Jumping off mistermix’s post, Republicans are going to have some problems cutting Medicaid for the same reason they can’t cut Medicare.
They ran and won on protecting and expanding benefits to senior citizens, and Medicaid is the other program that hugely benefits senior citizens.
They didn’t run on small government and conservatism. They ran on opposition to cuts in Medicare.
In Ohio. In Florida. In Wisconsin. In Pennsylvania.
Here’s Crossroads GPS in Pennsylvania:
The ad’s narration begins, “Over half a million Pennsylvanians unemployed, and what’s Congressman Joe Sestak done? He voted to gut Medicare, slashing benefits for Pennsylvania seniors. The Obama-Sestak scheme could jeopardize access to care for millions.” In the visuals, the ad says, “Reducing benefits for 854,489 seniors,” a statistic it attributes to the Kaiser Family Foundation, a non-partisan group that studies health care policy. The ad also says on screen that Sestak “voted to cut Medicare by $500 billion,” citing his vote in favor of the Democratic health care bill that was signed into law earlier this year by President Barack Obama.
That’s Medicare. Which small government conservatives just promised to expand, indefinitely, no matter the cost.
But Medicare isn’t the whole story for senior citizens. Conservatives omit the second half, which is Medicaid.
Medicaid helps poor children, sure, and they’re easy to pick on, but most of what Medicaid spends goes to the elderly and the disabled, for long-term care, which includes nursing homes:
Children account for about half of all Medicaid enrollees but just one-fifth of Medicaid spending. Only one-quarter of Medicaid enrollees are seniors or persons with disabilities, but because these beneficiaries need more (and more costly) health-care services, they account for two-thirds of all Medicaid spending.
Middle class senior citizens and the disabled (pdf) rely on Medicaid for long-term care, and the federal government picks up most of the tab.
If conservatives want to pick a fight on Medicaid, and adopt a brave and principled stand on ending access to medical care for poor children, liberals should be more than happy to have that fight. We can just recycle the Crossroads ads, and change a couple of letters.
Belafon (formerly anonevent)
Yep, I’m gonna love the budget fight coming up here in Texas.
wonkie
Sure they can. They ran against deficits they created. They raan agaist TARp they supported. They ran agaisnt Medicare cuts tht were their idea. TThey ran against Mitt Romney’s health care plan which many R politicians are on record as supporting beofre they decided to be against it. Republican politicianns don’t have any principles or beliefs beyond self promotion and servin ghe rich. They’ll say anything.
Howver onn these three issues: SS, Medicare, Medicaid, Medicaid being the lousy worthless lazy poor who get old or disabled on purpose jjust ot live oof the taxpayers, tey will have a harder time lying than usual. But that won’t stop them.
Zifnab
Republicans ran on “saving” Medicare, but the only thing they wanted to save was Medicare Advantage, the privatized portion of the Medicare program that cost 15% more per enrollee than the government run option. The entire schtick about saving the program was an attempt to rally public support to reinstate the private kickback plan. I have no doubt that if Obama had given Medicare the power to barter for prescription drug prices, the Republicans would have painted it as “deep cuts to Plan D benefits”.
But the thing to keep in mind is that Republicans ran on rhetoric. They didn’t run on policy. And if they win on rhetoric rather than on policy, they’ll just keep running the ball with the “say anything” strategy until they have the numbers to vote through the legislation they actually want.
They’ll gut Medicaid with a grin on their faces. They’ll happily throw the elderly to the wolves. And when 2012 comes around, they’ll campaign aggressively on how they saved Medicare and Medicaid and made the world a better place. And with billion dollar industries lining up to run hundreds of millions of dollars in campaign ads, they’ll deluge the opposition in negative, untruthful attack ads and run the board like in ’10.
kindness
They ran on that but they lie. I can’t believe you believe their press releases.
If it doesn’t pull down 7 figures at least annually, they could care less about you other than lip service during election years.
Kay
@Belafon (formerly anonevent):
Texas exempted long term care from their proposed Medicaid cuts. I don’t know how that works, though. I don’t think they can throw all the children off and still get 70-90% for seniors from the feds.
The Heritage Foundation is just completely full of shit. The Heritage analysis Texas based the proposed cuts on is quite literally unreadable, it’s so full of weasel words.
Senyordave
Poor children = dark-skinned children, end of discussion. It’s a done deal that they will try to gut Medicaid. They’ll just trot out another factoid like Obama’s $200 million that will have the media eating out of their hand for a few days until its shown to be a lie. And then they’ll move on. What were we talking about again?
ItAintEazy
Well, since these conservative white older voters are basically Lee Atwater’s willing lemmings, I predict they will vote against their own interest just as long as those “underprivileged children” (wink-wink, nudge-nudge, dogwhistle) don’t get any type of help from the eeevil librul gubmint.
Napoleon
@Kay:
So they are trying to just toss minority kids from the program (because you just know most of them probably are) but keep the white seniors in the program (because you just know most of them probably are).
DMcK
You’re right, this should be an easy fight for libs & Democrats. Can’t wait to see how they fuck it up.
mistermix
Good point on the poor elderly on medicaid.
I’ve been thinking about that post and really what I should have written is “who is this guy kidding, Republicans aren’t going to cut shit.”
Violet
Liberals will fight, but I’m not holding my breath waiting for the Dems in Congress to do anything more than capitulate in the interest of acting all bipartisany.
Paris
Scooters! Scooters for everyone.
kay
@mistermix:
I like him for writing it because he’s right: they ran on Medicare.
Can’t be said often enough. Karl Rove’s one and only idea this cycle was to scare the shit out of old people, relying on a liberal entitlement program.
Which makes all the lofty talk about the election being some primal ideological scream just so much bullshit.
daveNYC
How many seniors would actually know if they are on Medicade vs Medicare? Everyone “knows” that Medicare is for oldsters and Medicade is for the poor, so how likely is it that the average senior citizen just figures that Medicade cuts wouldn’t touch him?
Pug
@kay:
I’m not surprised so few are talking about the elderly turnout, up to 25% of the electorate on November 2nd, and why they went heavily Republican. That occurred because of the reductions in Medicare in the health reform bill.
For all the Tea Party noise about “spending”, what drove the election was old white people pissed off about reductions in Medicare spending.
But all we hear is a bunch of blather about “a center-right country”, blah, blah….
ThresherK
@Senyordave: This is another magic phrase in which “small government” means “cutting what ‘the other’ are getting”.
Ronald Reagan, no matter how insincerely he may have done it, had at least felt the need to form the words differentiating the WorkingPoor(TM) from the LazyPoor(TM). (The reader is left to their own dog whistle interpretation, and no second guesses.)
Now that’s too gushy and cushy for the GOP! Hilarious!
kay
@daveNYC:
This they might know.
They have to “spend down” assets to get on Medicaid and get nursing home care covered. It’s huge for them. No one can really “afford” years in a nursing home, unless they’re wealthy (or insured).
In the past, they just transferred property to protect it while relying on Medicaid (which was legal) but then Congress and the states reigned that in. Now you have to be actually poor.
I’m not really blaming oldsters for this anxiety, by the way. This country seems to produce anxiety like a product, and old people are actually vulnerable.
Alan in SF
Why would you possibly think that Republicans will act in accordance with anything they said in the campaign? Not even Democrats do that.
Nick
Clearly you’ve never heard anyone say “other people’s children are not my problem”
Show starving white children and maybe you’d have a chance. But then these people would just blame Mexican children for taking resources away from nice white kids
Ash Can
@kay:
Ignorance on the part of the American people about other countries and how they operate serves American politicians, especially Republicans, quite well. (And it goes without saying that it serves the American upper class extremely well.) GOP pols can keep their base rattled and cowering in fear in the face of the soshalist bogeyman because they don’t know, haven’t seen for themselves, that this is all bunk. So we as an electorate don’t demand more and better from our elected officials. And the countries in question keep humming along, their people not worrying about how to pay for their children’s educations, how to pay for health care, or how to care for elderly parents. Sure, they look at their own tax rates and compare them to American tax rates and say “yikes,” but then they compare their general well-being to the life problems facing most Americans and say “double yikes.”
kay
@Nick:
I know, Nick. It’s all futile and it’s best to just stand by and watch.
I’m not clear how (or why, really) you stay involved in this without actually engaging on anything specific or tangible. I don’t know how to do that, or why I would bother.
aimai
Kay, great line “produce anxiety like a product.” I think I might like it even better if it were “this country produces anxiety like its our main export.”
aimai
Mnemosyne
@kay:
I was listening to the radio this morning while getting ready to work and I swear to God I heard a promo for local evening news claiming that those popular rubber bracelets “can be hazardous to your child’s health.”
When we’ve gotten to the point where literally anything in your environment could potentially kill you, no wonder people are terrified of change.
Suck It Up!
@Violet:
liberals will fight Democrats. liberals will talk amongst themselves about how Democrats are not fighting. that is what I have observed in the past 2 years. Sorry, the most I’ve see liberals fight for since Obama took office is Keith Olbermann’s return.
Nick
@Violet:
No, no they won’t. Liberals will sit around and wait for marching orders, and when they don’t get them, they’ll bitch no one is fighting for them or telling them to fight, and then act like righteous like they were the unsung heroes of the night.
Nick
@DMcK:
How the hell should this be an easy fight for liberals and Democrats? What country do you people live in?
Johnny B
Thank you for this post. One of the dirty secrets is that Medicaid recipients aren’t all poor brown kids and their single mothers as the right repeats ad nauseum. Half the cost of Medicaid goes directly to seniors.
I was amused by the New York Times article in which it reported that Texas is considering ending Medicaid for its residents, except for those “on long term care.” Although not stated in the article, that means that it intends to end Medicaid for everyone but senior citizens.
I assume a state can stop administering the Medicaid program in its entirety if it was that stupid and cruel, but can it decide to continue part of the program (for seniors) and abolish it for everyone else. And can it decide to do so and still get federal subsidies from the Medicaid program. I’d love to know the answer.
Nick
@kay:
yeah, I never said that. I said it won’t be as easy as you think it is.
When are you going to stop with this ridiculous notion that the American people are inherently good?
Nick
@Johnny B:
There’s the opening.
My grandmother was a wealthy woman. After she suffered a stroke, her therapy wiped away her money. She almost had to go on Medicaid until her children, my fabulously selfish aunts and uncles, decided to spend some of their fortune on their mother. Of course, my fabulously wealthy Republican aunts and uncles would rather my grandmother suck up the taxpayer dollars while they wine and dine in their millions, because if not, someone who ACTUALLY NEEDS IT might get it, and that wouldn’t be fair, now would it?
To these types of people, those who actually need it don’t deserve it because if they deserved it, they wouldn’t need it.
If senior care can suck up her money, imagine what it does for people who aren’t as wealthy as she was, and imagine how they would survive without Medicaid.
Scare the crap out of old people. “Even if you think you can take care of yourself, you may not be able to. That’s why we have Medicaid”
Children, old people don’t seriously care about other people’s children.
Martin
The health care debate is too focused on top-line numbers and not enough on the details.
In 2004, the bottom 50% of the working population on earnings (leaving out retirees), were only responsible for 3% of the health care spending. The top 1% were responsible for 20% of the nations spending. The elimination of the insurance benefit deduction over a certain amount equates to a tax on the top 30% or so of income earners that will be used to subsidize that bottom 50%.
All of these ‘best healthcare in the world’ claims only apply to the top 1% that consume most of the plastic surgery and most of the exotic treatments. The bottom 50% have access to this care, in theory, and do get some trickle-down effect. But the US seriously lags in preventative care – particularly for that bottom 50%. HHS has estimated that given the current situation, every dollar spent on US care prior to age 65 will save $2.50 in Medicare costs.
So the solution with Medicare isn’t to cut services, but to shift spending over time. And this is what ACA primarily aims to do – by getting insurance for everyone and eliminating enough of the denial factors, to get more non-seniors to go to the doctor, to get medication, to get minor treatments done, and to head off problems before we have to deal with them as major issues after age 65.
Prior to age 45, the US spends about what other nations do on care, and less than many. On average, we spend about $1200 per capita. From age 45 upward that climbs up to about $9000 at 65+.
Now, the problem is how do you shift those costs when you need to maintain that spending for everyone you failed to provide preventative treatment for? And the answer is that you need to dump money into the system. A LOT of money. Since the Fed doesn’t have any money, we’re going to need to pay it out of pocket (mandate). But after about 10 years, that will have done its job, and costs should start to steadily drop – and, that’s what CBO projects will happen. At that time, a different debate should happen regarding the mandate.
Republicans are completely disregarding what everyone agrees needs to happen to get Medicare costs under control, and are suggesting doing the opposite. It’s really shameless. But it’s no different than the privatization ideas for Social Security. How do you hand control of your contributions back to workers while also paying for retirees who are receiving checks based on those contributions? The answer is that you have to dump a LOT of money into the system – which we did. They’re called 401Ks. Apparently that wasn’t good enough.
For the GOP this is all an exercise in making money out of nothingness. They promise one generation one thing and another something completely contradictory, and just wave their arms when you ask about where the extra money comes from. Democrats at least have been honest about the problem. The extra money to save Medicare and Medicaid will come out of our pockets in the form of the mandate. Suck it up and be thankful that Democrats didn’t lie to you.
kay
@Nick:
Yeah. That’s what I said, Nick. That people are inherently good. Except I didn’t say anything like that. Why are you so patronizing with this pseudo-sophistication?
Martin
@Johnny B: Ultimately, that’s going to backfire on them. The ACA mandate uses Medicaid to cover low-income individuals. If Texas were to successfully eliminate it, that burden will largely fall on employers or on the state directly, without the federal subsidy. That’s fine, but not what Texas is trying to do. They’re trying to set up a showdown with the Feds. They’ll lose that.
Phoenician in a time of Romans
And the countries in question keep humming along, their people not worrying about how to pay for their children’s educations, how to pay for health care, or how to care for elderly parents. Sure, they look at their own tax rates and compare them to American tax rates and say “yikes,” but then they compare their general well-being to the life problems facing most Americans and say “double yikes.”
You better friggin’ believe it.
The US is the best place to be if you’re rich – as in 1% rich – or young, driven, and intending to leave after you’re 30. Otherwise other Westerners shudder in horror.
Kat
Thank you, Martin, for posting such useful information.
Have you considered running for office?
At the very least, you should be writing ad copy for the Dems.
Elie
@Johnny B:
The other thing to remember here — and an important thing. Both Medicaid and Medicare are provider reimbursement programs. That means that person x gets care, but they are not given any money by the government. The government pays the provider of services.
Extending that out, you can see, that while people would not get services if they terminated both programs, a whole bunch of providers from hospitals, to suppliers to nursing homes and pharmacies, would not get ANY money either.
My guess is that they would not be too hot on that. Medicaid and Medicare keep many hospitals and other providers afloat. Otherwise, they only have the private insurers and charity care (what they are willing to give for free)
This is all so much bullshit. Doctors did not really get rich until Medicare was enacted. Before that lots of seniors did not get care but a lot of docs also did not get paid.
WereBear
Essentially, as I’ve explained to many people, Americans get their paycheck, and then pay for a bunch of stuff they have to have. While Europeans get a smaller check; but it’s all kind of spending money.
Some of them get it; and they get the saddest look on their face. That will help, I hope.
Nick
@WereBear:
That’s how I try to sell things to people.
“Yes, it will mean you pay more in taxes, but it means you’d have to spend less on essentials like medicine and doctor’s copays”:
but it usually comes down to them wanting it all for themselves to spend on items like clothes and TVs.