Surprise!

(Cartoon by Drew Sheneman/Tribune News Services and featured at US News.com.  Click on image to enlarge.)

What's old has become new again.  The force behind this miracle?  Why, it's Paul Ryan, who has decided it's time to re-introduce his already rejected budget.  No surprise here.

From the L.A. Times:

House Republicans will revive Rep. Paul Ryan's lightning-rod proposals to slash the federal safety net, beef up military spending and reduce taxes for the wealthy in a budget unveiled Tuesday -- an election-year calling card that Democrats are poised to use against the GOP.

The blueprint from Ryan, the party's former vice presidential nominee, is expected to be met with stiff opposition not only from Democrats, but also from hard-line Republicans who want deeper austerity cuts to more quickly balance the budget. ...

 ...House Republicans will return to the core ideas from Ryan, the Budget Committee chairman, that have come to define the party's approach: Cut federal spending on Medicare, Medicaid and other programs that make up the federal safety net, while reducing top individual and corporate tax rates to  25%, which Republicans argue will spur economic growth. ...

Drafting the budget for the 2015 fiscal year, which begins in October, was a challenge this time because the nonpartisan Congressional Budget Office projected sluggish economic growth. That made it more difficult to achieve Ryan's goal of eliminating federal red ink within 10 years.
To get to balance -- especially while protecting Pentagon accounts -- Ryan shifts the burden of reductions onto domestic programs.

He suggests money can be saved by cutting food stamps, capping college Pell grants, imposing more welfare work requirements, eliminating federal arts funds, even selling off public lands. He leaves the details to the House committees to sort out.  [Emphasis added]

And guess what?  The old-but-new-again budget was introduced just in time ... for the 2014 elections, that is..

What a surprise, eh?

And that old-but-new-again budget just might garner Mr. Ryan an award or two.

Stay tuned.

Oopsie! Their Bad

(Cartoon by Eric Pertin (3/16/10) and found here.  Click on image to enlarge.)

I have to admit that the Tea Partiers occasionally made some sense, at least on some issues.  One of the characters from Mr. Pertin's cartoon really hit home after I read a news article yesterday.

From the L.A. Times:

...in certain cases, Medi-Cal, California's version of Medicaid, will be able to collect repayment for healthcare services from the estate after a recipient dies, including placing government liens on property. ...

Despite government assurances that the vast majority of Medi-Cal patients needn't worry about the state trying to claim their assets, growing numbers of new enrollees under Obamacare are voicing concerns after reading warnings on healthcare notices that after their deaths the state "must seek repayment of Medi-Cal benefits" for services provided once they turn 55.

Some advocates for the elderly say the "estate recovery provisions" of Medi-Cal could threaten family finances and discourage people from signing up for health insurance. [Emphasis added]

How's that for a chilling bit of news for recipients of MediCal and their family?  The article continued with assurances from a state spokesman that the move isn't as terrible as it sounds.

Established in 1993, the federal government's estate recovery program was chiefly intended to recoup outlays for lengthy nursing home stays and skilled nursing care, which are among its biggest expenses.

But California and other states have exercised an option in limited instances to recover payment for medical services, from doctor visits and surgeries to managed care payments and drugs.

Norman Williams, a spokesman for the state Department of Health Care Services in Sacramento, says only a tiny fraction of the 9 million patients using Medi-Cal will be affected by cost recovery actions against their estates. Less than a quarter of a percent of the more than $600 billion the state spent on Medi-Cal over the past 20 years has been recovered, he said.

Only costs incurred for patients 55 to 64 years old are involved, he noted. And collection efforts will not begin while there is a living spouse, minor children or surviving dependents with disabilities. Families also may apply for hardship exemptions.  [Emphasis added]

I don't find that explanation all that reassuring, quite frankly.  People who qualify for Medi-Cal have to jump through all sorts of hoops just to qualify.  To find out that their meager estates are going to be wiped out by the state has to come as just one more blow to a beaten down family.

Additionally, given the fact that the state has only recovered a "tiny fraction", why do they bother?  I'm sure that the procedures and paperwork involved cost the state at least the amount recovered, probably more.  It just doesn't make any fiscal sense.  Surely the state has other ways to save money, like cutting some of the tax breaks given to corporations.

You think?

Granny Bird Award: Doctors Who Write Questionable Prescriptions

This edition of the Granny Bird Award, given from time to time by those who adversely affect the rights and benefits of elders, goes to those doctors identified in a recent report as issuing prescriptions for questionable drugs or over-prescribing medications as identified in a recent report noted in the Washington Post.

More than 700 doctors nationwide wrote prescriptions for elderly and disabled patients in highly questionable and potentially harmful ways, according to a report of Medicare’s drug program released Thursday.

The review by the inspector general of the Department of Health and Human Services flags those doctors as “very extreme” in their prescribing and says Medicare should do more to investigate or stop them. ...

The inspector general’s report focused on the prescribing by nearly 87,000 general-care physicians, such as family practitioners and internists, in urban and suburban areas in 2009. These doctors accounted for about half of all the prescribing in the program that year.

The review found more than 2,200 doctors whose records stood out in one of several areas: prescriptions per patient, brand-name drugs, painkillers and other addictive drugs, or the number of pharmacies that dispensed their orders.

Of those, 736 were flagged as “extreme outliers.” Their patterns, the report says, raised questions about whether the prescriptions were “legitimate or necessary.” ...

The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone — that is 151 times more than the cost of an average doctor’s tally, the report says.

Most of this physician’s drugs were supplied by two pharmacies, both of which the inspector general had identified previously as having questionable billing practices.   [Emphasis added]

Whether for fraudulent purposes or because of just plain sloppy medical management, these doctors cost Medicare/Medicaid a ton of money.  At a time when this very important program for elders and the disabled is under attack by all parts of the federal government, such behavior is extremely angry-making and needs to be stopped in its tracks now.  Hopefully CMS and the DOJ will come down hard on the miscreants.

My, What A Surprise!

(Editorial cartoon by Jim Morin / Miami Herald (March 18, 2013) and featured at McClatchy DC.)

Well, we've seen how the RNC report I posted on yesterday has been received by the Tea Party/CPAC faction of the Republican Party.  The basest base is clearly not going to roll over and die. Instead, it will indeed hold the knives against the throats of moderate Republicans. 

From the Los Angeles Times:

The austere House budget drafted by Rep. Paul D. Ryan (R-Wis.) that has come to define the Republican Party was approved Thursday on a strict party-line vote, as the GOP argues that a balanced budget should now be Washington’s top goal.

The blueprint is merely a proposal, without the force of law, but its overhaul of the Medicare program and steep reductions to other social safety net spending serves as the GOP’s opening salvo in renewed budget negotiations with President Obama. It was approved, 221 to 207, with no Democrats and 10 GOP defectors, largely conservatives or congressman in swing districts.

Republicans are anxious to reopen the debate over government spending with the White House even though some attribute the party’s setbacks in the November election to the plan from Ryan, the party’s former vice presidential nominee. ...

The centerpiece of the GOP plan would turn Medicare into a voucher-like program for the next generation of seniors, those younger than 55. When they become eligible, at age 65, those seniors will be offered a voucher that can be applied either to the purchase of private health insurance or toward the cost of Medicare, though the voucher may not cover all the costs of the policy chosen.

The Ryan budget also cuts Medicaid, the health program for the poor and seniors in nursing homes, as well as food stamps, welfare programs and student loans, while largely preserving money for defense accounts.   [Emphasis added]

Thankfully, the Ryan plan (version 2.2) is merely a proposal, but it does signal what the GOP in this Congress considers fair game for negotiation: the elders, the poor, the vulnerable.

People like me.

It's time for some "kingbirding."

Picking Their Fights

Doyle McManus had an interesting op-ed column this weekend, one that made sense to me and gave me a little hope that maybe this Congress will actually get something done.  He used the metaphor of "an orderly retreat," and I think it works beautifully.

Astonishingly, for perhaps the first time since they won the majority in 2010, Boehner's House Republicans were seized by a sudden fit of pragmatism. That debt ceiling that couldn't be lifted as a matter of sacred principle? It was "suspended" until May with only perfunctory debate.

Boehner's sometimes fractious lieutenants, Eric Cantor of Virginia and Paul D. Ryan of Wisconsin, fell into line. Tea party firebrands including Michele Bachmann of Minnesota voted no, but they remained uncharacteristically quiet.

Score one for Boehner.

It may seem painfully obvious that a political party needs to seek favorable ground on which to wage its battles — to choose "smart fights" and avoid dumb ones.
But until last week, Democrats could pretty much count on House Republicans to ignore that rule. Only three weeks ago, the same Republicans had dared President Obama to take the country over a fiscal cliff of brutal tax increases and spending cuts — only to retreat in disarray when they noticed that the country wasn't behind them.

The logic of Boehner's gambit last week was straightforward: A debt ceiling showdown looked like another dumb fight. The speaker wants to change the subject to federal spending, an issue on which conservatives think they have more public support. On March 1, deep automatic cuts in both domestic and military spending are scheduled to take effect. And on March 27, the federal government will have to shut down unless Congress passes a new spending bill. Both of those events, Republicans say, will let them push for new spending cuts without the hair-raising dangers of a debt-ceiling crisis.   [Emphasis added]

First, apparently Speaker Boehner is getting better at herding cats.  Maybe he got some coaching from Nancy Pelosi, or maybe House Republicans finally figured out that they actually took quite a hit in November and might want to change their mode of operating.  Their obstructionism in the last Congress led to their actually losing ground in both houses.

Secondly, and more importantly, the manufacturing of crises to get their way just didn't work the way they thought it would.  The President isn't playing nice any more, and he's making them look bad.

I'm not suggesting that congressional Republicans will turn into nice guys who will voluntarily cut the entitlements to oil companies, banks, large farm corporations, and wealthy investors.  Not hardly.  They've still got their knives out for Social Security and Medicare/Medicaid.  At least, however, they are now meeting with Democrats to start on the broad outlines for an immigration reform bill, something that has been totally off the table with them.  That's a start.

With a little more pressure from the public, they might even consider cutting the Pentagon budget, lopping off a few of the more ridiculous programs and cheating contractors.

I sure hope so, even though I know hope is not a plan.

Popcorn futures are up.

A Better Approach

(Editorial cartoon by Jim Morin / Miami Herald (January 10, 2013) and featured at McClatchy DC.  Click on image to enlarge and then hustle back.)

I used this cartoon a while back to head a post on Medicaid fraud.  I think it's even more useful when talking about getting Medicare and Medicaid costs under control.  I would direct your attention to the buttons labeled "Bureaucracy" an "Lax Oversight."

A think tank has issued a report suggesting a better way to cut costs in these programs than raising the eligibility age or lowering reimbursement rates to medical providers.  The report puts forward the rather interesting suggestion that if we change the paradigm, the programs will be stronger, more effective, and less expensive.

From the Minneapolis Star Tribune:

Most people in the Medicare reform fight argue about how much patient benefits and doctor and hospital reimbursement rates must be cut to deal with the burgeoning federal budget deficit.

UnitedHealth Group's Simon Stevens talks about saving more than half a trillion bucks over the next decade by doing neither.

"It is very important that the debate does not become a stylized arm wrestle between those two alternatives," Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in an interview last week.

The UnitedHealth Center has entered the Medicare deficit discussion in a surprising place. As think tanks and business groups line up on the side of raising eligibility ages or other austerity measures, the country's biggest private health insurer suggests ways to save the country's biggest public health insurance program without cutting services.

A new report from the UnitedHealth Center outlines ways to change Medicare from a fee-for-service program that pays doctors and hospitals per procedure to a results-driven, managed-care model that coordinates payments, offers greater rewards to medical professionals who give quality care and reduces the costs to senior citizens who make the healthiest choices.   [Emphasis added]

UnitedHealth is one of the largest private insurers in the country and has a huge chunk of the Parts B, C, and D Medicare supplement programs.  It is refreshing to see that kind of outside-the-box thinking from that part of the equation.  Yes, the program would be a "managed care" program, but frankly, all insurance depends on "managed care," as anyone who has health insurance well knows.

The news article contains specific details and I would urge you to read it all.  You can also read the UnitedHealth Center's summary of its report (which contains a link to the report itself in pdf format).  If you agree that this is a welcome alternative to what is currently under discussion by the Very Serious People in Washington, let your congress critters and the White House know.  I suggest you do that now.  The GOP is pushing hard to get Medicare cuts with the end goal of ultimately dismantling this valuable program, and I'm afraid the White House and the Democrats will give in on this.

Why We Can't Have Nice Things

(Editorial cartoon by Jim Morin / Miami Herald (January 10, 2013) and featured at McClatchy DC.  Click on image to enlarge and then hustle back.)

Although Jim Morin's cartoon is directed toward Medicare, I think it applies to Medicaid as well, especially since the two programs are often lumped together during budget talks.  That said, I am particularly interested in the buttons labeled "Fraud" and "Lax Oversight."  I've mentioned Medicare fraud in several prior posts, usually via a Granny Bird Award.  The same principles apply to this one.

Medicaid is usually administered, at least partially, by the states, and a recent article in the Minnesota Star Tribune details one such case of fraud.

The operator of a home health care agency in northeast Minneapolis stands accused of filing bogus Medicaid billings totaling more than $400,000, his second legal round of legal trouble while a businessman in the city.

Abshir M. Ahmed, 40, of Minneapolis, was charged Tuesday in federal court in Minneapolis with health care fraud. Ahmed was charged via information, indicating that he intends to plead guilty.

According to prosecutors, from January 2008 through June 2011, Ahmed submitted false claims through Lucky Home Health Care Inc. for services by personal care assistants that were not carried out.  [Emphasis added]

That's pretty much the same modus operandi used by Medicare fraudsters.  The scams go undetected for a long time both because some of the regulations are loosely written and because the claims are just accepted and paid unless someone notices something peculiar.  Especially in state cases, this can happen often because the regulatory agency just doesn't have enough funding to review each submitted claim carefully.

The Obama administration has done a pretty good job in discovering and shutting down fraud in the Medicare arena.  It would be nice if the feds and states would take the same stance on Medicaid, perhaps with regulation-tightening and with funded investigations.  Half a million dollars may not sound like much, but it mounts up quickly across time and across the country.  It's time to do some pushing here.

Deal/No Deal

(Editorial cartoon by Jim Morin / Miami Herald (December 31, 2012) and featured at McClatchy DC.  Click on image to enlarge and then please return.)

This is being written at 4:35 PM PST on Monday.  I'm not going to waste New Year's Eve tracking the yahoos in DC and any deals they might make before Midnight to avoid the fiscal cliff.  At this point, the tentative agreement between the White House and Senate Minority Leader McConnell has not yet been voted on.  Even if it were voted on and passed, the House leadership has already announced that it will not hold a vote on the bill before Midnight.  That means we go over the cliff. 

BFD.

Now, it's possible that all of this is simply posturing and that a bill will sail through both houses tonight.  If that is the case, I will update the post and apologize for being a slacker tomorrow.  Tonight I intend to spend curled up with my cat, my kindle, and the vaporizer which is finally dispelling the chest congestion which has bedeviled me all week.  At midnight, when all the fireworks go off in the neighborhood, and there will be plenty, I will toast the new year with hot apple cider.  And then I will go back to sleep.

Assuming, however, that the House has no intention of passing any kind of bill, I do have a few suggestions for the White House and the Democrats in Congress.  Come January 1, 2013, it's a new ball game.  It's time to tell the Republicans that all previous negotiations are null and void.  Time to start from scratch.  Those Bush tax cuts are over.  That Pentagon budget is sliced.  You want a deal, start talking.

And, no, we're not cutting Social Security and Medicare/Medicaid.  And, yes, we are extending Unemployment Insurance for another year.  So, what should we be talking about?

Of course, that's not the way the White House and the DLC Dems negotiate, and that's a rotten shame.

Other than that, Happy New Year everyone!

New Day, Same Old Crap

(Editorial cartoon by Mike Luckovich and published 12/19/12 in the Atlanta Journal-Constitution.  Click on image to enlarge.)

Kind of says it all, don't you think?

Back to the phones:

Senate

House

White House

Sic'em!

Granny Bird Award: Charles Agbu

This edition of the Granny Bird Award, given from time to time to those who harm the rights and lives of elders, goes to Charles Agbu, who has copped a plea in a Medicare fraud case.

A Carson pastor pleaded guilty Monday to submitting more than $11 million in Medicare reimbursement through fraudulent clinics and by promising patients expensive equipment, according to the Department of Justice.

Charles Agbu, 58, of Carson, pleaded guilty to one count of conspiracy to commit healthcare fraud and one count of money laundering in U.S. District Court.

Agbu, a pastor at Pilgrim Congregational Church, faces up to 20 years in prison and a $500,000 fine when he is sentenced in May.

Agbu admitted to owning Bonfee Inc., a fraudulent medical equipment supply company, and acknowledged that he paid patient recruiters to approach Medicare beneficiaries and convinced them to give him their Medicare information in exchange for specialized power wheelchairs, officials say.

Agbu would then bill Medicare officials for the wheelchairs without delivering them to his clients. He also admitted to paying for fake prescriptions and other fraudulent documents in order to be able to continue  billing Medicare for medical equipment, authorities say.  ...

The case was brought by the Medicare Fraud Strike Force, a special unit of investigators launched in May 2009 by the Justice and Health and Human Services departments.   [Emphasis added]

Apparently "Pastor" Agbu wasn't too familiar with the Ten Commandments, especially that one about lying.  Some attribute for a man of God.

While the article isn't clear as to how much money the good "pastor" reaped by his scam, the fine does seem a little low, even by plea-deal standards.  That 20 years in prison, however, does seem appropriate and I hope the judge gives him all 20 years.  That will at least send a message.

Finally, at a time when the vile idiots in Washington are considering cuts to Medicare/Medicaid, perhaps that could be accomplished by tightening up the language of the original legislation which left loopholes for this kind of fraud to be accomplished.  The Center for Medicare/Medicaid Services, the agency charged to oversee such billings needs to be ramped up so that it can spot these scams before they hit the $11 million mark.  And more money to the agencies investigating such fraud (DOJ and HHS) would also be helpful in rooting out the wrongdoers, recovering their ill-gotten gains, and slamming their backsides in prison for long terms.

Let your congress critters know that these are the only kind of "cuts" to Medicare/Medicaid which are acceptable and do it today.   

Please Drop Dead

(Editorial cartoon by Mike Luckovich and published 8/24/12 by the Atlanta Journal-Constitution. Click on image to enlarge and then kindly return.)

When I read the news about the "fiscal cliff" and rumors of a "grand bargain" to avoid it, I get nervous. It does indeed appear that the White House and the Democrats are only too happy to deal away Social Security and Medicare/Medicaid. The latest has to do with raising the eligibility age for Medicare to 67.  The excuses are always the same: people live longer now, thereby using up the money more quickly; as the Baby Boomer generation hits 65, many more people than anticipated will be getting the benefit, thereby using up the money more quickly; healthcare costs are rising and Medicare will soon be eating up more and more of the budget. All of that is bovine excrement being spread to hide the fact that our owners want the programs ended and all of us dependent on private insurers who will charge accordingly.

The Los Angeles Times published an editorial which, I assume, attempted to be "balanced" by listing all of these arguments as if they had merit. However, to be fair, the editorial did get around to addressing the real issues behind the rising costs of Medicare and Medicaid and suggesting more rational approaches to solving the problems.

Many of the steps lawmakers are considering treat Medicare's growing costs as an isolated phenomenon. In fact, they're symptoms of larger problems in the healthcare system. The United States spends far more per capita on healthcare than any other country, including Western European nations with much older populations. The extra spending yields better results in some areas, worse in others.

One factor in the elevated costs is advancing medical technology, or rather the fact that new and more expensive technologies are continually introduced with no consideration of whether they're more effective than what's already available. Another factor is the way healthcare is organized, delivered and paid for. Historically, there has been little coordination among the various doctors, specialists and hospitals who see a given patient. The payment system is even more Balkanized, creating a confusing matrix of prices and reimbursement rates that seem to have no relation to the value of the service performed.

More fundamentally, the system rewards providers for treating the ill and injured, not for keeping the public hale and hearty. Its financial incentives encourage providers to deliver as much treatment as possible. And there's little or no connection between what providers are paid and how effective their care is. As a result, the industry has an incentive to deliver an increasing number of treatments of greater complexity — to build more capacity, then find a way to fill it.

Bingo!

For those who would scream that this approach is just another form of health care rationing, I would point out that private insurers have been rationing health care, or at least the portion they are willing to pay for, for a long time.  And that rationing has often been capricious and malicious, requiring multiple appeals and threats from state insurance commissioners for those claimants with the time and money to protest. The kind of rationing to which the editorial refers are open and transparent and make sense. They also will save billions over the years.

Digby suggests that the rumor to raise the eligibility age for Medicare may be just a trial balloon being floated by the White House to see if it will fly. If Digby is right, and she usually is, then we really need to continue to phone, email, fax, write our representatives and the White House to let them know that the balloon is made of lead and not worthy of consideration.

I urge you to do some kingbirding and continue to bug Washington until it gets the message.

Tyrannus Rex

So, has Grover Norquist reached his use-by date, like Karl Rove?

I don't think so, but David Horsey does, and so do many others.  This is one of those times I'd love to be wrong.

Norquist has never been elected to anything. Nobody ever said he should be in charge of the GOP’s true religion (although he claims President Ronald Reagan urged him to found his lobbying group, Americans for Tax Reform). But he certainly has been the Republicans’ key political theologian, making opposition to tax increases the party’s central tenet for more than 25 years.

He got 95% of Republican candidates for Congress, the presidency and state offices to sign a pledge never to raise taxes and he enforced it by getting retribution at reelection time on anyone who failed to keep the promise. Now, though, he is facing a dramatic rebellion in the ranks. The country is teetering on the so-called fiscal cliff thanks to Republican-backed legislation from 2011 that will automatically begin slashing the federal budget and raise taxes on Jan. 1 if an alternative plan is not adopted by Congress. This has everyone a bit freaked out, including quite a few GOP senators and representatives who have expressed a willingness to consider revenue increases for the sake of making a budget deal with the Democrats.   [Emphasis added]

I do understand the logic.  Republicans are suddenly faced with a problem of their own making, a big one.  In fact, it's a very big one.  They've just lost an election and, while they still hold the House, they've lost ground in both houses of  Congress and the electorate appears to be in a very pissy mood when it comes to tax breaks for the 1%.

And President Obama, who has that second term Mitch McConnell was determined to deny him, has suddenly gotten a little surly.  He seems to think that he has a little political capital to spend so he's whipping that out against the GOP on the fiscal cliff issues.

House Republicans said on Thursday that Treasury Secretary Timothy F. Geithner presented the House speaker, John A. Boehner, a detailed proposal to avert the year-end fiscal crisis with $1.6 trillion in tax increases over 10 years, an immediate new round of stimulus spending, home mortgage refinancing and a permanent end to Congressional control over statutory borrowing limits.

The proposal, loaded with Democratic priorities and short on detailed spending cuts, was likely to meet strong Republican resistance. In exchange for locking in the $1.6 trillion in added revenues, President Obama embraced $400 billion in savings from Medicare and other entitlements, to be worked out next year, with no guarantees.

He did propose some upfront cuts in programs like farm price supports, but did not specify an amount or any details. And senior Republican aides familiar with the offer said those initial spending cuts might well be outnumbered by upfront spending increases, including at least $50 billion in infrastructure spending, mortgage relief, an extension of unemployment insurance and a deferral of automatic cuts to physician reimbursements under Medicare.

This is a great opening gambit, one that should have been used four years ago when the Democrats had control of both houses as well as the presidency.  It would have made a difference then.  But, no, Mr. Hopey-Changey was all into bipartisanship, and the Democrats for all sorts of reasons played along.  That's why a single payer system or even a public option system for health care were never on the table. 

Gitmo is still open.  We are still operating under Bush rules for reading our emails and checking our library habits.  Oil companies are still drilling in sensitive areas, even after a catastrophic spill in the Gulf Coast.  Our use of drones has been expanded.  Wall Street is still calling the tunes.  No change, and for most of us, no hope.

 So, is the opening gambit a sign that times have changed?

I tend to think not.  Sometime before Christmas, a deal will be reached.  Our current crop of Democrats in the 112th Congress will have their collars tweaked by our owners, as will the President. Social Security will suddenly be on the table, as will Medicare/Medicaid, all before Christmas.  And we know what that means.  In 2014 both Karl Rove and Grover Norquist will be back in action.  With a vengeance.

Like I said at the start, I'd love to be wrong, so I called the DC offices of Senators Boxer and Feinstein and Congressman David Dreier and made my wishes clear.  I figure one for three is the best I'll do, but maybe that will be enough to get us to the 113th Congress.  Maybe we'll have better luck there.

The Poor? Never Heard of Them

(Editorial cartoon by Joel Pett / Lexington Herald-Leader (October 16, 2012) and featured at McClatchy DC.  Click on image to enlarge and then return.)

There are several issues notable for their absence in the presidential campaign.  Climate change is one of them.  Another one is that of poverty in America.  We have been hearing a lot of rhetoric about Helping The Middle Class, but virtually nothing about the poor, many of whom have fallen into that status from the middle class in the past five years.

Steve Lopez has an interesting column in the Los Angeles Times on the missing issue.  He suggests several reasons for the absence of any meaningful discussion of poverty by the candidates.

 If you've been following the presidential campaign, you might easily have gotten the impression that the poor no longer exist. The word "poverty" was mentioned once in the first debate between President Obama and GOP challenger Mitt Romney. Together, the two candidates made 29 references to the middle class. And in Tuesday's debate, I lost count after Romney reeled off more than half-a-dozen references in a single answer.

In the vice presidential debate, the word "poverty" got one mention. But Vice President Joe Biden and GOP challenger Paul Ryan dutifully followed their leaders, with 33 references to the middle class. ...

And yet, said Harris-Dawson, many poor people have an interesting thing in common.

They don't consider themselves poor.

"We actually came up with a list of people on welfare and went door-to-door, and do you know what? The majority of people said they were not poor," said Harris-Dawson, who thinks the candidates may be aware of this phenomenon.

He said people who were out of work framed it as a temporary condition related to the distressed economy or some other factor.

"Being poor has been so demonized. Being poor means being on 'Jerry Springer.' That's what it means nowadays, and who wants to be on 'Jerry Springer?'"

Yes, and it means that in 2012, with 46 million people living in poverty — 16 million of them children — candidates for president of the United States seem to think it won't matter if they pretend you don't exist.   [Emphasis added]

I suppose that's one good reason the candidates have shied away from discussing poverty:  the newly poor don't want to claim that status because that would make them one of the 47%.  But I think there's a bit more going on, and I think Avedon Carol has done her usual excellent job in sussing it out in a post having to do with  the purpose of voting.

 Something I think I've mentioned before, and that Stuart Zechman and I talk about privately, is that without the New Deal framework, social progress goes down the drain. It was that New Deal framework that made social progress movements possible, and that's why the arch-conservatives and Big Business banded together to destroy it.

And it's working. It is already difficult-to-impossible to obtain local access to abortion in most parts of the United States. It is not only difficult but damn-near illegal to protest in public. And even where you can legally protest, you get diverted, attacked, and arrested anyway. The relationship between your politics and your ability to obtain or keep a job is increasingly so strong that anyone who isn't on board with the arch-conservative program is terrified to make any statement that can be interpreted as economically liberal in the hearing of anyone who might make their employer aware of it.

These things add up, especially in an environment where "equality" means little more than an equal shot at no jobs.

And this is why, above any other issue, I am on board with Stuart when he says:

    Restoration of the New Deal framework is my priority policy agenda.

    This is because I am convinced that social liberalism's successes, e.g. civil rights, the successes of liberation movements (sexual, women's, etc.), intolerance with respect to security state regimes, etc., follow from the small-d democratic, economic and cultural empowerment of the majority of ordinary citizens. The history of the 20th century is the history of the balance of powers created by such a modern liberal-democratic framework, and the "culture of liberty-entitlement" that such empowerment produces in populations of otherwise reactionary-agricultural or labor-competitive citizens.

    Without the New Deal, or a New Deal-oriented governing framework, there is no liberal democracy, only oligarchy. Without liberal democracy, the cultural forces of popular reaction take hold in American populations, and social liberalism's creativity has little value in solving the problems faced by ordinary folks

 under plutocratic rule. Without liberal democracy, majority literacy itself is at risk. Bedford Falls' economy's culture produces the broad acceptance and (therefore) legality of privacy rights. Pottersville's economy's culture produces the broad rejection of and (therefore) illegality of natural selection being taught in public schools. One comes before the other. In post-19th century capitalist America, there can be no civil rights, and no dominance of individual liberty without first securing the economic rights and democratic power of the majority against "the old enemies of peace."

    Of all of the policy agendas I support, such as limiting executive power, expanding privacy rights, de-industrial militarizing of America, reforming the justice system, inhibiting poverty creation, etc, there is a preference order, with "Restoration of the New Deal Framework" being at the top. My vote will therefore reflect what I believe to be the priority policy agenda for movement liberals.

Yes, because the New Deal framework is fundamental to any other social liberty.

Bingo!

We know that the key features of the New Deal, the ones still left, are "on the table" as far as the president, his administration, and entirely too many Democratic members of Congress are concerned.  Oh, they talk about "tweaking" Social Security, Medicare, and Medicaid, but it is clear that is only the first step in the drive to dismantle them (although I guess the favored euphemism is "privatize" them).  Federal programs which provide even a minimal safety net for the poor (Food Stamps, WIC) are slashed or eliminated as both sides fight to increase the defense budget so as to keep defense contractors fat and happy.

And those of us who object are marginalized, quite literally kept far away from the seat of power (hence the Pett cartoon above) and arrested for exercising the most basic of First Amendment rights.

It doesn't appear that there is much we can do this election cycle, but come January it might be time to put our comfortable shoes on.

RepubliCare

The Republicans want to move on from the Akin debacle and want the presidential campaign to concentrate on economic issues.

OK, I'm up with that.

Mitt Romney has declared that the first thing he would do as president is repeal Obamacare. Apparently he believes that, like a CEO, he can rule by fiat. I'm sure that congressional Republicans will disabuse him of that misconception soon enough.

Romney also wants to restore the billions that Obamacare cut from Medicare. That is almost as interesting, especially since those "cuts" have resulted in savings in health care and have shored up Medicare (see Off the Charts for a summary as to how that works).

And he would stop funding such wasteful programs as NPR, PBS, and the National Endowment of the Arts, because, of course, they've had such a heavy impact on our burgeoning budget deficit.

That's about as specific as Mr. Romney has been so far when it comes to the economy, which makes a discussion of his plans kind of short winded. Fortunately, his partner on the ticket, Paul Ryan, has been more specific. As a congressman, he proposed a budget which dealt with Medicare in a very interesting fashion: he would, in effect, privatize it, throwing Medicare recipients some vouchers to use in shopping for health care insurance in the open market.

David Lazarus took another look at Ryan's plan in his his latest column for the Los Angeles Times. He suggests that it's not just the elders who would suffer under such a proposal.

Amid all the chatter about whether Paul D. Ryan's proposed changes would, as Democrats say, "end Medicare as we know it," one group has been largely overlooked: disabled people.

The vast majority of Medicare's roughly 48 million beneficiaries are seniors over the age of 65. But about 8 million are disabled people of all ages. The federal program was expanded in 1972 to include those with permanent disabilities.

Many seniors are rightly concerned that Ryan, the conservative congressman tapped by Mitt Romney as his vice presidential running mate, has proposed a plan that could result in higher out-of-pocket expenses for Medicare coverage.

But disabled people could be in for an even bigger shock.

"People with disabilities are among the most vulnerable of the Medicare population," said Tricia Neuman, senior vice president of the nonprofit, nonpartisan Kaiser Family Foundation. "They have chronic conditions that require ongoing care, and, in many cases, they have relatively low incomes." ...

[David Lipschutz, policy attorney with the nonprofit Center for Medicare Advocacy] also warned of significant consequences for so-called dual-eligibles — people who qualify for both Medicare and Medicaid because of age or condition as well as income level.

According to some estimates, the Ryan plan would cut Medicaid federal spending for low-income people by about a third over the first decade. Healthcare analysts expect many people to be dropped from the program as funding dwindles. [Emphasis added]

So, not only would Granny be put on the ice floe to oblivion, so would Uncle Harry with the testicular cancer. Nice plan, that.

Is that really what we want for this country? Healthcare for the upper classes but not for the most vulnerable among us?

Lazarus concludes that the surest way to a decent healthcare plan for the nation is to offer Medicare to everybody, something I don't think I'll see in my life time, but I think he's right:

What's the solution? I suggested it last week, but I'll make it more explicit here: Medicare for all.

Rather than increasing the role of mostly for-profit companies in healthcare, a more economically rational and socially equitable approach would be to spread medical risk throughout society via a national insurance plan. ...

"Government-run healthcare doesn't work," Ryan said last year. "Wherever we've seen government-run healthcare, it's failed."

He's wrong about that, as the facts plainly show. And he's wrong about any reform of our healthcare system that makes things tougher for the very people we need to help most.

Amen!

I'm not thrilled about another four years of Barack Obama, given the last four, but he's sure as hell a lot better than the two yahoos the Republicans have thrown at us.

Priorities

David Lazarus, business and consumer columnist for the Los Angeles Times, finds the GOP stance on Medicaid to be mean-spirited. Of course it is. The only family values these yahoos have involve their families and only their families.

My colleague Noam N. Levey reported this week that conservative politicians at the state and federal level are laying the groundwork to scale back Medicaid if the GOP takes control of Congress and the White House in November.

Some Republican governors are already cutting coverage for low-income people, arguing that Medicaid has grown ineffective and unaffordable. Meanwhile, GOP lawmakers in Washington are renewing calls to limit Medicaid funding from the federal government.

This is scary stuff. Medicaid, or Medi-Cal as it's known in California, is the safety net for individuals and families who can't afford health coverage or don't receive medical benefits from employers.

Medicaid and the related Children's Health Insurance Program cover about 70 million people. Half this number are poor children. ...

Medicaid has some real problems, not least the fact that many physicians won't treat people covered by the program because they say the government's reimbursement rate is too low. Medicaid is also straining to keep up with rising demand that has resulted from the prolonged economic downturn.

But the program also is a bulwark against society cruelly turning a blind eye to those most in need. Medicaid is a declaration that healthcare in the United States is not limited solely to those fortunate enough to have well-compensating jobs or fat bank accounts.

Medicaid isn't just another budget item, such as the nearly $80 billion the Air Force has spent so far developing a new fighter jet, or the almost $600 billion that the Navy will spend on warships over the next 30 years.

Medicaid is people. It's a fair chance.

I guess it's all a matter of priorities with the folks in the Republican Party. Poor people are not high on their list. In fact, poor people are probably not even on their list.

I'm getting too old for this.

And The Hits Just Keep Coming

Elders in Minnesota got some rather disturbing news in the mail recently. The premiums on their long term health care policies have gone up, some by as much as 90%.

Premiums are soaring by 20 to 90 percent for thousands of Minnesotans who carry long-term care insurance, and many older people are struggling to figure out what to do. ...

The unforeseen premium increases have caused a rash of calls to state regulators and advocates from worried or irate older Minnesotans.

But the effect could go much further. It could dampen a new three-year effort by state agencies to convince more people to finance their own long-term care in old age. About 7 percent of nursing home residents have long-term care insurance. But about two-thirds are covered by Medicaid, which spends $3.5 billion a year on long-term care in Minnesota and whose rising costs present growing budget problems for the state.

And it's not just Minnesota which is being hit. Across the nation, premiums for the policies that pay for nursing home/rehabilitation hospital stays and for at-home health care givers are going up as well. Most of these costs are not covered by Medicare, which leaves elders with few options. They can either find a way to pay the increased premiums or they can spend their life savings down to zero and then hope to qualify for Medicaid. State governments are beginning to panic.

Is this just another example of health insurance companies making a grab for more dollars? Sadly, mostly not.

Insurers say higher premiums became necessary because people are living longer and fewer than expected are dropping their policies. At the same time, extraordinarily low interest rates mean insurance companies are earning less on investments that back the policies. For the most part, state regulators have agreed.

Some elders, using a little creative thinking, have changed the terms of the policy by lowering the number of years the policies would pay for the covered costs, say, from six years to two. Others are cutting back on other expenditures to pay the higher premiums. In both cases, the problem is being delayed, not solved.

The solution to this problem is going to be very difficult. Nursing homes cost at least $5,000 a month, much of which is not covered by traditional Medicare Parts A and B. A way to include more coverage of these expenses has to be found, and reducing payroll contributions is just not going to help matters. Costs themselves have to be contained at the provider level, something the ACA hopes to address, but whether the new law makes it through the Supreme Court challenge remains to be seen. Long term health care insurers are going to have to find ways to serve their customers better and more efficiently than they have. And the economy has to grow so that the premium investments yield more than they have the past five years.

Of course, other nations have found ways to solve this problem, primarily through a single-payer system or through nationalized health care. Apparently those options are still way off the table.

Not Quite Surprising News

According to the Republican presidential candidates, it's time to cut Social Security and Medicare/Medicaid. The programs are too expensive and too poorly run to keep in their present form. That isn't all that surprising. Wall Street doesn't like all that money tied up in government programs when it could be all tied up in the banksters' and streeters' ledgers. And the Tea Partiers have made it clear that they want a smaller government and less money flowing from their pockets into the government coffers. The candidates, along with a lot of congress critters, have a mandate from the voters.

Or do they?

Perhaps not, according to a recent poll taken of Republican voters in Florida.

Florida Republican voters have a clear feeling about cuts to Medicare and Social Security: Don’t do it, according to a new poll by the AARP.

By wide margins, the survey shows that Republicans of all kinds — whether they’re Hispanic, moderates or in the tea party — would rather fix the nation’s budget by withdrawing from the Iraq and Afghanistan wars, eliminating foreign aid or eliminating so-called tax loopholes. ...

The issues are particularly important in Florida, which has the largest number of retirees in the nation. The poll shows that 60 percent of the Republican primary voters in Florida are retired, and that 87 percent of all respondents say Social Security benefits are or will be important to their retirement. Nearly 45 percent say they rely on Medicare for health insurance.

If you think about it, this isn't all that surprising, either. It's a form, I guess, of NIMBYism. "Cut, but not those programs which are important to me." And the numbers are pretty dramatic:

But even modest changes to benefits for future retirees are opposed by 66 percent of voters, the poll shows. Only 27 percent favor future reductions, which could include raising the retirement age, though the poll didn’t specifically address that issue.

Asked if they favored or opposed reducing Medicare benefits to help reduce the deficit, only 22 percent liked the idea. About 70 percent didn’t.

When given predetermined choices to cut the deficit, most voters wanted to “eliminate tax loopholes” (40 percent), cut foreign aid (34 percent) or reduce involvement in foreign wars (18 percent). [Emphasis added]

Quite a disconnect with the voters, there. And it just leaves Wall Street as wanting those government programs switched to the market place, which also is not all that surprising. After all, there has to be a reason why even some Democrats in Congress are willing to go after these programs in some grand attempt at reducing the deficit without hurting the feelings of our owners.

So the voters, regardless of party affiliation, have some work to do. One place to start is with the current crop of elected officials. Rep. John Conyers has an idea that I think is a good one. Click on over to his web site and join him in "co-sponsoring" a bill which will leave these programs in place. Let Congress know what the 99%, those who actually do the electing, think of shredding the safety net.

Like I said, it's a good place to start.

Mitt Joins The Crowd

The entire contingent of GOP candidates for president appear to have only one thing in common: bashing Social Security and Medicare/Medicaid. Yesterday, Mitt Romney joined them with his own proposal to carve up these "entitlements". I'd have awarded Mitt the "Granny Bird Award" but his plans were too hazy, too ambiguous to nail down, so he will have to wait for the coveted award. I'm sure it will be real soon, now, that he will fill in the blanks enough for me to make my decision.

Romney's proposals to reduce federal spending to 20% of the nation's gross domestic product by 2016 were far-reaching but often lacked specifics.

The former Massachusetts governor said he would lower the cost of Social Security by raising the eligibility age for benefits, but he did not specify how quickly those changes would be phased in. He estimated that he could achieve tens of billions of dollars in savings by capping the cost of Medicaid, the federal program that provides medical care to the poor, and allowing the states to take it over — a move his campaign said would "empower them to innovate."

In one of the most controversial elements of his plan, Romney proposed a major restructuring of Medicare, which currently provides health insurance to about 47 million elderly and disabled people. Under the changes, Medicare would become just one of many plans that seniors could purchase with a new "premium support" system that would give them a set amount of money each year to purchase a plan. [Emphasis added]

What we have here is a little me-too-ism, some "I can cut Social Security/Medicare/Medicaid just like the other guys." Extending the work life of roofers, mechanics, waitresses, and all of the rest of us at a time when the job market is non-existent for all but farm laborers working at subsistence levels is such utter cheap-sausage that I'm surprised the wealthy scion took so long to discover it. At least he's smart enough to not disclose just how soon the changes would be phased in. He knows the nomination is one thing, but winning the general election is another.

As to his proposals on Medicare and Medicaid, he really hasn't revealed much more than his colleagues have already set out. These safety nets, nets woven by contributions made by the recipients over the years, are superfluous. Let the market decide, the market driven by profit not the timely and effective provision of health care.

Yesterday I pointed to the staggering number of people who now fit into the category of the "poorest of the poor." Mitt and his cohorts are obviously not satisfied that only 1 of 15 Americans are mired in deep poverty. Their goal is raise that number, especially among the elderly.

Morons.

Really, Really Stupid

Steve Lopez points out in his latest column for the Los Angeles Times just what we can expect with all of the cuts to Medicare and Medicaid, and it isn't at all very pretty. Lopez' father had recently been injured in a fall, requiring a stay at a convalescent home. Now he is being released and Lopez' mother has to take on the task of primary care giver, not an easy job for a woman herself in her 80s.

It's a scenario that is playing out for scores of elders, and it is being complicated by cuts to programs which have provided assistance to care givers by providing day care relief. Those programs are now in jeopardy because Gov. Brown has cut the Medicaid for such centers as part of the program to balance the budget.

Medi-Cal had paid for many of those seniors to spend four to six hours daily at the centers, providing social interaction for the participants and needed relief to family caregivers. But Brown has decided to eliminate that funding after Nov. 30 this year. ...

Many of the centers will have to close, leaving family care givers without any respite during the day and depriving patients with needed social stimulus. If the patients and families don't have the cash or the insurance, there is really only one long term alternative, one that is going to be very expensive.

"If just 20% of the people currently in adult day healthcare go to nursing homes, we could wipe out the savings," said state Assemblyman Bob Blumenfield (D-Woodland Hills).

In other words, this is a penny-wise, dollar-foolish cut. And it's another example of incoherent, jumbled healthcare policies in a country of rapidly aging boomers. A country that spends billions keeping terminally ill patients alive with pacemakers and feeding tubes only to inflict more suffering on them.

While I don't have detailed knowledge of just what the "Great Compromise" reached by President Obama and congressional leaders entails, I do know that Medicare and Medicaid cuts were in the mix. We can expect that this scenario will now be played out on the national stage, not just in California.

But, hey! It's just a bunch of old geezers. They've had their lives.

A pox on all the politicians' houses.

We Have To Destroy The Village To Save It

[Note: I promised regular blogging today, and here it is. I still could use some financial help (scroll down to see the problem), so if you are so inclined, please hit the Donate button. Thank you.]

They're not even pretending anymore. The Republicans are finally getting their chance to roll back the safety net provided by FDR and LBJ, and they are doing so with a vengeance. The excuse? We can't afford to take care of our elders, poor, and vulnerable.

From the Los Angeles Times:

Republicans are betting that a high-profile fight over government spending will swing budget-minded voters their way in the 2012 campaign.

But the largest savings in their plan would come from slashing popular programs that cover about 100 million Americans.

The GOP proposal would phase out direct payments to doctors and hospitals under Medicare, scale back the Medicaid program for the poor and disabled, and throw out government insurance subsidies that the new healthcare law is to make available to millions of Americans starting in 2014.

That would force seniors to pay more for their healthcare and would likely make states cut back their Medicaid programs, the Congressional Budget Office concluded. ...

That could mean that senior citizens, the disabled and the poor will pay more, even as Washington pays less.

As one who is about to qualify for Medicare, I am both disgusted and worried. For years now I have been "prepaying" my Medicare premiums via tax deductions, so I am also more than a little resentful that Paul Ryan has decided to wipe all of that and my future security out. What really outrages me, however, is some rather interesting parts of the bill that apparently is going to make the rest of America feel better about his plan:

At the same time, Ryan's plan would permanently extend tax cuts signed into law by President George W. Bush.

It lowers the top tax rate for individuals and businesses from 35% to 25% and simplifies the tax code by eliminating unspecified loopholes, tax breaks and tax brackets.

See, it's all very simple. I, and the rest of the elders, will lose our benefits so that the wealthy can get all of theirs and more. Voila! Budgetary problems solved.

Stinks, don't it?