Tag Archives: Medicare

“Trumped Up” Social Welfare Crises

There are two utterly incompatible approaches to the maintenance of social safety nets–and beliefs about the obligation of a society to its most vulnerable members.

On one side are those who recognize the obligation, who see the payment of taxes to support social programs and government services as the “dues” we owe to the “club” we call America. On the other side are those who reject that obligation, who insist that individual citizens (including, presumably, children, the elderly and the disabled) must be personally responsible for their own needs, and to the extent they are unable to do so, that private charity should fill the gap (despite copious evidence that charity is grossly insufficient to the task).

Those in the first category have legitimate differences about how we discharge our obligations to each other, about the efficiency of programs put in place, about the evidence we can reasonably require in order to separate out the truly needy from the merely greedy. But they understand that no society that ignores its neediest citizens can be “great” or even good–let alone stable.

Those in the second category tend to be financially comfortable (or better). Their incentive to ignore reality and the plight of others is rooted in their desire to keep more of what they have and their insistence that they have “earned” their good fortune and other folks could too if they really wanted to.

They are the ones who have controlled Congress. And as Robert Reich has written,

Republicans would love to get rid of Social Security and Medicare. But they can’t, because Social Security and Medicare are among the most popular of all federal programs. Besides, most Americans have been paying into them their whole working lives, and depend on them.

Since any overt attack on these programs would be politically suicidal, the Republicans have decided to do nothing–aggressively– to refrain from the “fixes” and accommodations to economic changes that all such programs require from time to time.

The trustees for Medicare and Social Security – of which I used to be one – say Medicare will run out of money by 2026, three years sooner than last projected, and Social Security will run out in 2034.

But this doesn’t have to be the case.

Here are three easy fixes to Social Security and Medicare that Republicans don’t want you to know about.

First: Raise the cap on income subject to Social Security payroll taxes.

This year, that cap is $128,400, meaning that every dollar earned above $128,400 isn’t subject to Social Security taxes.

As Reich points out,  the CEO of a big company making $15 million dollars a year pays Social Security taxes on just $128,400 of that, while the nurse practitioner taking home  $100,000 pays Social Security taxes on every dollar of his or her income.

Reich’s second “fix” addresses a situation that most of us find outrageous:

To help rein in Medicare costs, allow the government to use its huge bargaining power to negotiate lower drug prices.

Every other country negotiates these prices; that we do not is an unconscionable gift to big Pharma, which already benefits from the immense amounts through which taxpayers subsidize research. (Pharma already spends more on advertising, marketing, and lobbying than it does on research, so protests that lower profit margins would curtail research are disingenuous at best.)

Reich’s third “fix” is the least intuitive–and the most intriguing.

Third: To deal with a basic reason why Social Security and Medicare are running out of money, allow more young immigrants into the U.S.

The basic reason why Social Security and Medicare are running out of money is the American population continues to age and live longer – leaving a relatively smaller working population to pay into Social Security and Medicare.

What to do? Allow in more young immigrants. Immigrants and their children are the fastest growing segment of the working population, already contributing billions in payroll taxes every year. Instead of shutting immigrants out, allowing more immigrants into the country will help secure the future of Social Security and Medicare.

I have previously reported on the multiple benefits conferred by immigration; this is another.

If you belonged to a club in which some members refused to pay the dues that maintained the facility and its amenities, you’d terminate their membership. We can’t terminate the citizenship of people who are unwilling to pay their fair share, but we can save Social Security and Medicare. As Reich says,

Raise the cap, negotiate drug prices, and allow in more immigrants. Do these three things and you won’t have to worry about Social Security and Medicare not being there when you need it.

 

 

 

The Unarguable Benefits of Universal Healthcare

As political posturing over the Affordable Care Act (aka “Obamacare”) continues, the fiscal and social benefits of expanded access to healthcare become steadily more obvious.

The journal Health Affairs recently reported an 8 percent increase per year in the number of early-stage colorectal cancer diagnoses since passage of the ACA. Extrapolated across the country, the researchers estimate the ACA led to approximately 8,400 additional early-stage colorectal cancer diagnoses among seniors between 2011 and 2013.

A 2015 study published in JAMA found that the ACA had increased the number of early-stage cervical cancer diagnoses in women aged 21 to 25.

Early diagnosis doesn’t just increase the likelihood of successful medical intervention; it significantly reduces healthcare costs. When cancer is caught earlier, it is cheaper to treat.

America’s healthcare costs have long been far higher–and our outcomes considerably worse-– than in countries with universal systems. The lobbying clout of Big Pharma and Big Insurance continue to make a cost-effective “Medicare for All” politically impossible, but even with its problems, the ACA has vastly increased the number of Americans who are insured while significantly slowing the rise of healthcare spending; last June, Fortune Magazine reported

The United States will save about $2.6 trillion on health care expenses over a five-year period compared to initial projections made right after the passage of the Affordable Care Act.

While health spending spiked briefly in 2014, evidence shows that it has once again slowed down and will help save Americans trillions between 2014 and 2019, according to a new study by the Urban Institute and Robert Wood Johnson Foundation.

Spending declines will happen across both private health insurance as well as Medicare and Medicaid. Centers for Medicare and Medicaid Services actuaries predicted that total Medicare spending between 2014 and 2019 would be $455 billion lower than the ACA baseline forecast. Projected Medicaid spending over the same time period is expected to be $1.05 billion lower than previous ACA estimates, while private insurance spending projections declined by $664 billion.

I simply do not understand the Republicans’ hysterical opposition to the ACA. Both health outcomes and cost controls have improved, and problems with the program can be fixed with relatively minimal tweaking. The program’s popularity has also improved. (According to survey research, approximately half of those who do remain unhappy with Obamacare complain that it doesn’t go far enough–they would prefer a single-payer system.)

It isn’t just the ACA. Paul Ryan and the GOP are threatening to dismantle both Medicaid and Medicare–programs with low overhead and proven effectiveness– and they are intent on defunding Planned Parenthood, which delivers critical medical services to millions of poor women.

It isn’t as though a free market system could work for healthcare. Market transactions require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction. Equal bargaining power doesn’t describe real-world doctor-patient relationships. In that real world, insurance companies have virtually total control over the options available to those fortunate enough to have coverage.

It seems inconceivable that Ryan, et al, simply do not see the multiple fiscal and social benefits of universal–or at least expanded–access to healthcare. So what accounts for their persistent hostility to programs that have proven their effectiveness? Why are they intent upon substituting block grants for Medicaid, turning Medicare into a “voucher” system, destroying Planned Parenthood and eviscerating the ACA?

If the answer to that question is what I think it is– slashing social programs that benefit millions of Americans will allow them to subsidize the insurance and pharmaceutical industries even more generously and deliver more tax cuts to their wealthy patrons–I wonder how they sleep at night.

The Incomprehensible Attack on Medicare

I understand a lot of the fixations of the far Right (although I disagree with virtually all of them). But I’m at a loss to understand their vendetta against Medicare, or their belief that access to healthcare should be considered a privilege, not a right.

If we take Paul Ryan and his ilk at their word, they evidently believe that market competition will bring healthcare costs down, and that guaranteeing access to healthcare promotes overuse (i.e. you’ll go to the doctor more frequently than you really need to). They believe these things–if they really do– despite overwhelming evidence to the contrary.

The great virtue of markets is that they enable voluntary exchanges; they provide an incentive to provide goods at a price buyers are willing to pay. The classic description of a market is “an exchange between a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction.”

That is not a description of the “buyer” having a heart attack. Even in the absence of insurance requiring the use of specific providers, people do not–cannot–“shop” for medical care. We are  generally not “willing” buyers, and as non-experts, we certainly do not have sufficient “information relevant to the transaction.”

As Josh Marshall pointed out at Talking Points Memo,

You think it’s hard getting good insurance when you’re 30 or 50? Try getting good private insurance when you’re 70 or 80.

Providing health insurance coverage to seniors will unquestionably cost more if run through private insurance. No one who has looked at the comparative data on the cost efficiency of Medicare and private carriers can question this. There’s no money savings. Quite the opposite. The only difference is that seniors will pay vastly more out of pocket because the vouchers won’t come close to the costs of a policy. The upshot of the Ryan plan is significantly increasing the cost of what society pays for the medical care of seniors and then making seniors pay dramatically more out of pocket. All with none of the bedrock gaurantees Medicare provides.

There’s a reason administrative costs of Medicare–which doesn’t need to advertise, show a profit or cover outsized salaries to upper management– are dramatically lower than those of private insurance companies. As Marshall points out, the irony is that at the same time they are attacking Obamacare, Ryan and his cronies are proposing to replace Medicare with something that looks very much like Obamacare.

But building an exchange and subsidy adjunct for non-seniors onto an existing and fairly robust private health insurance system is one thing. Creating one from scratch for people who are all pretty much by definition bad risks is close to laughable. Laughable if you’re not bankrupted or dying because you couldn’t get care.

Remember the other things Medicare significantly guards against. If parents have insupportable medical bills or have no way to pay for care, they go to children. In the absence of any other options, that’s how it should be. But that money comes out of other things: buying homes, putting kids through college. The social insurance model of Medicare has positive effects well beyond direct beneficiaries.

Recent polls suggest that significant majorities of Americans don’t want to get rid of Obamacare, let alone Medicare. I still remember that senior at a Town Hall meeting carrying a sign that said “Keep Government’s Hands Off My Medicare.” He may not have recognized that Medicare is a government program, but he’ll certainly identify the perpetrators of attacks on it.

Fortunately, even in the Time of Trump, efforts to deprive millions of Americans of access to basic healthcare will not be a slam-dunk. As Marshall has also reported,

Many Republicans can see the political danger of touching Medicare. No one campaigned on this in 2016. Support for phasing out Medicare and replacing it with private insurance and vouchers is minimal outside libertarians and conservative ideologues. That’s why word play about ‘reform’ and averting ‘bankruptcy’ and ‘saving Medicare’ are the catch phrases. If anyone said, ‘We have an idea to have seniors get private insurance instead of Medicare and a check from the government to pay part of the cost’ they’d be laughed out of whatever room they were in. What’s most salient is that it is toxic within the coalition around which Donald Trump has at least temporarily remade the GOP.

In the real world, nothing about this Ryan/Trump effort makes sense. Practically, fiscally and politically, it would be a disaster. Given the characteristics of those who would be in need of coverage, it wouldn’t even benefit insurance companies or Big Pharma.

This is ideology-cum-religious fundamentalism: don’t confuse me with the facts.

 

Even While We’re Falling Off a Cliff…..

A couple of days ago, the New York Times reported on a little-noticed provision inserted in the “fiscal cliff” legislation. The report is a prime example of what ails our broken Congress.

According to the Times, a bare two weeks after pleading guilty in a major federal fraud case, Amgen, the world’s largest biotechnology firm, scored what the Times called “a largely unnoticed coup” on Capitol Hill. Lawmakers inserted a paragraph into Section 632 the “fiscal cliff” bill that delays the effective date of a set of Medicare price restraints on a class of drugs that includes Sensipar, a lucrative Amgen pill used by kidney dialysis patients.

The provision gives Amgen an additional two years to sell Sensipar without government controls. The company’s chief executive immediately informed investment analysts of this measure and its likely positive effect on the company’s bottom line.

That one simple bit of language may gladden the hearts of corporate investors, but it is projected to cost Medicare up to $500 million over that period. 

And there you have it–the deep corruption that lies at the heart of the current legislative process. At the same time sanctimonious Congressional “fiscal hawks” are wringing their hands over “runaway” health spending and demanding reductions in Medicare coverage and benefits for millions of seniors living on fixed incomes, they are voting for costly measures to benefit big Pharma. In this case, adding insult to injury, a big Pharma company that had just admitted to defrauding the government.

Economists warn about the growing inequality in America, and the pernicious effects of the growing gulf between the 1% and the rest of us. This was a vote to take from the middle-class and give to the rich. Political scientists warn of political cynicism and its corrosive effects. This is the sort of blatant quid pro quo that feeds that cynicism.

Pollsters tell us that Americans prefer head lice and cockroaches to Congress.

This crap is why.

A Choice, Not an Echo….or the Base that Roared

Bowing to the demands of the purist GOP base, Mitt Romney has chosen his running mate. Paul Ryan is the final signal of his capitulation to the True Believers.

I think it was during the Goldwater campaign that Phyllis Schlafly wrote a book titled “A Choice, Not an Echo.” The idea was that the two parties have too much in common, collaborate too frequently (shades of Richard Mourdock!), and that what Americans really want is a for-real choice between starkly different platforms and philosophies.

Well, the choice of Paul Ryan means we’ll have that choice this November!

Ryan is mostly known for his budget and tax plan–a plan Roll Call says would slash Mitt Romney’s effective tax rate from 13% to 1%. (And we thought “Romney Hood” was bad…)

The New Republic describes the effects of Ryan’s budget–millions of Americans losing health insurance (Ryan’s budget would end Medicare), senior citizens falling back into pre-social security poverty, a Government “so starved for resources that, by 2050, it wouldn’t have enough money for core functions like food inspections and highway maintenance.” The richest Americans would get a huge tax cut.

The Catholic Bishops and nuns haven’t been agreeing on very much lately, but they agree that the Ryan budget is “immoral and unChristian.”

The Economic Policy Institute estimates that 1.4 million jobs would be lost if Ryan’s budget were passed. The budget proposes to eliminate Pell Grants for over a million college students; it would continue subsidies for Big Oil, but cut funding for alternative and clean energy development. (In 2011, The Daily Beast reported that Ryan’s family leases land to oil companies, and benefits from those subsidies–I’m sure that’s just a coincidence…)

Paul Ryan has called Social Security a “Ponzi Scheme,” and supported privatizing it, but he would actually increase the already-bloated Defense budget. (When several Generals testified that the reductions in Obama’s Defense Budget would not jeopardize national defense, he called them liars. He later apologized.)

If you are thinking–okay, the guy is just one of those deficit hawks, well, you don’t know the whole Paul Ryan. He may reject his Catholic faith’s teachings on social justice, but he enthusiastically embraces its anti-choice positions.

Ryan sponsored a “Fetal Personhood” bill. That bill gave fetuses full personhood rights from conception and would not only outlaw all abortion, but most popular forms of birth control. He voted to defund Planned Parenthood, and supported  a bill which would have allowed hospitals to refuse to provide a woman with an emergency abortion even if it was necessary to save her life.

Ryan has pooh-poohed the science of climate change. He voted against the Lily Ledbetter Act to ensure equal pay for women.

There’s more, but this should give any voter a pretty good idea of the agenda we are being asked to endorse.

Paul Ryan is the Koch brothers’ wet dream. In a sane world, someone this radical would be unelectable.

Pray for sanity.