Tag Archives: Paul Ryan

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.

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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.

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The Perils of “Balance”

I love Paul Krugman. Unlike most economists (apologies to certain of my academic colleagues), he writes clearly–as if he is actually interested in communicating, rather than impressing–and more often than not, he hits that proverbial nail squarely on the head.

Even for Krugman, though, “The Crazies and the Con Man” was exceptional. Krugman’s subject was the GOP effort to get Paul Ryan to accept the Speaker’s gavel. You really need to click through and read the entire column, but I’ll share a few of the gems:

What makes Mr. Ryan so special? The answer, basically, is that he’s the best con man they’ve got. His success in hoodwinking the news media and self-proclaimed centrists in general is the basis of his stature within his party. Unfortunately, at least from his point of view, it would be hard to sustain the con game from the speaker’s chair.

To understand Mr. Ryan’s role in our political-media ecosystem, you need to know two things. First, the modern Republican Party is a post-policy enterprise, which doesn’t do real solutions to real problems. Second, pundits and the news media really, really don’t want to face up to that awkward reality….

After offering several examples of the GOP’s lack of policy seriousness (where is that alternate health plan??), Krugman hones in on the real problem:

Most of the news media, and most pundits, still worship at the church of “balance.” They are committed to portraying the two big parties as equally reasonable. This creates a powerful demand for serious, honest Republicans who can be held up as proof that the party does too include reasonable people making useful proposals….

But Mr. Ryan has been very good at gaming the system, at producing glossy documents that look sophisticated if you don’t understand the issues…He is to fiscal policy what Carly Fiorina was to corporate management: brilliant at self-promotion, hopeless at actually doing the job. But his act has been good enough for media work.

Krugman attributes Ryan’s reluctance to take the Speaker position to a recognition that his  “con” wouldn’t survive the additional scrutiny.

Predictions aside, however, the Ryan phenomenon tells us a lot about what’s really happening in American politics. In brief, crazies have taken over the Republican Party, but the media don’t want to recognize this reality. The combination of these two facts has created an opportunity, indeed a need, for political con men. And Mr. Ryan has risen to the challenge.

I hate to sound like a broken record, but this analysis–like so many others–points to the  American media’s major contribution to the cluster-f**k that is our current national legislative branch. Until the media and those of us who depend upon it for essential information understand and appreciate the difference between balance and accuracy, we will continue to be disappointed by con men.

And wonder why our government doesn’t work anymore.

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Man of the Century

Paul Ryan is the man of the century. Unfortunately, that century is the 14th.

Per Daily Kos:

Ryan basically wants to divide the poor up into two groups: the deserving poor (elderly and disabled people), who will get special protections from his plans; and the undeserving poor, who will be his guinea pigs. This group would have to sign contracts promising to meet specific goals and would lose aid if they didn’t meet the goals, and they’d be trying to hit their goals with lots of personal supervision from the government or a private company with a government contract.

The notion that some poor people are “deserving” and others are not can be traced all the way back to the English Poor Laws, which (among other things) prohibited people from giving “alms to the sturdy beggar.” 

Supporters of social welfare programs and the critics of those programs are still arguing about policies dating to 1349, when England enacted the Statute of Laborers, prohibiting alms, or charity, for those who had the ability to work–that is, to “sturdy beggars.” (Never mind whether work was available to them.)

The distinction between the “worthy” and “unworthy” poor was substantially grounded in the Calvinist belief that poverty is evidence of divine disapproval, while virtue is signaled by material success. That belief has morphed somewhat (the undeserving poor now lack “middle class values” rather than divine approval), but it continues to influence American law and culture.

In the early 1900s, this moral opprobrium directed at the poor found an ally in psuedo-science, and poverty issues were caught up in the national debate between Social Darwinists like William Graham Summer and their critics. In language reminiscent of those earlier admonitions against rewarding “sturdy beggars,” Sumner wrote:

“But the weak who constantly arouse the pity of humanitarians and philanthropists are the shiftless, the imprudent, the negligent, the impractical, and the inefficient, or they are the idle, the intemperate, the extravagant and the vicious. Now the troubles of these persons are constantly forced upon public attention, as if they and their interests deserved especial consideration, and a great portion of all organized and unorganized effort for the common welfare consists in attempts to relieve these classes of people….

If I believed in reincarnation, I’d seriously entertain the possibility that Sumner has returned as Paul Ryan….
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Sold!

The sale of American democratic institutions hasn’t exactly been a market transaction. After all, in order for a market to operate, you need a willing buyer and a willing seller, both of whom are in possession of all relevant information.

Instead, we have the House of Representatives, controlled by Republicans who owe their current majority to gerrymandering and voter suppression, preparing to endorse Paul Ryan’s most recent budget. Not only are the American people not willing buyers, those “selling” this travesty are doing their level best to ensure that we have only the haziest notion of what it would really do.

As a fiscally-savvy friend of mine–a REPUBLICAN–posted to Facebook

The Ryan Plan in the House GOP’s own words: “Promotes saving by eliminating taxes on interest, capital gains, and dividends; also eliminates the death tax. “

In short, the Kochs and the Waltons, two families each at over $100 billion net worth, each worth more than 40% of Americans combined, would likely receive $2-3 billion a year in passive dividend income tax-free, used to buy back more shares from the public and into their own hands to earn more dividends, all compounding and passed on as ever more massive estates to their heirs, who also would received billions a year on income and never pay taxes. Meanwhile, you and I would be paying taxes on our earned income to provide these families with the secure and educated society on which the preservation and growth of their fortunes depend. The end of American capitalism and civil society as we know it. Outrageous. Abominable. Grotesque. Indefensible.

I stole his description because he said it better than I could.

The only thing standing between the 99% and this abomination is a Democratic-controlled Senate–and Nate Silver tells us the GOP has a 60% chance of retaking the Senate in November.

The fact that Federal lawmakers are falling over each other to do the bidding of the wealthy can be explained by lobbying and campaign contributions. What is inexplicable is why the Supreme Court–whose members are insulated from such pressures (and apparently from reality as well)–would further open the floodgates and invite the plutocrats to buy America.

The decision in McCutcheon was about “speech” only in the sense that money talks. More about that tomorrow.

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