Friday, April 15, 2011

Ryan's Medicare proposal is dead already. Good riddance.

Does anyone really think that Paul Ryan's Vouchers-for-Medicare plan can work? Ask the insurance industry which companies want to offer health insurance to the over age 65 demographic. This is from Benjy Sarlin at Talking Points Memo.
Unlike the Affordable Care Act, which mandated that millions of young and healthy Americans purchase insurance with government subsidies, the Paul Ryan plan would instead bring the oldest, sickest, and least profitable demographic to the table. And with the CBO projecting that the average senior would be on the hook for over two-thirds of their health care costs within just 10 years of the plan's adoption -- a proportion that is projected to worsen in the long run --- the government subsidies backing them up may not bring in enough profitable customers to make things worthwhile.

"If reimbursement rates are too low to provide basic benefits, they'll tell the government, 'You do it,'" one insurance lobbyist told TPM. "I don't think they can require they lose money, they'd just pull out."

Dan Boston, a veteran lobbyist for health care providers and co-owner of Health Policy Source, said in an interview with TPM that he was taking a "wait and see" approach on the GOP budget before judging its value. (The American Hospital Association opposes the plan). But he cautioned that a major concern would be whether hospitals and private insurers would be left on the hook for low-income seniors eligible for both Medicare and Medicaid, who could run up significant costs with little hope of ever paying them off.

"I think everyone is going to be looking at the viability of the funding," he said.
Any so-called insurance company that tried to offer policies to the Medicare demographic would not last two years.

Ryan's plan is a perfect example of the crap that Republicans and much of the MSM call thoughtful and innovative. Ann Rand would have loved this stuff.

[Cross-posted at Whiskey, Tango, Foxtrot - over.]

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Friday, April 08, 2011

Healthcare. Does America get promises of magic or real down-to-earth efforts to improve health care and lower costs?

Ezra Klein has an important posting on Ryan's health care proposals. The point he makes is that while the media has fallen in love with Ryan's vision of a new health care policy that, if implemented, would shift the increase in health care costs away from the government and onto the sick, the Democrats have an actual plan that includes many elements designed to actually lower health care costs. In short the Affordable Care Act actually includes many rational elements which will lower health care costs, Ryan offers the magic of the invisible hand and a snake-oil salesman's promise that if the insurance payments are changed, providers will change what they charge to get and keep patients well.
At the heart of Ryan’s budget are policies tying the federal government’s contribution to Medicare and Medicaid to the rate of inflation — which is far, far slower than costs in the health-care sector typically grow. He achieves those caps through cost shifting. For Medicaid, the states have to figure out how to save the money, and for Medicare, seniors will now be purchasing their own insurance plans and, in their new role as consumers, have to figure out how to save the money. It won’t work, and because it won’t work, Ryan’s savings will not materialize.

Even Ryan’s fans agree you can’t hold health-care costs down to inflation. But even if you grant that Ryan’s target is too low, his vision for reforming Medicare would like miss a more reasonabke [sic] target, too. Consider the program Ryan names as a model. He said his budget converts Medicare into “the same kind of health-care program that members of Congress enjoy.” The system he’s referring to is the Federal Employee’s Health Benefits Program, and cost growth there has not only massively outpaced inflation in recent years, but actually outpaced Medicare, too. Ryan’s numbers are so fantastic that Alice Rivlin, who originally had her name on this proposal, now opposes it.

Democrats don’t just have a proposal that offers a more plausible vision of cost control than Ryan does. They have an honest-to-goodness law. The Affordable Care Act sets more achievable targets, and offers a host of more plausible ways to reach them, than anything in Ryan’s budget. “If this is a competition betweenRyan and the Affordable Care Act on realistic approaches to curbing the growth of spending,” says Robert Reischauer, who ran the Congressional Budget Office from 1989 to 1995 and now directs the Urban Institute, “the Affordable Care Act gets five points and Ryan gets zero.”
So from Ryan we get promises of magic, smoke and mirrors that will lower health care costs if we just keep the government from paying for them. His magical vision is to shift all cost increases off to the patient. The magic does nothing to actually lower health care costs.

In constrast the Democrats have the already enacted and partially implemented Affordable Care Act which does the following
The Affordable Care Act’s central hope is that Medicare can lead the health-care system to pay for value, cut down on overtreatment, and cut out treatments that simply don’t work. The law develops Accountable Care Organizations, in which Medicare pays one provider to coordinate all of your care successfully, rather than paying many doctors and providers to add to your care no matter the cost or outcome, as is the current practice. It also begins experimenting with bundled payments, in which Medicare pays one lump-sum for all care related to the successful treatment of a condition rather than paying for every piece of care separately. To help these reforms succeed, and to help all doctors make more cost-effective treatment decisions, the law accelerates research on which drugs and treatments are most effective, and creates and funds the Patient-Centered Outcomes Research Institute to disseminate the data.

If those initiatives work, they head over to the Independent Payment Advisory Board (IPAB), which can implement cost-controlling reforms across Medicare without congressional approval — an effort to make continuous reform the default for Medicare, even if Congress is gridlocked or focused on other matters. And if they don’t work, then it’s up to the Center for Medicare and Medicaid Innovation, a funded body that will be continually testing payment and practice reforms, to keep searching and experimenting, and when it hits on successful ideas, handing them to the IPAB to implement throughout the system.

The law also goes after bad and wasted care: It cuts payments to hospitals with high rates of re-admission, as that tends to signal care isn’t being delivered well, or isn’t being follow up on effectively. It cuts payments to hospitals for care related to infections caught in the hospitals. It develops new plans to help Medicare base its purchasing decisions on value, and new programs to help Medicaid move patients with chronic illnesses into systems that rely on the sort of maintenance-based care that’s been shown to successfully lower costs and improve outcomes.

I could go on, but instead, I’ll just link to the Kaiser Family Foundation’s excellent primer (pdf) on everything the law does. The bottom line is this: The Affordable Care Act is actually doing the hard work of reforming the health-care system that’s needed to make cost control possible. Ryan’s budget just makes seniors pay more for their Medicare and choose their own plans — worthy ideas, you can argue, but ideas that have been tried many times before, and that have never cut costs in the way Ryan’s budget suggests they will.
So what will America get from the government in order to control runaway health care costs? Ryan's promises of magic, smoke and mirrors with no system of accountability for the effectiveness of health care services? Or the Affordable Care Act the Democrats have, at great cost, already crafted and begun to implement which takes a solid, working approach to actually improving the effectiveness and efficiency of the health care procedures themselves?

I'll take the output of the practical mechanic over the wild promises of the flashy "magician" any day. So will any intelligent grown up.

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Tuesday, April 05, 2011

"Fix" Medicare? Nah, Ryan just wants it abolished.

Medical costs are climbing sustainably. No question. But America pays more than twice as much per person for health care as any other industrial nation while NOT getting as good results for what is bought as those other nations get! So what is the Republican solution as presented today by Rep. Ryan? Abolish Medicare.

Here's an excellent description of what was offered written by Josh Marshall,.
What the Republicans are proposing are not cuts. Some level of cuts and/or cost containment in Medicare are necessary because medical inflation is growing so quickly. But these aren't cuts. They're using a temporary budget crisis and the need to slow the rate of Medicare costs over long run simply to abolish the program. That's a bait and switch. It's the medical side equivalent of the "private accounts" bamboozle that President Bush used in 2005 to try to phase out Social Security.

Medicare is a federally-backed health insurance program for seniors. Why seniors? Because seniors as a group are just too sick for the private health care insurance sector to adequately provide coverage for. To rein in costs you can reduce benefits that the program provides or place more cost containment measures in place. Real pain is involved in both. But that's a legitimate area for debate. Medicare is a long term budget problem, unlike Social Security which isn't.

Or you can decide just to abolish the program altogether. Just eliminate Medicare in its entirety. This is what Rep. Ryan (R-WI) calls "fixing" Medicare, i.e., getting rid of it. Getting rid of it means abolishing the program and pushing seniors back into the private health insurance system and providing a subsidy to help pay the costs of your average 75 year old's health care. If costs go up? Well, start saving now.
This piece of Republican bamboozlement is going to get a lot of media blather in the next few weeks - even as the tea baggers shut down the federal government. But what it should get is total rejection. There is simply nothing here except a conservative primal scream shouting "We hate government except for Wars!! Government exists to Kill - kill - Kill and nothing else!!"

What no one today remembers is that when Medicare was passed in 1965 there was no insurance for anyone after age 65. If you had insurance and turned age 65 that health insurance was cancelled and there was no company in the market which would sell you a policy. People over age 65 were simply uninsurable.

This is the nature of the market that Paul Ryan wants to throw medicare beneficiaries back into.

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Friday, April 01, 2011

A band of stupid criminals has taken control of the House and is looting America

The Republicans in the US Congress have proposed H.R. 1255, a bill which states that once it is passed, if the Senate does not also pass it then the bill becomes law without Senate passage and without the President's signature. Since the Republican House Majority established the rule that every bill proposed in the House had to include a clear statement of what part of the US Constitution permits the House to pass such legislation, naturally they will have included the statement in H.R. 1255. I wonder where? I seem to have missed it.

Rep. Peter DeFazio (D-OR) Stood on the House floor yesterday and congratulated the GOP on its April Fool's day joke. Boehner, Cantor and the tea baggers have stated very clearly in this matter what utter fools they are. Whoever is pulling their strings should be quite proud of how his underlings will abase themselves in public for a few dollars under the table.

Include Rep. Tom Marino (R-PA) in the list of fools currently pretending to act like legislators in the U.S. Congress. He's the idiot who, upon being awakened and made aware that Obama had established a no-fly zone in Libya responded by wondering if that action means America might even go into Africa next. Jay Leno pointed out that it is clear why Marino is not on the Intelligence committee.

To add to the stupidity, the Republican-dominated House has passed a bill that permits Agribusiness polluters to dump pesticides into public waterways. No doubt those Representatives have enough bottled water available so they don't have to drink any of the polluted water - and they are probably too crazy to bother bathing.

They have also just passed an amendment sponsored by Rep. Bill Shuster (R-PA) which will gut the regulations designed to ensure that pilots have enough sleep to safely fly their aircraft. The amendment tailors rules applying to a variety of segments of the aviation industry and exempts other segments. Those rules are the direct result of lessons learned after crashes caused by pilot fatigue. No doubt an idiot Congressman from Pennsylvania has no need to get on a plane to travel, so what does he care?

Rep. Darrell Issa (R-CA)is a crook. Here's more proof. In the same Republican dominated House that raised such an objection to the budget-busting nature of ear-marks, brother Darrell has earmarked some $2 million in taxpayer funds to provide street improvements and parking for a commercial building he owns.

But it's not all at the federal level.

An idiot Montana State Representative who runs a bar in Basin, Montana, is complaining that the DUI laws are damaging small businesses. "They are destroying a way of life that his been in Montana for years and years." Yeah, just because drunks on the highway kill people we certainly don't want to make it more difficult for bar owners to sell liquor to drunks, do we? We don't want to damage the "way of life" of people like Louis Nieves, do we?
Louis Nieves, 23, the driver of a 1996 red Ford pickup that slammed into the fully loaded fuel tanker while headed the wrong way on I-30, is under arrest on suspicion of driving while intoxicated and intoxication manslaughter, Fort Worth police said.
I'm sure the bar-owner who sold Louis his drinks before Louis went the wrong way down the freeway, struck a loaded fuel truck and killed the driver wouldn't want to interfere with Louis' way of life. It has been around for a long time in both Montana and in Texas.

And as "ways of life" we wouldn't want to interfere with, in Maine the Republicans don't want to interfere with sending children out to work at a young age. Not only is it important to get children in the work force and out of school at a very young age, the Maine Republicans also want the children paid sub-minimum wages so that they can take jobs away from adult workers. Naturally the sub-minimum wages will stop when the children become 18 so that their employers will fire them and replace them with more low-cost children.

It's not just paying workers the lowest possible wage and working them the longest hours possible. The Republicans also don't want corporations to pay any taxes. GOP Rep. Rob Woodall (R-GA) responded to a caller who complained that Exxon paid no income taxes with the statement 'We need the lowest corporate tax rate we can get.' Gee. That means that when the US sends American troops into the Middle East to defend the exploitation of American oil companies then the companies themselves want to shift all the taxes to pay for the wars there to the America middle class and the workers. No doubt that is why they are trying to get the entry age for Social Security retirement jacked up to age 69. The FICA tax can then be siphoned off to pay for the Pentagon the corporations are using around the world and the workers will pay for it. Mind you, the Social Security Retirement system is in no danger of running short of money until at least 2037 and that estimate it a worst case prediction. The Social Security System has never met the worst case estimate in its 7 decades of existence.

The Republicans aren't just stealing the money from American working people. They also want to force radical religion down our throats. This is what Mike Huckabee is trying to sell.
While many of the GOP 2012 presidential hopefuls graced both stages, only at Rediscover God in America did they offer Americans two revealing facts: “America should be governed by biblical law,” and that discredited historian David Barton is a genius.

A former Texas GOP official, David Barton is a “Christian historical revisionist” who contends that “the United States of America is a Christian nation” and the separation of church and state is a “liberal myth.” He is also one of the most radical Tenthers in the country who believes the federal highway system is unconstitutional. So radical was his view that even the Tenth Amendment Center disavowed his federal highway theory.

Though he “holds no advanced degrees and does not teach at any legitimate institution,” Barton is no small figure in conservative politics. He was invited by Fox News host Glenn Beck and Rep. Michele Bachmann (R-MN) to teach as a “scholar” on American history. At the conference, former House Speaker Newt Gingrich said that “every time he hears Barton speak, he learns something new.” But Right Wing Watch’s Kyle Mantyla captured the most outrageous endorsement yet. Introduced by Barton, Gov. Mike Huckabee (R-AR) insisted that children need to be “under his tutelage” and said that every American should be forced “at gun point” to “listen to every David Barton message”:

HUCKABEE: I don’t know anyone in America who is a more effective communicator [than David Barton.] I just wish that every single young person in America would be able to be under his tutelage and understand something about who we really are as a nation. I almost wish that there would be something like a simultaneous telecast and all Americans would be forced, forced — at gun point no less — to listen to every David Barton message. And I think our country would be better for it. I wish it’d happen.

So America has a band of thieves, bankers and radically ignorant preachers taking over the governments at both the state and federal levels. They want our money and our children working their mines and businesses. And they are allied with the most repressive and backwards-looking types of religious fools (Terry Jones, anyone? to take control of America while they loot the money and ship America's jobs to China.

If there is anything positive about the conservatives (who also caused the Great Recession and forced Americans to bail our the Wall Street banks) I don't see it. These are people whose ideas and attitudes were rejected during the Great Depression in the 1930's. They need to be forced back into their caves and buried there.

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