Category Archives: Medicare

Trump: Everybody Gets a Pony! But Maybe Not Health Insurance

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By now you’ve probably heard that Trump is putting the finishing touches on a health care plan that will provide health insurance for everybody.

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid. …

… Trump said his plan for replacing most aspects of Obama’s health-care law is all but finished. Although he was coy about its details — “lower numbers, much lower deductibles” — he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.).

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said. He noted that he is waiting for his nominee for secretary of health and human services, Rep. Tom Price (R-Ga.), to be confirmed. That decision rests with the Senate Finance Committee, which hasn’t scheduled a hearing.

Since he mentioned Tom Price here, one suspects that if there is an actual Trump plan, it’s Tom Price’s. So let’s look at that. Here is what Price has proposed:

1. Get rid of the insurance exchanges and their subsidies. Instead, offer fixed tax credits to help people buy insurance on the private market.

Those tax credits would be fairly modest, ranging from $1,200 a year for people 18 to 35 years of age to $3,000 for those 51 and older. In many regions of the country, that would hardly begin to cover the premiums and out-of-pocket costs for a relatively comprehensive health insurance plan.

2. Insurance companies cannot deny insurance to people with pre-existing conditions provided they been insured continuously for the previous 18 months. If you lose coverage because you can’t make a payment, too bad. No insurance for you.

3. “Expanded” health savings accounts. HSAs are great for young, healthy people who need tax shelters; not so much for anybody else.

4. There would be taxpayer funded high-risk pools for sick people who can’t get insurance. These have been tried in the past and have proved to be bottomless money pits. I’m sure the insurance companies like this idea, though, because it lets them off the hook for insuring really sick people.

Price appears to be seriously low-balling the scope of the problem by proposing to invest a mere $3 billion into state risk pools over a three-year period. Ryan’s “Better Way” plan, for instance, would provide $25 billion over the coming decade, and even that might prove to be woefully inadequate.

5. Price wants to limit the employer tax exclusion for providing health insurance to $8,000 a year for individual policies and $20,000 for families. I suspect people would see their employee benefit health insurance taking bigger bites out of their paychecks.

6. Able-bodied single people would no longer be eligible for Medicaid, no matter how poor they are.

7. Price wants to allow insurance companies to sell insurance across state lines. Republicans are in love with this idea because they think that the competition would force insurance premiums to go down. Nobody who understands the health insurance industry thinks this would work.  See also articles in The Fiscal Times, Forbes, and the New York Times explaining why this is a dumb idea.

What Trump probably will propose is a system that would in theory allow anybody to get insurance, but in practice probably would leave out most or all of the people who gained insurance under the ACA, and more beside. Paul Ryan and other Republicans like to make speeches about giving people “universal access” to health insurance, instead of universal insurance coverage, which I interpret to mean “you can buy all the insurance you want, as long as you can pay for it.” Which, of course, is the catch.

But Trump specifically said,

“We’re going to have insurance for everybody,” Trump told the Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

He’s either lying or he doesn’t know what he’s talking about. Of course, both might be true. You either stick with some version of the ACA, or go with a single payer/national health care plan, or throw people into the private insurance market to sink or swim. There really aren’t any other options. Tom Price’s ideas won’t work to make health insurance affordable or  reduce health care costs. Health care costs are the real cause of high premiums, and health care costs are high in the U.S. because we have a for-profit system that allows for rampant price gouging.

The part about allowing Medicare to negotiate drug prices is something Republicans have fought tooth and nail since Part D was established in 2003. (Medicaid already allows for some negotiation.) President Obama tried to tweak the Medicare system a bit to allow for some negotiation, but Republicans balked at that, too. Part D is a cash cow for the pharmaceutical industry, and those lobbyists aren’t going down without a fight. Trump will be in for a fight from his own party on that one.

(I have to crab about Democrats, too, however. Recently Bernie Sanders introduced an amendment that would have allowed importation of cheaper drugs from other countries. This had enough Republican votes it would have passed, except that a gang of Democrats voted against it.)

 

True Colors: Republicans Hate Poor Old People

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You might remember that just about the day after Donald Trump won the presidential election, Paul Ryan started bleating about privatizing Medicare. He couldn’t wait. Nobody was talking about privatizing Medicare during the election, but Ryan acted as if the election gave him a mandate to do so.

Now Republicans are going after Social Security already. They aren’t even waiting to seat the next Congress.

A key House Republican on the issue of Social Security introduced a bill Thursday that would impose major cuts to the program. The bill, the Social Security Reform Act of 2016, was introduced by Rep. Sam Johnson (R-TX), the chair of the House Ways and Means subcommittee on Social Security.

It would, among other things, gradually raise the retirement age from 67 to 69 on Americans 49 or younger at the present. It would change the formula that determines the size of a retiree’s initial payments. And it would switch the program to a less generous formula for raising payments according to cost of living increases. …

… The cuts in the bill lean more heavily on high income-earners, but most workers would see cuts — some of them drastic — if Johnson’s bill became law.

They want to make Social Security more “solvent” by cutting it. Raising funds, such as by raising the cap on Social Security taxes, is not even considered in this bill.

If you’re a Republican, you screw old folks. It’s just what Republicans do.

See also How The GOP Social Security/Medicare Doomsday Machine Works

New Shoe Drops: Ryan Disses Social Security, Medicare

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This is on the website of America: The National Catholic Weekly. Back in 2005 Paul Ryan made a speech to the Atlas Society in which he praised Ayn Rand and admitted that he wanted to target Social Security and Medicare to be privatized to reduce government dependency.

This is the America blogger, Vincent Miller:

It is impossible to summarize these statements without sounding like a breathless conspiracy theorist. Here’s what Ryan says. Don’t trust my bullets. Read the transcript. Don’t trust my transcript, listen to the audio on the Atlas Society site.

  • Ryan describes Social Security and Medicare as “collectivist” and “socialistic.”
  • Ryan’s strategic plan: privatize Social Security and Medicare in order to convert people from “collectivism” to believers in a “capitalistic individualistic” philosophy. So that there will be “more people on our team” who “won’t listen to” Democrats.
  • Ryan’s acceptance of Pinochet’s Secretary of Social Security José Piñera’s similar program of Social Security privatization as a “moral revolution” that made Marxists into capitalists who started to read the Chilean equivalent of the Wall Street Journal. Ryan is overheard, “Yeah” “That’s right.”

For Ryan “defined benefit” programs such as Social Security and Medicare are problems in themselves. This isn’t something he saves for gatherings of the Ayn Rand Society, such concerns about “dependency” are scattered throughout his Path to Prosperity—again hidden in plain sight. This transcript doesn’t so much reveal a secret, as highlight a clear theme in his policy rationale that is always present, but in more public settings subordinated to his prophecies of fiscal apocalypse. Thus, it is no surprise his budget cuts the safety net and radically reshapes Medicare first and addresses the deficit later.

For the audio file, go to this page, scroll down to the bottom of the post, and click on the little audio icon.

Vincent Miller has transcribed parts of the 2005 speech that were not transcribed before. Ryan really is calling Medicare and Social Security “collectivist” and “socialist,” and he is calling for complete privatization of both.

So if there were any Social Security/Medicare recipients out there who didn’t believe the 47 percent included them, this should clear things up.

Which $700 Billion?

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Today’s Romney-Ryan-Republican demagoguery is that President Obama cut $700 billion from Medicare. Yesterday when he officially announced that he was adding Paul Ryan to the ticket, Mittens said,

“Unlike the current president, who has cut Medicare funding by $700 billion, we will preserve and protect Medicare and Social Security.”

And Mr. Caterpillar went further —

“This president stole — he didn’t cut Medicare — he stole $700 billion from Medicare to fund Obamacare,” said Republican National Committee Chairman Reince Priebus, on NBC’s “Meet The Press.” “If any person in this entire debate has blood on their hands in regard to Medicare, it’s Barack Obama. He’s the one that’s destroying Medicare.”

The old lie was that Obama had cut $500 billion from Medicare, and I wondered where they got the new number. I saw it attributed to a new revised analysis of the Affordable Care Act by the Congressional Budget Office, done after the recent Supreme Court decision on the ACA. I found the analysis, dated July 2012, but it didn’t seem to say much about Medicare.

But then I found “Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act,” dated July 24, 2012. Boehner had requested a revision on the budget impact of repealing the ACA.

So the CBO wrote back and said, dude, repealing Obamacare will cost us big time. It would add $109 billion to the federal deficit during the period 2013 to 2022. And then it said,

The ACA also includes a number of other provisions related to health care that are estimated to reduce net federal outlays (primarily for Medicare). By repealing those provisions, H.R. 6079 would increase other direct spending in the next decade by an estimated $711 billion.

And that’s where they got the $700 billion. If repealing Obamacare would add $700 billion to Medicare spending, it must be that Obamacare is draining $700 billion out of Medicare spending. Except, it isn’t. No programs are being cut; the the $700 billion represent savings in cost made possible by Obamacare.

For example, when the individual mandate kicks in in 2014, about 30 million more Americans will get health insurance who don’t have it now. That means hospitals won’t be stuck with so many unpaid bills, which will save them much money. The Obama administration used that to negotiate a reduction in Medicare hospital reimbursement rate. That’s a chunk of the $700 billion. Ending the overpayments to Medicare Advantage is another chunk. There are several other such chunks that should make it possible to run Medicare with less money.

The savings are to keep Medicare solvent. No benefits are being cut. The ACA is not taking money away from Medicare and giving it to some other program. Now, it’s possible that when all the pieces are in motion it will not work as planned, but to say that the $700 billion is being cut out of Medicare to fund “Obamacare” is just dishonest.

Paul Ryan’s budget, on the other hand, cuts just as much out of Medicare to help fund tax cuts for the wealthy.

We’re going to be hearing all about the awful $700 billion over the next few days, if not weeks. I just thought we all ought to be clear about what’s being discussed.

Wingnutism as an Obsessive-Compulsive Disorder

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Along with not being able to control their fear/loathing of women, wingnuts also are decidedly knee-jerk when it comes to government social programs. So it is that some Republican Senators (Rand Paul, LIndsey Graham, Jim DeMint, and Mike Lee) have trotted out a new plan to “save” Medicare by destroying it.

Dana Milbank writes,

If you’re thinking of answering this in the affirmative, you might want to pause long enough to learn what transpired on the third floor of the Capitol on Thursday. There, four prominent Republican lawmakers announced their proposal to abolish Medicare — “sunset” was their pseudo-verb — even for those currently on the program or nearing retirement. …

… For years, Republicans have insisted that they would not end Medicare as we know it and that any changes to the program would not affect those in or near retirement. In the span of 20 minutes Thursday, they jettisoned both promises.

And in an election year, too, although I don’t know if any of these four is up for re-election this year. Rand Paul isn’t, of course.

DeMint and his colleagues think the time to end Medicare is now — with a cold-turkey conversion to a private program, effective in 2014. “I think if Americans actually find out the truth about what we’re doing, it will be a very big positive for Republicans in the fall,” DeMint forecast.

The plan is to scrap Medicare and enroll seniors in the health care plan for federal workers. Exactly how this would save money is a mystery to me, although Rand Paul says it would save Medicare $1 trillion over ten years, a figure I assume he pulled out of his ass. It’s possible he doesn’t appreciate that adding all those seniors to the federal group insurance plan would drive up the cost of the federal group insurance plan.

At Thursday’s news conference, Jonathan Weisman of the New York Times pointed out that the lawmakers were proposing to do with Medicare almost exactly what President Obama’s reforms do for non-retirees: Direct them into private insurance with a subsidy for those who need it most.

Paul was flummoxed. “Uh, anybody want to comment on that?” he asked, producing laughter in the Senate TV studio.

DeMint gave it a try. “Medicare’s already set up as a government program, so we’re beginning to privatize with this idea,” he said. He said his plan takes Medicare recipients “out from under that manipulative umbrella of the Democratic Party.”

I’ve seen primary exit polling that suggests many seniors vote for Republicans because they believe they will “save” Medicare from the evil President Obama, who wants to “cut” it. Of course, the opposite is actually true. The President is trying to keep the program as it is but keep it solvent by putting tighter controls on payments to providers. On the other hand, all of the GOP candidates, including Mittens, have endorsed some variation of the Paul Ryan Medicare-killing plan. But a big talking point with them is a promise to maintain the current program for people already on it.

Now Rand, DeMint et al. are challenging the candidates to go even further Right on Medicare than they were already, which would be a disaster for whichever one of them is in the general election. That they couldn’t contain themselves and wait until after the November election to make this proposal makes them all look even more like lemmings than they did already.

Related: “The Case for Crazy.” John Avlon argues that the best thing that could happen to the GOP is to nominate Rick Santorum and lose in a historic landslide in November.

If Mitt Romney does finally wrestle the nomination to the ground, and then loses to Obama, conservatives will blame the loss on his alleged moderation. The right wing take-away will be to try to nominate a true ideologue in 2016.

But if someone like Rick Santorum gets the nomination in an upset, the party faithful will get to experience the adrenaline rush of going off a cliff together, like Thelma and Louise—elation followed by an electoral thud.

Part of the delusion that is “movement conservatism” is the belief that a large majority of the American people agree with teabaggery, and that only a fringe of elitist liberals stand against them. A teabag candidate sinking like the Titanic might wake some of them up, and might also be a warning to the small group of gazillionaires underwriting this nonsense that there’s a limit to what their money can buy, even in the age of Citizens United.

The GOP Mantra: Medicare Broke in Nine Years?

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A Republican bobblehead I saw on television last night kept repeating the mantra that “The CBO says Medicare will go broke in nine years.” I googled for this, and all I got were a bunch of quotes from Republicans saying the CBO says Medicare will go broke in nine years, with no links to a source at the CBO. It’s an unsourced talking point, in other words.

I assume that some worker drone in the right-wing think tanks was able to extract a claim that Medicare will go broke in nine years from some CBO document, but whether that’s what the CBO actually thinks is, of course, another matter.

I went to the Congressional Budget Office site and found no document explicitly saying that Medicare will go broke in nine years. I did find the “March 2011 Medicare Baseline” analysis, which to me might as well be written in Greek. If anyone can explain what these numbers are saying, I’d appreciate it. But I’m not seeing anything that jumps out at me and says Medicare will be broke after 2020 on this chart.

It’s obvious the “broke in nine years” claim is going to be a big factor in the Republicans’ defense for destroying Medicare. I wish someone with the time and expertise to follow up on this would figure out how and where they are getting this claim and what the CBO actually says.