More Labor Day reading:
David Sirota: “Republicans are waging a war on the very workers they purport to care about.”
The problem is that a country with such stark divides between rich and poor is in deep trouble. Especially when that country is a democracy.
Some still think of the V.A. as a decrepit institution, which it was in the Reagan and Bush I years. But thanks to reforms begun under Bill Clinton, itâ€™s now providing remarkably high-quality health care at remarkably low cost. …
… Not surprisingly, hundreds of thousands of veterans have switched from private physicians to the V.A. The commander of the American Legion has proposed letting elderly vets spend their Medicare benefits at V.A. facilities, which would lead to better medical care and large government savings.
Instead, the Bush administration has restricted access to the V.A. system, limiting it to poor vets or those with service-related injuries. And as for allowing elderly vets to get better, cheaper health care: â€œConservatives,â€ writes Time, â€œfear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.â€
Think about that: they wonâ€™t let vets on Medicare buy into the V.A. system, not because they believe this policy initiative would fail, but because theyâ€™re afraid it would succeed.
Meanwhile, the Bush administration is pursuing a failed idea from the 1990â€™s: channeling Medicare recipients into private H.M.O.â€™s. … Years of experience show that H.M.O.â€™s actually have substantially higher costs per patient than conventional Medicare, because they add an expensive extra layer of bureaucracy and also spend heavily on marketing. H.M.O.â€™s for Medicare recipients prospered for a while by selectively covering relatively healthy older Americans, but when the government began paying less for those likely to have low medical costs, many H.M.O.â€™s dropped out of the Medicare market.
In 2003, however, the Bush administration pushed through the Medicare Advantage program, which offers heavy subsidies to H.M.O.â€™s. According to the independent Medicare Payment Advisory Commission, Medicare Advantage plans cost the government 11 percent more per person than traditional Medicare. Oh, and mortality rates in these plans are 40 percent higher than those of elderly veterans covered by the V.A. But thanks to the subsidy, membership in Medicare Advantage plans is surging.
On one side, then, the administration and its allies in Congress oppose expanding the best health care system in America, even though that expansion would save taxpayer dollars, because theyâ€™re afraid that allowing a successful government program to expand would undermine their antigovernment crusade and displease powerful business lobbies.
On the other side, ideology and fealty to interest groups make them willing to waste billions subsidizing private H.M.O.â€™s.
Remember that contrast the next time you hear some conservative going on about excessive spending on entitlements, and declaring that we need to cut back on Medicare and Medicaid benefits.