10million dollars for screwing up your company part. It’s the new American way you know. Also, job creators.

In the settlements,  Columbia/HCA pled guilty and agreed to a $600+ million fine in the largest fraud settlement in US history. They admitted systematically overcharging the government . . . They also admitted fraudulently billing Medicare and other health programs by inflating the seriousness of diagnoses and to giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. They filed false cost reports, fraudulently billing Medicare . . .  In addition, they gave doctors “loans” never intending to be repaid, free rent, free office furniture, and free drugs from hospital pharmacies.

That ‘overcharging the government’ part? That’s us, that’s taxpayer money he stole.

In late 2002, HCA agreed to pay the U.S. government $631 million, plus interest, and pay $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims.[26]In all, civil law suits cost HCA more than $2 billion to settle, by far the largest fraud settlement in US history.[27]

 

Let the fittest survive . . . and get rich. USA! USA! USA!

An interesting graph from a column in the venerable Journal of the America Medical Association (JAMA) : it details who is covered by Medicaid, the program Paul Ryan described as “a hammock that lulls able-bodied people to lives of dependency and complacency”.

The largest group covered by Medicaid by far is children. The second biggest group, adults, contains large numbers of pregnant women. Medicaid covers about 40% of births in the United States. The third largest group includes people who are blind or disabled. That leaves what are known as dual eligibles. Those are elderly people who are so poor that they receive both Medicaid and Medicare benefits.

If I’m reading this chart correctly, while children constitute the largest constituency, the blind/disabled receive the most dollars.

(link is from a Paul Krugman column)

Memories . . . Citizens United: the early days

Was reminded of this bit of history at Hullabaloo today. (It’s from here.) Remember Alan Grayson, the one-term gajillionaire firebrand rabble-rouser Democratic FL Congressman? The one who regularly took to the floor of the House to chew up and spit out the special interests?  The one who caused thousands of lobbyists to develop gastro intestinal disease? Yeah, that one. (video below)

He was one of the first victims of an unrestricted opening of the spigots of corporate money in a congressional race. According to a Politico article late in the campaign in 2010, almost 20% of all of the independent expenditures in House races in the entire country were deployed against Alan. His district was flooded with an unrelenting radio and television smear campaign by the corporations who didn’t appreciate his hard work on behalf of consumers and workers. The average person in Orlando saw 70 negative ads against Grayson– $2 million of which was paid for by the Koch Brothers, $2 million by the health insurance industry and another million from the NRCC. The cash that flowed into the district from the Chamber of Commerce and Rove’s band of cutthroats was a direct response to Alan’s reform efforts on the House Financial Services Committee and because he was the most effective national Democratic spokesperson in Congress. The DCCC, of course, offered him no help whatsoever in defending his seat. [Dems didn’t want to fool with the banksters either – who would have financed their campaigns?)

Newt keeps a straight face. Lessons from Mrs. G the Third?

Gingrich’s characterization of his activities at his own lobbying firm is simply breathtaking. The media should be on the floor and laughing out loud at this one.

Just saw this at The Washington Examiner (new conservative paper in DC, headed by Micahel Barone and Byron York). Good for them. They took a look, stepped back and took another look, and then headlined their story:

Newt Gingrich was a lobbyist, plain and simple.

. . . we know he was paid consultant for drug makers. That’s the first criterion for being a drug lobbyist.

Here’s the second criterion: While some consultants simply provide strategy or advice, Gingrich directly contacted lawmakers in an effort to win their votes.

Three former Republican congressional staffers told me that Gingrich was calling around Capitol Hill and visiting Republican congressmen in 2003 in an effort to convince conservatives to support a bill expanding Medicare to include prescription-drug subsidies. Conservatives were understandably wary about expanding a Lyndon Johnson-created entitlement that had historically blown way past official budget estimates. Drug makers, on the other hand, were positively giddy about securing a new pipeline of government cash to pad their already breathtaking profit margins.

One former House staffer told me of a 2003 meeting Continue reading

We are mock worthy. Indeed we are.

From Medical Transcription, via Andrew Sullivan. The best part:

The U.S. spends roughly $400 billion on paperwork and other administrative costs per year. This is enough to completely fund health care reform in 2011.

Read on if you dare . . .

Continue reading

Obama gives good speech

POSTED BY ORHAN

Measured and persuasive, last night President Obama was the soul of moderation, rationality, and responsibility as he made the case for passing his version of the debt deal. But he did leave a few items out of his story:

He blamed his predecessor for squandering the budget on two wars and a prescription drug program. But he neglected to mention that he continued those wars, and expanded American military operations into new countries; meanwhile he secretly bargained away the public option with the same pharmaceutical companies that had benefitted from the drug program he criticized.

He pointed out that Americans making under $250K would see no tax increase at all. But he neglected to mention that those same Americans will be in fact paying more, by having to make up for the cuts to Social Security and Medicare out of their own pockets.

He called his plan a balanced approach and said no one would be required to sacrifice too much, while acknowledging the cuts would be “painful”. But he neglected to mention that he was planning Social Security and Medicare cuts as far back as January 2009; the kind of cuts a Republican president could never push through.

Obama’s narrative of reason and compromise heroically standing up to the Tea Party’s barbarian hordes was quite stirring, and if one ignores the fact that he just happened to shit-can fundamental Democratic principles and programs as the first step in the process, quite true. No doubt at this moment, Democrats are battling tooth and nail to get his version of the debt ceiling deal passed, a deal they would have fought to the death if proposed by George W. Bush.

All in all, it was an excellent speech; classic Obama.

A dime’s worth of difference?

POSTED BY ORHAN

So Obama offers a debt deal to the Republicans: he’ll cut Social Security and Medicare. In exchange, the Republicans will, maybe, allow the Bush tax cuts to expire. Or hike some other taxes; whatever.

Now the Republicans are saying no deal, they’ll only accept spending cuts; they’ll cut Social Security and Medicare, plus keep the Bush cuts, but deep-six the tax hikes.

So, let’s see, that means if Option 1, the Democratic plan, had been accepted, the rich would have been back to where they were under Clinton, and the poor and middle would have been worse off. But if Option 2, the Republican plan, is enacted, the rich will keep what they got from Bush, and the poor and middle will be worse off.

What can we say about America’s future from the horns of this little dilemma? If it plays out the way the health care farce did, we can make a few predictions:

The Tea Party will be left swinging in the breeze. The folks who screamed, “Keep your hands off my Medicare!” are about to have their Social Security and Medicare seriously FUBARed. Even the most hardcore non-rich Tea Partier will realize sooner or later there’s nothing here but, as the song says, the promise of an early death.

The Democratic base will be left swinging in the breeze, after having its veins opened, its throat slit, and a dagger slipped between its ribs. The new default “far left” bargaining position will start with Social Security and Medicare cuts. Obama will initiate his trademark “compromising” from there. Predicting which once-sacrosanct progressive program he’ll negotiate away next will be all the rage in DC.

Mainstream middle and working class Republicans will be left swinging in the breeze; it’ll just take them a while to figure it out. Sooner or later the most diehard trickle-down true believer will realize the upcoming corporate cash infusion (via “amnesty” or any other method) isn’t going to create any jobs for Americans, other than the corner-office and lobbying jobs for the politicians who sold us all down the river; but CEOs will no doubt receive some kickass bonuses over the next few years.

Life is about to get one hell of a lot harder for most Americans. Thanks to Democrats. And Republicans.

Making Florida safe for Democrats again

My governor, Rick Scott, is hitting new lows in approval and has gone from 22% disapproval to 57% in just six months. Good work gov. Brings to mind some oldies but goodies. My favorite line? “I’m not sure what ‘market’ means.”

For those who don’t know, Columbia HCA, founded by Scott and of which he was the CEO, had to pay the largest civil criminal fine in US history for massive Medicare fraud.

Major hurdle for Republicans in 2012: Reality

POSTED BY ORHAN

Economist Dean Baker points out that Republicans are a tad miffed that their vote for Representative Ryan’s plan to end Medicare is being used against them. Various groups around the country are using the vote in attack ads against incumbents, and they lost an upstate New York congressional seat that they held for 50 years. Says Baker:

Medicare is a hugely popular program. Polls consistently show that the program has enormous public support among all political and demographic groups. Not only do Democrats and independents overwhelmingly support the Medicare program, even Republicans overwhelmingly approve of Medicare. Even Tea Party Republicans overwhelming approve of Medicare.

The Republicans can try to deny that their plan actually ends Medicare and hope that voters will be sufficiently confused that they won’t hold the vote against them. They have already been staking out this ground, claiming that they just want to “change” Medicare. Instead of saying that they would give beneficiaries a voucher to use to buy a health insurance policy, which would allow people to understand their proposal, they are instead saying that it is a system of “premium support,” which is a term that no one understands.

This may help with a few pundits, but if the Republicans can’t keep their political opponents from pointing out that their plan actually does replace Medicare’s insurance with a voucher system, this silly charade will not buy them much. People know the difference between being handed a check for $8,000 and being told to go buy insurance and the current Medicare system, which covers most of the cost of most care.

The problem is that those pesky Democrats are actually talking about what the Republicans did. For instance, New Hampshire Representative Charlie Bass tried to keep television stations from running ads that said that he voted to end Medicare, but ran up against that other pesky little problem, the first amendment. In any case, Republicans are going to do their best to convince the public that they didn’t really do what they did: vote to end Medicare.

Baker offers the GOP a simple solution: reverse the vote. Since Republicans control the House, they could hold a vote tomorrow and repeal the budget plan. And they could probably convince Harry Reid to permit a vote that would allow Senate Republicans to do the same. As Baker says, “This is the sort of advice for which they would pay political consultants millions. But the Republicans can get it here for free. If they were smart, they would take it.”

Granny won’t die

Quality not quantity is  something we simply cannot tolerate in Medicare. But according to this story from today’s New York Times (via my Herald-Tribune), that’s just what’s coming your way under the new health care law.

For the first time, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive . . . A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

And surprise, surprise, the hospitals are all hot and bothered. Apparently we will all now die.

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said . . .  the administration was “off track” in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital. “That’s unrealistic, beyond the pale,” Kahn said.

. . . .For years, federal health officials have emphasized the importance of higher-quality care, mentioning efficiency as an afterthought. Now, alarmed at the trajectory of Medicare costs, they emphasize efficiency as an equally important goal.

This part of Medicare reform is aimed at reducing the growth of spending and cuts into the out of control “fee for service” culture that drives hospital costs. It’s been a goal of reformers for years,  if not decades. It starts next year.

Whatever the argument will be, expect one from the Republicans becauseany positive result interrupts their script and their script says Medicare must not be saved.