Here’s a shocking development. Conservative candidates were all wrong about Medicare. The last time they were this wrong was 2003.
One of the most significant savings envisioned in the new health- care law – limiting payments to the private health plans that cover 11 million older Americans under Medicare – is, so far, bringing little of the turbulence that the insurance industry and many Republicans predicted
Nearly a fourth of the participants are in Medicare Advantage, as the private part is known under a 2003 law. Enacted when Republicans controlled Congress and the White House, the law began three years later to give health plans more money as an incentive to offer extra benefits and, in turn, attract more Medicare patients.
For 2011, the reimbursements to health plans will be frozen at the same level as this year, meaning that the typical plan will be paid 10 percent more than rates to health-care providers in traditional Medicare in the same community – compared with13 percent higher in 2009.
You read that right. The typical Medicare Advantage plan costs Americans 13% more than traditional Medicare. Obama cut that 13% over-payment by 3%, by freezing rates this year. The payment cuts go up from there, sensibly and reasonably, because we’re over-paying.
The hysterical screeching we heard from Crossroads conservatives and the libertarian Koch brothers in the 2010 midterms about Democrats gutting Medicare? It was about cutting 3% off an over-payment of 13%. Clearly, the world was ending, and grandma was on life-support.
One GOP House committee aide said Republicans would like to restore some or all of the cuts and has asked for budget estimates on ways to offset them – but acknowledged that the $145 billion in expected savings “is a lot of money” in a climate of large federal deficits. Still, the aide said, “however we can get to the point of where every senior, no matter where they live in the country, will have a choice, that’s what we will work toward giving them.”
Conservative leaders will work towards giving every senior “a choice” between an entitlement program that costs the federal government less and one that costs the federal government more. The conservative version of the entitlement program costs more, but that’s immaterial. Rigid ideology trumps basic common sense, again.
When I think about all those newly elected Tea Party members of Congress and their solemn vow to cut spending, I have to laugh.
Think about this: there was 145 billion in absolute wasteful spending contained within a 2003 conservative initiative that can and will be reallocated to the uninsured with no harmful effects (so far). That’s how good conservatives are at cutting costs in health care. Their signature health care cost containment measure wound up costing us 145 billion more than the plain-vanilla public program, and, incredibly, they vow to reinstate funding for this absolute proven loser of an idea.
I have to agree with the GOP aide in the article. That’s a lot of money. Why Republicans threw it away should be the next question posed to that helpful aide, before we get to his solemn vow to throw it away again.
Dave
Wow, this was an incredibly informative post. Thank you, Kay.
Dave
I can’t wait until Democrats negotiate to restore the funding because it’d be too problematic to hold the line.
cyntax
I too would very much like to see this question asked of Republicans in general. I can’t imagine anyone in the media doing it though, and I’d be very surprised if any Dems managed to interject this question into our national discourse. I imagine it would give Gergen and Cookie the vapors.
Sue
If only there were someone, some elected official, someone who by the power of his office commands attention, who would ask that question. Repeatedly.
But that would be impolite.
catclub
Could someone please clarify how the $145B relates to a 3%
change? I really doubt that $145B is 3% of the Medicare cost for one year – since 3% of $4.83T is $145B and I do not think that medicare is that costly for one year.
This is one thing that bugs me;
How much does the extension of all tax cuts (including of $250k) cost? $4T, and the over $250k part is $800B
THAT IS OVER TEN YEARS.
But ask how much extension of unemployment benefits is,
and you get the one year – or one extension cost only.
Apples to apples, please.
The Grand Panjandrum
Pure fact. Nothing quite like it. And shaping this argument as:
Is a win for progressives and Democrats. This is an excellent opportunity for people with Republican Reps and Senators to let them know we are following every move and every word they utter.
OT: BTW I’m listening to Obama speak about the economy in NC. He just used “Sputnik” and green technology arguments for investing in basic research. They sounded quite similar to what John Kerry said yesterday on MTP. Interesting.
FormerSwingVoter
Why don’t Dems point out when Republicans are wrong? Like on this? I mean, every single prediction they make – no recession or housing bubble in 2008, exploding inflation in 2009, Obama will re-instate the Fairness Doctrine or put FOCA into law, and so on and so on – all end up false. Every single one of them.
Why doesn’t anyone rub their fucking faces in it?
Joseph Nobles
So Republicans, fully aware that Medicare was a sinking lifeboat because of rising health care costs, enacted a plan that pays out MORE money from Medicare than normal?
If I didn’t know any better, I swear they were bailing the wrong way on purpose.
Culture of Truth
That money could have gone to job-creators!
Comrade Dread
This is one of the many things that gall me about the Republican party these days.
They’ve completely abandoned a conservative mindset in favor of conservative pop ideology.
Thus, it does not matter that one option saves 145 billion dollars, because the ideal of ‘choice’ is more important to them.
They are acting like radicals.
mikefromArlington
But but, the bill was a corporate sell out and should have been blocked, or so says my leader Hamsher…
Whatever she says, is like, totally legit, n stuff.
amirite?
Zifnab
@catclub: I think that’s savings over 10 years, for starters. Most quoted numbers are. “$700 billion in tax cuts to millionaires” is over 10 years, for instance.
Unemployment benefits extensions are happening year-to-year and so we don’t get the 10-year window because we aren’t expecting to extend them over a 10-year time frame. It would be like stretching the $250 COLA Social Security adjustment bill over ten years. It’s only a one time thing, and wouldn’t make sense to spell out in that regard.
Beyond all that, I thought Obama had nipped the entire 13% off when he passed the Affordable Care Act. That he only staunched 3% of a 13% overpayment drives me nuts. I mean, it beats the GOP alternative. But when we’re only overpaying by $450 billion over ten years rather than $595 billion…
How the Republicans keep winning this fight on entitlements continues to baffle me. Is it really that hard to point at the budget and say, “It’s this privatization nonsense that is costing us all the money”? Where was that battle cry in 2010?
Democrats can find fat to cut. But they’re trying to serve two masters – the populists and the corporationists.
BGinCHI
The formula for right-wing success is right there for the beholding:
Screech that there is a tragedy to the media, media spends NO time investigating such claims, runs right to the camera to bleat about it as though it were the most burning issue ever.
Mass Fucking Hysteria.
Kay
@FormerSwingVoter:
This is just me, I don’t speak for “Democrats” but the second I saw that Democrats were cutting Medicare Advantage to fund expansion, I knew what conservatives would do. Literally. The minute I heard it.
On balance, though, I have to say, I wouldn’t have raised it, had I been an elected Democrat. It’s difficult to explain, media don’t understand health care, and no one was going to hear anything but “cuts” in that whirlwind of insane screaming.
In this instance, I think Democrats made the right call, and left it alone. They got killed on it, but, honestly, it’s a tough call, raise it themselves or hope it doesn’t catch fire. I’m not sure they made the wrong one here.
I think they should scream and shout NOW. They already took the hit. They have nothing to lose. Scream it from the rooftops now.
FormerSwingVoter
@Comrade Dread:
Heh. “Acting like”. That’s a good one.
KG
You’re missing the point. The Republican Party only cares about winning elections. They don’t care about governing. They just want the big offices and the fancy titles. The way you win elections is by giving people free shit… Neocons want a war, fine, here’s a free war; Seniors want free drugs, fine, here are some free drugs; everyone wants tax cuts, fine, everyone gets a tax cuts (shhhh, don’t mention that these guys are getting more in tax cuts than you make in a year).
So, of course they are going to over pay on something like drugs for seniors and then bitch and moan when someone else does it more responsibly.
This is going to sound a bit Sullivan-ish, but I think the best way for the Dems to counter this bullshit is to simply claim the mantle of fiscal conservatism. Paint the Republicans as the party of borrow-and-spend; and point out, repeatedly, that its the Dems who have fought to balance the budget and reign in entitlement spending (at least on Medicare).
Kay
@FormerSwingVoter:
If you talk to older people, too, they do not know they are enrolled in a private program. Take a look sometime at the blizzard of marketing material they receive. I would have trouble with it.
The same is true for S-CHIP, I might add. Parents do not know where that program comes from. I ask them, and they don’t have an answer. They have some vague idea that it’s a state program, something, something….insurance! Like that.
KG
@Comrade Dread:
FTFY
Annelid Gustator
@Zifnab: Can’t remember where I saw it, but I could swear I saw something like $300B has been spent on unemployment benefits since the crisis began. Total.
catclub
@Zifnab: agreed.
I am in favor of extending unemployment benefits, but when the comparison is “Unemployment benefits extension is only $14B
but extending the millionaires tax cuts is $800B” my apples to apples radar goes off – and I have seen that one.
Also, no one has changed their language to only look at two years of millionaires tax cut extension (which is what is now being discussed), they are still using the ten year numbers, because they are bigger. So I still think there are plenty of incommensurate ( a big math word!) numbers thrown around.
Rick Massimo
Shared sacrifice!
Strong medicine!
Cut the spending!
Don’t do anything unless you can point to the bit in the Constitution that gives you the power!
Every senior gets a choice of which government-funded insurance plan they want to be on!
GOP 2010!
Mike Goetz
All of this information confuses me, so I’ll just go ahead and assume it’s another reason why we should primary Obama.
jon
It’s time to end Medicaid and expand Medicare to all the people eligible for either one. Take the power away from the states, which don’t like the strings attached. And put the power in the Feds, who seem to be a little better at handling the money than the states. Less bureaucracy? Check. Lower cost overall? Check. One set of rules instead of 51 or so? Check.
But the socialism we have is too important and American to trust it to a better form of socialism with an Obama stamp. So it must never be.
kth
There’s a second Medicare issue, regarding the “doc fix”, and it’s another source of teatard FUD. (details here). Basically, the Republicans will probably try to hold up the “doc fix” and tie it to Obamacare, even though the bill necessitating the doc fix was passed in 1997 (Republican congress + Clinton signature = bipartisan!)
BTW, the main reason that the ACA was 50,000 pages long was to ensure backwards compatibility with a healthcare system that had been built up incrementally and ad-hoc since the late 1940s. It would have been much simpler had they started from scratch, but of course that would have elicited a different but equally shrill and deranged cacophony of screeching from the teabaggers.
Mike Goetz
@KG:
Hey, it’s the thing to do now! Don’t knock it.
Comrade Javamanphil
@cyntax:
See, the problem is this issue involves facts and numbers and some mathematics and frankly, that’s all a bit much for the press corpse to understand. OTOH, Palin’s twitter feed is right at their level!
catclub
@Annelid Gustator: I would ask: is this all federal money?
Also, if there 15 million unemployed for an average of a year,
that is $20000 to each one – at $384 per week.
Sounds large but plausible.
Annelid Gustator
@Annelid Gustator: But thinking about that a bit, it seems very roughly right. The numbers look like ~$5B/month, and we reached our previous unemployment low in Oct of 2007. Just very roughly, 38 months at $5B/month, and you’re talking $200B since the meltdown began.
So something like $60B/year. I guess, then, that preventing the tax cuts for richies would pay for 10 years of unemployment benefits. Woot.
USA FTW!
Alwhite
I was very disappointed by the recent appearances of St. Ronnie’s budget director, Mr. Stockman.
After he left the office he wrote a scathing book explaining that he actually believed in the supply-side bullshit but nobody else in the admin did. They told him their actual goal was to bankrupt the Federal government so it could do nothing. He missed a great opportunity to refresh people on that as well as point out how successful those people have been over the last 30 years.
They want the death of every safety net program and are well on their way to seeing their nightmare come true.
Kay
@kth:
That’s a huge hurdle, too. Health care reform is so much fun, and so politically advantageous, I am amazed no one tackled it before :)
Where I live, the CEO of the local private hospital blames each and every one of his management mistakes on ACA.
He decided to build a huge expansion in a rust belt town of 9,000 that hasn’t added population since 1996, right before the economy crashed. It’s Obama’s fault that he has a crushing note he can’t pay, and no new patients. I say this as often as I can, to as many people as I can.
Annelid Gustator
@catclub: Your question is good; I really don’t know. Not having any luck tracking down a good cite for what I (thought I) read.
TomG
Wait a minute….since WHEN are libertarians (Koch funded or not) ever upset that Medicare was cut ? I’d love to see sources for that.
mikefromArlington
I’m starting to think this health care bill was what a Republican would want but doesn’t have the courage to vote for.
cyntax
@Comrade Javamanphil:
Too true: math is both not easy and not sexy.*
*To the general populace that is. I don’t mean to dis anyone who dressed as a sexy CPA this past Halloween.
danimal
Maybe a devious legislator with nothing better to do should propose to restore the $145B funding. Then the GOP can decide to vote in favor of a $145B boondoggle or admit they were making loud, gaseous rectal screams during the 2010 campaigns.
Belafon (formerly anonevent)
@mikefromArlington: Remember, a lot of this bill is what Republicans proposed in the 90s when the Clintons tried to reform health care. So your observation is partially correct. But they would never vote for the bill: It takes care of people.
Kay
@TomG:
The Koch brothers funded the Tea parties and their main issue was health care reform. The hypocrisy there was obvious enough it became a national joke. Keep government out of Medicare!
Democrats funded health care reform with cuts to a privatized conservative initiative called Medicare Advantage.
You know, rank and file libertarians can continue to make these distinctions, and insist that supporting the Tea Party is based on libertarian principles, but as a practical matter, unless the Koch Brothers fund a multi-million dollar campaign against Medicare proper, I don’t buy it.
The practical result of the libertarian opposition to health care reform is going to be reinstating 145 billion in waste. You’ll have to show me some different result before I credit the Koch brothers with “principle”. What happens matters. What libertarians say matters less.
ricky
@Belafon (formerly anonevent):
You are demonstrating the flexibility of today’s modern, evolving Republican.
They have gone from being opposed ( but not unanimously) to Medicare to supportive of Nixoncare to repeal of Obamacare while masquerading as friends of Medicare. It only took a half a century.
It took twice as long for them to reverse themselves on state’s rights and secession.
Suck It Up!
@Mike Goetz:
When in doubt cry “sell out!”
Jose Padilla
The aide’s thinking (correctly) that if he helps get this subsidy reinstated there’s a six-figure job waiting for him in the insurance industry, so that’s where his incentive lies.
John - A Motley Moose
The Goopers want to replace Medicare with vouchers. Medicare Advantage was the first step towards that goal. If they succeed, people like me (I go on Medicare in a little over a year) will be out of luck. There’s no way the vouchers will come close to covering my costs, if I can even get coverage. As Alan Grayson said, my option if I get sick is to hurry up and die.
Zifnab
@Mike Goetz:
You can snark all you want, but Democrats are in a serious dilemma here. The question persists – is our President doing the best job possible? I think evidence is mounting concerning Obama’s list of mistakes. This was a man ready to cede the Affordable Care Act – watered down as it was – because he just couldn’t win Joe Lieberman’s vote. A politician that comes to the table ready to compromise first and settle for the least. An executive more concerned with unemployment extensions for the next three months than fiscal health for the next thirty years.
Obama refuses to make the GOP feel pain at his own expense. That’s what this tax cut fight boils down to. He is more concerned with his “No tax hikes under $250k” promise than any other duty to his constituency. More concerned with “winning” in Afghanistan than with troop withdrawal. More concerned with National Security than with what his nation is hiding and what it’s actually securing.
It’s a fucking fail parade.
Belafon (formerly anonevent)
@Zifnab:
Isn’t that being concerned about the one constituency that cannot afford a tax hike right now?
ricky
Here’s a shocking develoment. Kay is all wrong about Republican candidates being wrong about Medicare.
The issue helped win the election for them. Perhaps Kay meant they were “factually incorrect.”
Erik Vanderhoff
@kth: Oh, man, the Democrats are wasting a golden opportunity with that! The Republican argument is thus:
“We must pay for the doc fix by eliminating the public health funds from ACA. Spending must be paid for!” (Never mind that the ten-year cost of the public health fund equals only one year of the doc fix…)
The Democrats should respond thusly:
“It was paid for. Twice over. By letting the tax cuts for the wealthy expire.”
jwb
@KG: “but I think the best way for the Dems to counter this bullshit is to simply claim the mantle of fiscal conservatism. Paint the Republicans as the party of borrow-and-spend; and point out, repeatedly, that its the Dems who have fought to balance the budget and reign in entitlement spending (at least on Medicare).”
I think this was in fact candidate Obama’s plan before the economy wiped out. If the economy gets back on its feet, I think you’ll see Obama try it again. Because the only way our politics get sensible again is if we as a country can have reasonable discussions about trade offs between government services, taxes and debt. I really sincerely hope that Reagan is burning in hell for that promise of a pony.
Chyron HR
@ricky:
Well, there you go. And Obama must be a Kenyan Muslim SociaIist, because that’s what the GOP said and they won a House majority so they can’t be wrong.
Steve LaBonne
It’s not about “ideology”. It’s about the simple fact that for Republicans, the whole purpose of winning power is to be able to funnel public money to their cronies. That’s what every form of privatization is all about, not just Medicare Disadvantage.
Joseph Nobles
OT: Glenn Beck’s jaguar god rant today must be heard to be believed.
geemoney
But choice is good, right? And shouldn’t we be concerned about how the federal government is enacting a health care monopoly?
I don’t know why you all hate America like you do.
Snark aside, thanks for the facts here. The numbers involved, and what we could actually do to help people’s lives in this country with that money, is mind boggling. We live in a time where we could achieve things on a societal scale that have been, to this point in human history, as good as unimaginable. But I guess that kind of thinking makes me a .
Martin
@catclub: $145B is over 10 years. The 3% is a start. That entire 10% premium disappears next year, so the big move is yet to come. In place of the premium is a ‘bonus’ for particularly well run programs of up to 5%. Right now only one program would qualify for that (Kaiser) but CMS has acknowledged that their metric is quite flawed and they are finalizing a revision to it. That will likely bring a few more programs up into that bonus area – but the quality of programs varies significantly by state suggesting that the problems lie not at the federal but at the state regulatory level or within the insurers themselves. It’s unlikely that any programs outside of CA, OR, WA, HI, MA, PA, NY, MI, or ID will qualify. You’ll note that one of those states is not like the others. Size and income aren’t factors.
CMS cancelled 300 Part C contracts for a variety of reasons (including insurers backing out of the program). What people don’t fully appreciate about this system is that some insurers have a different Part C plan for each county in some states. That could be 100 plans in one state by one insurer, each one with as few as dozens of policyholders. It’s a very odd system, in part due to strange decisions by the states, in part due to strange decisions by insurers.
Socraticsilence
There’s a reason the 2003 MMA (the Medicare Advantage thing) passed on a virtual partyline vote even with the endorsement of the AARP- Dem’s viewed it as a pointless expansion of Medicare aimed at ballooning costs and destroying the program- while a lot conservatives thought it was sweet– I mean it didn’t need to be funded (much less deficit neutral)- and it funneled public dollars into private hands with no discernible benefit (it has ancillary benefits like Gym Membership to some Seniors which is why a lot of them like it but no published study shows a statistically significant improvement in efficacy or efficency- indeed most show just the opposite).
Seriously, if it wasn’t a Republican Idea (and didn’t have most of its waste end up in private hands be it from stock dividends or executive/administrative overhead) this would be the single biggest target for the GOP after Healthcare Reform– its freaking moronic and any attempt to balance the budget or increase healthcare spending efficency would have slashed this boondoggle.
Sister Machine Gun of Quiet Harmony
The reason that the GOP doesn’t get pounded on this is because all these people really care about are tax cuts. They don’t really care about deficits. Plus, the GOP’s base are socially conservative seniors. Those are the people they can rely on to vote. After all, those are the people who gave the GOP their victory this fall (They were 25% of the electorate). This is the reason that when the GOP had absolute power, they didn’t cut entitlements to seniors. They expanded them. They will never consent to cut SS or Medicare for current recipients, only future ones. They get away with it because the seniors think they deserve those benefits (plus more), and think the really budget problems are caused by brown people getting something without working for it. Last time I looked, 1/3 of all state, local, and federal tax dollars were direct wealth transfers to seniors. Those seniors will never acknowledge that they are bankrupting the future.
wengler
Republicans believe that taxpayers’ money ending up in the hands of the rich is no vice. It’s when that money goes to the people that really need it that the whining begins.
jwb
@John – A Motley Moose: This is how it plays: everyone now under 50 will be getting a voucher, those over 50 will get regular Medicare. The argument will be: if Medicare continues beyond that point it will bankrupt the system but we as a country made a deal with our older Americans and they planned with regular Medicare in mind. Or some such shit. That’s how the goopers would go about trying to set up the generational warfare to gut Medicare (and also Social Security), and it was almost certainly generational warfare that the goopers were test marketing with the “keep government out of Medicare” farce. Hopefully, HCR will prove too complicated to unravel in this fashion. Personally, I think the goopers are doomed if they try: they’ll find that people, even their supporters, hate whatever they come up, because health care reform really only presents a set of very bad options.
Socraticsilence
@Dave:
MA has the same thing going for it that we like with virtually every other entitlement- namely the recipients love it and will fight to the death to defend it- unfortunately the recipients in this case are the single most disproportionately influential group in the US- the elderly, so even though the program is a freaking money bleeding failure- the GOP can stand with Seniors by defending it.
(I don’t mean to be cruel but its freaking ridiculous the disparity between entitlements for those 65+ and those under it- for godsakes SCHIP didn’t even come into being until the late 90s and had to be almost doubled by Obama to make it anywhere near adquate- but Seniors get SS, Perscription Drug Plans, MA, etc- then add in the fact that average life expectancy when the first of these programs took effect was actually lower than the retirement age- and it gets to be a bit much– I’m not a Republican but its going to be pretty freaking annoying when something like the SS input rate and/or the income cap is raised because the work:recipient ratio is way way too low (the latter I’ve always agreed with but on principle its annoying). And yet these are in large part the same people who are against Health Care Reform for others (the oldest among them remembered FDR and fight the good fight, the others are the early boomers and Reaganauts who apparently think now that they got theres its time to pull up the ladder).
jwb
@Zifnab: Don’t deceive yourself. It’s Obama in 2012 or a Republican. You can reasonably decide that a Republican in 2012 would be a strategic advantage to long-term progressive goals, but the idea that a serious primary challenge would do anything but help the Republicans in 2012 is fantasy.
Socraticsilence
@FormerSwingVoter:
that’s the point of the posts- if they were actually hardline budget cutting radicals they’d call for the repeal of “Obamacare” but the preservation or even enhancement of the ACA’s cuts to Medicare advantage.
Socraticsilence
@Zifnab:
Dude, you can argue Obama rolled on a number of things- heck you can even argue he compromised too much on the ACA (though I’d argue differently)- but you can’t say he didn’t fight for Health Care Reform- it would have been so, so easy to cave after Kennedy died- to just pull a Clinton and give it up entirely but Obama fought on- heck if anything he fought too hard and too long for HCR to the exclusion of things like Jobs or Taxes (I don’t agree with that criticism since I think its a monumental achievement the scope of which wont be fully understood for years).
Mnemosyne
@ricky:
I’m pretty sure she meant “factually incorrect” when she said they were wrong.
I think she was (snarkily) giving them the benefit of the doubt when they claimed that they really really thought this was The Death Of Medicare and reminding them that it, you know, wasn’t.
Judas Escargot
@Comrade Dread:
“Acting like” radicals?
Keep in mind that anything that makes our health care system more efficient also makes our workers and local companies more effective and able to compete globally.
Now, who would have any interest in undermining that?
Just Some Fuckhead
Breaking News:
The terriers have won.
Mnemosyne
@Zifnab:
You know when people complain that progressives keep taking wins and turning them into losses? This is the kind of thing we’re talking about. You’re claiming that he was “ready” to cede it … but he didn’t. And it passed. But apparently your belief that he secretly wanted it to fail somehow means that it did fail even though it is now the law of the land.
Marmot
Jesus. I had a conversation with my low-information wingnut mom yesterday, where she’s all terrified that she and my ailing dad are going to lose Medicare coverage if they move to a new city.
“Obama’s the anti-Christ,” she says, because fewer doctors are now accepting Medicare, and with the help of wingnut blather, she’s attributed that to the recent health care reform law.
The simple fact is that here in Texas and elsewhere, fewer doctors have been accepting Medicare because of low reimbursement rates, and they’ve been doing that for years–especially since 2007.
It’s all I can do to get her to actually find the truth behind their health care problems, but wingnuts won’t believe the “liberal media,” and apparently won’t believe anyone beyond their insane in-group. Why that in-group is worthy of such devotion in their eyes is the biggest mystery to me.
Omnes Omnibus
@Mnemosyne:
Isn’t it obvious? He is such a failure that he fails at failing.
debbie
They didn’t just throw it away — they threw it away in addition to what they threw away on the Medicare Part D bill. I wonder what the running total is for the costs of Republican wasted initiatives, especially in comparison to all the money they shriek that Obama is wasting?
As for the Republican aide’s remark that their real motivation was to give seniors choices, I say kah-kah. What they gave, and I think intentionally, was a subsidy to the insurance companies.
debbie
@Mnemosyne
I think these guys all want to be Chris Matthews or David Gregory when they grow up.
Sister Machine Gun of Quiet Harmony
@debbie:
Subsidies to insurance companies AND the ability of GOPer seniors to have special cool ‘private sector’ insurance instead of evil government insurance. This isn’t just about shoveling money into the private sector. It is also about pandering to their base, who don’t care about the economic state of the US in the future, because they won’t be alive to see it.
Mnemosyne
@Omnes Omnibus:
I don’t want to bash Zif too much, because he’s usually a pretty sensible guy. That’s one of the reasons it was so weird for him to insist that ACA was somehow OBAMA FAIL even though it, you know, passed and was signed into law, a feat that no other president has managed.
I seriously doubt that the entire ordeal was successfully resolved against Obama’s wishes. That gives a whole lot more credit to Harry Reid and the Senate than I’m willing to give.
KG
@jwb: I think we’re on the same page when it comes to candidate Obama. I always thought he was much more temperamentally conservative than any of the other candidates in 2008. But the problem is, you have people like most in my family who cannot get past the idea that Democrats will always raise taxes. I remain a fan of Reagan, however unpopular that sentiment is among the commentiart. He did raise taxes as governor to balance the budget and he did repeatedly raise taxes after the initial cut as president. But different world, different issues… I think given where we were at the time, his policies made sense. I don’t believe they make sense now; which I guess puts me in the same camp as Bruce Bartlett, wondering why it’s always 1980 for some people.
Zifnab
@Mnemosyne:
Because Nancy Pelosi dragged it across the finish line.
My point isn’t that all liberals are useless and they all fail. My point is that Obama doesn’t get full points for HCR if he’s ready to throw in the towel at the threat of every GOP filibuster.
You can go back and look at the same issues in the stimulus bill. Obama gave concession after concession to win over a bare three votes. And now we’re still neck deep in a recession, with unemployment insurance and Medicare set to run out again because he didn’t fight for bigger extensions of benefits and fewer high end tax cuts back in January ’09 when he had the Republicans by the balls.
geg6
The GOPer kvetching over this is the same as their crying about the death of the FFELP college loan program.
I had to explain it over and over and over to students and parents who called complaining that “they were losing their choices for federal loans! Boo hoo hoo!” When it was explained that going to a Direct Loan only system saves millions and millions of dollars that was costing current students and future students and was just going into banksters’ very deeply lined pockets, the poutrage ended and they were happy, indeed, that Congress stopped shoveling their kids’ cash into bankster pockets and that more money would be available to current and future students with lower costs.
Zifnab
@Belafon (formerly anonevent):
No, because the tax hike is going to be piddly. We’re talking a couple hundred more a year. And that’s assuming the Republicans hold firm after tax cuts expire in at the end of the year, and we don’t do a retroactive patch if the GOP caves.
The one constituency that needs the most help right now is the unemployed. But their needs aren’t even on the table. We’re bartering to get unemployment benefits extended for a few months in exchange for tax cuts for years.
@jwb:
Fine. Then give me the best Obama you’ve got. I don’t want a cowed and broken Republican-Lite in ’12, because he’s not going to win anything.
JohnR
There you go again, with your typical Liberal lies! It wasn’t “thrown away”; it was passed from the wasteful, shiftless, lazy and corrupt government to the powerful, yet gentle hands of the wise, productive members of society, who generate jobs and make America strong! Why do you Liberals hate America so?
Martin
@Socraticsilence: The participants love it because the insurers use the extra 15% to provide all kinds of other benefits like dental.
That always becomes the crux of the argument I have with the defenders of the program. They say ‘why do you want to eliminate dental care for seniors’ to which I reply, I don’t – but Medicare has a limited funding pool and that funding should go to major medical and other care instead of dental. If Republicans want to expand payroll taxes to provide for Medicare E ‘Dental’ coverage, I’m all in favor.
It’s really astonishing how ‘fiscally responsible’ they are right up to the moment you talk about paying for stuff, at which point it goes right out the window.
Alwhite
I don’t know about others but I consider ACA a failure because there are several landmines in it that will make it more expensive while providing less coverage than what was promised. This will make it an ideal foil for Republicans for years to come.
They know they can not repeal it & if fact do not want it repealed. There is a lot for them to whine about when it comes into full effect. Expect to hear a lot more about how the government has never been successful at anything and how ACA is going to bankrupt the country.
Martin
@Zifnab:
With all due respect, the rule here seems to be:
Every legislative victory is due to Congress, every failure Obama.
The only thing Obama has direct influence over is the veto pen.
Martin
@Alwhite:
This smacks of the sorts of arguments that the single-payers were tossing out as opposition to ACA, without giving any real details. Can you give examples of what these landmines are?
jwb
@KG: It was severing the connection between taxes and government spending that was and remains unforgivable, because it makes rational debate about policy impossible since fucking no one can resist the allure of free ponies.
jwb
@Zifnab: Obama is who he is, and there’s not a thing you, I or anyone else outside a small group of advisers can do to change him. The question is, given that fact, what’s the best use of our resources? I’m not at all sure, and I’m looking for good ideas, though I’m certain that working to replace Obama would be a complete waste of those resources.
Upper West
The hysterical Crossroads ads screamed about 500B in Medicare cuts. I thought almost all of these were Advantage-related. Where are the other $355B in cuts (savings)?
gnomedad
Entitlement programs are bad because they never get rolled back! Elect us and we’ll prove it!
Mnemosyne
@Zifnab:
Yes, I’m sure that Obama was kicking and screaming the entire way as Pelosi forced — forced! — him to sign a bill that he never really wanted in the first place.
Seriously, dude, you’re showing some signs of ODS. The fact that Pelosi got it over the finish line doesn’t mean that Obama was opposed to passing it.
ETA: Pointing out that bills can’t pass without Congressional support is not exactly “stop the presses”news.
Omnes Omnibus
@Mnemosyne: That is one of the things that is killing me right now. Ostensibly sensible people seem to have suddenly lost it with the process. I am not sure what caused it.
Martin
@Upper West: Most of the rest was due to Obama’s deal with drug companies (which he was attacked for from both sides) to reduce what Medicare needs to pay out for prescriptions.
There were no cuts to Medicare services. There is in fact a small expansion of services. The only ‘cuts’ were in what Medicare pays for the same coverage. Apparently Republicans want Medicare to overpay for services.
Martin
@Omnes Omnibus: Obama isn’t doing enough to get legislation through! Why isn’t he calling McCain and demanding he repeal DADT!
(Obama hears the complaints and gets more involved in legislation)
Obama is fucking up tax cuts by not leaving it to Pelosi! Why can’t he just stay in the WH where he belongs!
Mnemosyne
@Zifnab:
To be more clear, what’s driving me nuts is people retroactively deciding that wins were instead losses because we had losses later. Not only that, but that somehow Obama must have been secretly opposed to the wins all along and it was only other people’s efforts that thwarted his attempts to kill HCR, fin reg, etc.
It’s not the criticism of the strategy that I’m complaining about. I think the administration’s strategies of the past two years can stand a LOT of criticism. It’s the “oh, Obama must have secretly wanted his entire agenda to fail because otherwise it never would have failed!” claims that are annoying me. Sometimes, people fail when they try to get things that they want, and it’s not always because they were sabotaging themselves or secretly working against themselves the whole time.
It’s like these critics have take the whole jokey “11D chess” idea and applied it to the notion that Obama is a secret Republican plant who only put forth the agenda that he did as a cunning plan to reverse everything he said once he was elected. And, yes, I have seen some people who seem to seriously claim that.
Allen
Correction to second sentence: Replace ‘2003’ with ‘the last time they opened their mouth.’ You’re welcome!
Get Yr Math Right
I can’t believe has pointed this out yet. The payment went from 13% to 10%. That means the overpayment was cut by 3 percentage points, not 3 percent. In percent terms, it was cut by 23%.
Lirpa
@Comrade Javamanphil: CNN used numbers today in their piece on the tax battle. They showed how taxes would change for example taxpayers if all the tax cuts expired. One example was for a two income family with two kids making $75,000 a year. They now pay under $1100 in federal income taxes and if the cuts (esp. child tax credit) expired, they would pay nearly $6000. The focus of the CNN discussion was how hard that $5000 tax increase would hurt the family. All I could think was “what do you mean a family could make $75K and pay $1K in income taxes? That is way way way too low altogether!” To my mind, the story was the current incredibly low tax burden and that it makes sense we are in debt if this is all we are asking our citizens to pony up.
Once again, there I am yelling at the TV for completely missing the facts right in front of them.
Rugosa
Is anyone here actually ON Medicare? I am and I have an Advantage plan. It got canceled because it was too expensive, and I have been researching new plans for about 2 months now.
I hit the “donut hole” last month, so the prescription that has been costing me $35 all of a sudden was $120. Obama’s plan actually requires SOME coverage in the donut hole, but still. Medicare alone has no prescription coverage. Medicare alone, which costs $110 a month, also provides minimal coverage (e.g. I would pay 20% of doctor’s and hospital’s fees for my arthroscopic surgery next month.) A stand-alone prescription policy will cost $25-$150 a month, depending on the level of coverage.
I will probably go for an Advantage plan that covers meds — about $120/mo. in addition to Medicare’s $110. Two meds are not covered, and they will be about $100/mo. each. Neither has a generic form, although they are both about 20 years old. The doctors are not the problem.
Upper West
@Martin:
Thanks, Martin. The problem is that the Crossroads groups and the Republicans can scream anything in ads, no matter how false, and say it over and over again until it is imprinted on the minds of low information voters (i.e., 80 percent).
Medicare Advantage is a good example — the problem is that it’s complex to explain why the 500B savings is not a “cut.” You summed it up best — simply say these are not cuts; they are savings preventing duplication in services.
It is Orwell in its most dramatic form. The enemies of Medicare win election by screaming about fictional cuts in Medicare.
Martin
@Get Yr Math Right: Depends on how you look at it. Yes, the overpayment dropped by 23%, but we went from paying 113% of the real cost to 110% of the real cost, or about 3% decrease in the cost to Medicare.
I don’t think anyone is looking at the amount that we’re overpaying, I think people are looking at how to bring Medicare in line with revenues, and it’ll never get below 100% of Part A+B.
Martin
@Rugosa:
Yeah, there’s no question that prescription drugs are still a major problem. If you can go with generics, the costs work out pretty well, but as you say, some drugs don’t have generics, and some generics don’t work nearly as well (my wife is on one like that).
I think the pharma fight will happen in 2014 when the mandate kicks in. Interests will be aligned again, but mostly this is a case of the US refusing to play by global rules. Pharma negotiates with nations, not state-level corporations, and so we’re going to lose that negotiation every time because we can’t get our shit together (and because the GOP refuses to allow the Feds to swing their big stick).
Zifnab
@Mnemosyne:
I think there’s a difference between Obama being some secret 5th columnist plant and Obama simply not being committed to the legislation working its way through Congress.
Health Care Reform isn’t even really Obama’s bag. That’s a legacy from the Clinton era, and a subject that became the center point of the ’08 election, the same way it dominates every Democrat rally year. Obama cares about nuclear proliferation. He cares about anti-poverty programs. He’s not a tax reformer or a war protester.
So, while I’m sympathetic with a guy who got elected President with his own agenda, only to be saddled with political battles going back to FDR and a GOP that won’t agree on the time of day, I’m worried that his commitment isn’t there. I keep seeing a guy trying to take the easy way out.
Punt on ENDA.
Cede public option as a bargaining chip.
Keep the agenda moving and don’t fight out a filibuster.
Don’t let any benefit expire, no matter what the cost.
Get whatever health care bill will pass, because you don’t want to end up like Clinton.
Keep begging those Republicans for that one critical vote on DADT, and Climate Change, and Immigration Reform, and TARP, and stimulus.
Obama refuses to play hardball. He refuses to let his constituency take a hit in the short term to win benefits in the long term. He refuses let his Justice Department get political.
He refuses to consider that maybe we DON’T need a Bush tax cut. Rich OR Poor. And that’s what pisses me off most of all.
Marc McKenzie
@Mnemosyne: Well, Mnemo, I still wonder how some commenters refer to Obama as a Republican. Because if he was, then why are the Repubs trying to bring down his administration?
You are right in that there is quite a bit that one can level constructive criticism at when it comes to this administration. You’ve done it, and well. But…hearing the old toss from others about how, “he secretly wants to sabotage everything and hand it over the the Republicans”…now, that is just a steaming load of horseshit.
For all the mistakes he’s made, he’s done quite a lot of good for the country and its standing in the world. And I’ll say it again–he’s damned better than the idiot we had in office from 2001-2009 (you know, the one who instigated a lot of the nonsense that Obama now has to extricate us from).
alwhite
@Martin:
There is no real cost controls built in but there is a subsidy to help cover the cost of insurance. That means rates are going to go up. The controls to review the reimbursement rates are weak at best so you can expect CEO bonuses to increase but companies still magically hit their numbers.
There were a couple more specific issues I recognized at the time but have forgotten – let me do a bit of googling & see if I can find them.
Its not an awful start if it can be fixed but too many Dems owe too much to the insurance/pharma lobby to hold out hope.
kay
@Rugosa:
I see what you’re saying, but the whole point of Medicare Advantage was to cut costs on total federal Medicare outlays, through the magic of markets. If it was costing you less and the feds less, it would be a success. As it is, it (in a sense) bleeds the public program, and allows conservatives to continue to claim that the whole program is an unaffordable disaster.
Health care costs really are out of control. Health care can’t eat up this much money. There won’t be anything left for anything else.
I would have done it differently. I would have focused on providing a base level of affordable primary care for everyone first, with my beloved community health centers, where you would have to go, after I issued my 600 page executive order.
I would have worked on health care.
But.
Everyone would hate my plan, too, and Alan Grayson would challenge me in a primary, and win :)
Gregory
Gosh, it’s almost like the Republicans were arguing in bad faith all along…
Capn America
The worst part of Medicare Advantage is that it actually selects for the healthiest seniors (through things like free gym memberships). So, we are overpaying to have for-profit private companies manage the health care of our healthiest seniors. This is the definition of government waste.