I don’t know why Republicans decided to vote nearly unanimously and completely symbolically to end Medicare. I don’t know if they would have acted differently — and not voted to end Medicare — if Bobo/Sully/Klein etc. had questioned the numbers rather than just creaming themselves over the courage of it all. But I think this is one place where the simplicity of running ads that say “Republican candidate X voted to end Medicare” trumps all the narrative bullshit.
Republicans are lucky they lost the NY-26 special election tonight, because now they’ll back up off of it and sit their cup down. Make no mistake, though, the decision to vote the Ryan plan through the House was the stupidest political decision of our generation. Stupid because it was pointless — it would never become law — and stupid because it probably costs Republicans 10+ seats in the House. You don’t give up ten seats to accomplish nothing.
MikeJ
Giving up ten seats to accomplish nothing is also called “the bully pulpit.”
sukabi
if you’re an independent or a dem… it was stupidly AWESOME!!!!1
Just Some Fuckhead
Their idea was to preserve it for their target demographic and screw everyone else. I don’t think any of us understands quite why that idea failed- America loves her some generational warfare.
BGinCHI
Dude, Graham Parker!!
I’ve waited my whole life for this!
OK, not really, but I’ve been a GP fan since Heat Treatment, and I was 10 when it came out.
Hill Dweller
But, but, the beltway buffoons keep telling me Boehner is a great Speaker.
Edit: Why would Huntsman say he would vote for the Ryan plan just last week, knowing full well the damage it was causing the Republicans?
handy
Sure they’ll pay a price, but they’re in it for the long haul. They know they’re going to take some lumps along the way, but their strategy is clear: dismantle the New Deal and Great Society, brick by brick. While the village cheers and an ever-increasing number of complicit Dems lend a hand while scrambling for the Serious and Sober Center.
Doug Harlan J
@Hill Dweller:
I think that’s complicated, given that the alternative is Cantor.
BGinCHI
@BGinCHI: Ps. “Stick to Me” is one of the most underrated records of all time.
Elvis Costello wishes he’d made that.
trollhattan
From three-thousand miles away I can’t process the importance of this vote, but any win is a win. Hereabouts, Jerry is calling out carpetbagger Grover, which is way past due. Maybe the Democrat turtle is poking its head out at long last.
http://blogs.sacbee.com/capitolalertlatest/2011/05/jerry-brown-grover-norquist.html
Church Lady
Doug, I am seriously asking this: what would you do to change Medicare, Medicaid and Social Security to keep them solvent, given the coming demographic changes? It’s real easy to pooh pooh something you disagree with, but you need to offer up an alternative idea. What’s yours?
Doug Harlan J
@Church Lady:
Find a way to rein in medical costs.
By the way, you’re an idiot and I don’t know why I respond. I dislike you.
Hill Dweller
The Ryan plan doesn’t even address the real problem that everyone faces: medical costs.
Ultimately, this country will implement cost controls for basic medical procedures like every other industrialized country on the plant has successfully utilized. Hell, we will get to single payer eventually, but it will likely cost trillions of dollars and lives before we, as a country, come to our senses.
An industrialized health care system is doomed. We’re the last country to figure that out.
MikeJ
@Doug Harlan J: And of course the start of reining in medical costs is the Affordable Care Act.
Frankensteinbeck (The ex-Uloborus)
@Church Lady:
Like Doug just said, like it has been said by Obama and by everyone here repeatedly, you control medical costs. Medicare isn’t facing financial trouble because of the Baby Boomer bump. It’s facing financial trouble because medical costs double every 6 years. That’s not an inevitable thing. It’s not happening in any other country but the US.
Regulation is the answer. Regulations like, oh, the pile of them in the ACA.
Abandoning seniors to die because those prices will still go up but they no longer have enough Medicare to pay them sure as Hell ain’t the answer.
MagicPanda
I think republicans knew full well that medicare was popular and that by voting to end it, they were incurring a risk. They just thought they could have their cake and eat it too. They could vote to cut entitlements to show the tea party that they were serious about deficits, but because the bill would not become law, they thought they wouldn’t piss off moderates, who tend not to follow politics closely.
Further, they figured that if they walked in lock step and said the same thing over and over again, that they would be able to browbeat the members of their party who had doubts.
As it turned out, enough old people were sufficiently pissed off about the Medicare vote (even though they themselves were exempted) that it backfired.
Lev
@Doug Harlan J: Staffing the Medicare Payment Advisory Board could be a good start.
As for the stupidity of the decision…geez, you’re asking me why a party run by John Boehner and Eric Cantor, consisting to a large extent of freshman and sophomore reps who before this job were professional rich people would make an ill-advised decision that benefits rich people? Bad leadership, dumb greedy people. They’ll annihilate themselves over it.
Mark S.
Shit, I think the Republicans will double down on this. They really are that stupid.
I still can’t believe none of the presidential candidates will denounce it (besides Newt, who retracted it). Whoever does becomes the instant frontrunner.
James E. Powell
@Church Lady:
My serious answer is that I would seriously raise taxes.
And I would make some effort to begin the discussion that might lead to the debate that might lead to sober consideration of the dismantling of the American military empire. It costs billions every year and does nothing to improve the lives of the American people
Steve
@Church Lady: Here’s my idea, which also happens to be the policy position of the Democratic Party: Implement the cost-control provisions of the Affordable Care Act. Stop blocking qualified presidential appointees like Donald Berwick who know more about managing health-care costs than you or I ever will. Stop threatening to block appointments to the Independent Payment Advisory Board and allow it to rein in the growing costs of Medicare. Or, demagogue all of the above, prevent any of it from happening, and then claim that the Democrats have no plan.
Social Security barely has a problem. Raise the income caps if you have to. The prudent strategy, in light of the lack of urgency, would be to wait 10 years and then see how the projections look. No matter what they try to tell you, no one really knows what tax revenues will look like in the year 2037.
Carl Nyberg
Republicans and the Beltway elites seem to be vulnerable to getting themselves in Right Wing circle jerks where they are so impressed with each other they don’t apply any common sense.
Iraq War?
If these people had any talent instead of just money and connections they’d be much more dangerous than they are now.
trollhattan
@BGinCHI:
Recently found “The Parkerilla” on CD, which made me a happy man because I never could find it on vinyl. Live version of “Hey Lord, Don’t Ask Me Questions” is a must-have.
handy
@Church Lady:
Yes, let’s get real serious and solve something that may be a problem in 25 years by taking a sledge hammer to it now.
Or maybe we can do things like listen to those hippies in the Pentagon and reapportion all that military spending to other things.
Roger Moore
@Just Some Fuckhead:
Because the “preserve it for their target demographic” is too nuanced to make a good campaign slogan. The Democrats can campaign on “They voted to kill Medicare!”, while the Republicans are left sputtering about technicalities. It doesn’t help that the technicality is so obviously naked pandering to one side of the generational divide that it’s going to piss off everyone under 55, even people who might otherwise be inclined to vote for them.
Villago Delenda Est
Having the health care system be “for profit” cannot continue, because there are no actual cost controls built into such a system.
It must be administered with the economy of the whole in mind, not the personal profit of individuals in it.
Costs must be brought under control, and the the way we’re set up now, the system actually works against controlling costs, because too many profit from it the way it is now. The best example is substituting mandatory emergency care for preventative care that is much less expensive but cannot be afforded by the low income people. It’s insane to operate it this way, but some profit from it, and the public picks up the tab.
Carl Nyberg
@Church Lady: The fix on Social Security is dirt simple.
The Republicans simply don’t want to fix Social Security so they can lump it in with Medicare and say all entitlements are a problem.
Atrios explained the difference between the Dem and GOP approaches to Medicare pretty well.
Republicans want to change Medicare in a way that destroys the program. Democrats want to reduce the cost of the program while maintaining the principle of affordable, comprehensive medical coverage for seniors.
The fix is that we need to spend less money by reducing access to highly expensive procedures that provide marginal (or no) benefits.
The Democrats tried to make progress on this by having responsible discussions between physicians and seniors about end of life options.
And Republicans went around screaming “death panels”. Remember?
BGinCHI
@trollhattan: And recently he’s been doing a lot of quality stuff on Bloodshot. Really prolific. Check it out.
I’ll be singing “Protection” as they wheel me away in my dying day.
a hip hop artist from Idaho (fka Bella Q)
@BGinCHI: Thanks for making me feel old. Though I wasn’t old enough to vote when it came out, so, never mind.
I think the Republicans have indeed lost all sense of reason, and considering that it was already in woefully short supply on that side of the aisle, you get things like Doug J, son of Doug J describes.
agorabum
Well, the Democrats did pass cap n trade in the house, even though it never had a chance in the Senate. I’m sure it cost some folks in coal/oil country their seats.
I’d note the policy was fine, but with the Senate doing its 39% is the majority thing, it was doomed
Baron Jrod of Keeblershire
@Church Lady: You truly are a terrible human being. Just soulless and stupid.
cthulhu
@Church Lady: Anyone who conflates Social Security, Medicare and Medicaid as facing similar problems is not being serious in starting a discussion as per all the reasons stated above.
Ruckus
@Church Lady:
Let’s see…
One way to fix something that is not broken is to eliminate the max wage ceiling on medicare. IOW raise taxes.
Control costs. So many have pointed out that ACA does a lot of that. Maybe not enough. Yet. Once enough people see where the major problem lies then more will be able to be done.
Get assholes out of the way of progress. That’s the rich and the stupid. Take the hint.
Jewish Steel
@BGinCHI: I wish I still had my copy of Struck by Lightning. Some of my favorite songs are on there.
piratedan
hey now, for Republicans, passion is no ordinary word, just look at how they enforce party purity and attack any and all threats to their power and control, why they’re practically soviets about it, the party above all and damn the consequences.
Kane
Republicans claimed that they wouldn’t touch Medicare for those 55 and over. The notion that seniors would be so selfish that they would accept a plan that would benefit them while taking away future Medicare from their children, grandchildren and great-grandchildren underestimates our seniors and ignores our history.
sj660
I’m so old I can remember what happened in 1998 when they were obsessed with Clenis.
eemom
@Just Some Fuckhead:
oooh, lookit this — fuckie’s getting all serious about serious shit ‘n shit. Moving off the one-note I WAS ON THIS BLOG FIRST, and YOU ALL SUCK schtick.
I call……oh, whatzisname again? Oh yeah. Bullshit.
Mike in NC
Church Lady is a dimwitted asshole. And in other news…
Church Lady
@Ruckus: There is no income cap on Medicare. You pay on every dollar of wages. The cap is on Social Security. And I am all for eliminating the cap. Too bad no one in Washington seems to want to eliminate it.
Doug says rein in medical costs to fix Medicare and Medicaid. Once again, how? Technological advances in medicine, which come with a great price most of the time, have extended our lifespans out to a degree that was unimaginable sixty, seventy or eighty years ago. There probably are not that many people that, given the possibility of a cure for some malady, will opt not to take it. That’s just human nature-most people want to delay death as long as possible.
Using just my parents, my in-laws and my mother’s new husband as an example (ranging in age from 75 to 81), in the last ten or so years, Medicare has footed the bills for four knee replacements, a shoulder replacement, two spinal fusion surgeries, prostrate surgery, radiation therapy for prostate cancer, removal of part of a lung for lung cancer, surgery and radiation treatment for melanoma, radiation treatment for a malignant tumor, chemotherapy for Stage IV lung cancer, insertion of a cardiac defibrillator and later replacement of it, removal of cataracts and multiple trips to the emergency room. Between the five of them, I cannot even begin to imagine the total paid out by Medicare. I’m sure it’s some jaw dropping amount. And I can’t begin to imagine the reaction of any of them if they had been told “No, you can’t have that, because it’s not cost effective.” And they are just five of millions, with tens of millions lined up behind them as the baby boomers reach retirement age.
I don’t begin to think that I have the answer, but I can see the problem and I don’t think that that Medicare, in it’s present form of paying for anything and everything, is sustainable.
Church Lady
@Doug Harlan J:
My question was not being snarky. I was seriously wanting to know what your ideas were. It seems you don’t have many.
eemom
you know what would REALLY help this stupid ass blog?
If all creatures great and small mastered the difference between
“it is” = “it’s”
and
that which belongs to it = “its”
so simple, yet so incomprehensible to stupid people of all political persuasions.
piratedan
@Church Lady: here’s a way to rein in costs… single payer, you eliminate the middle man, who does nothing but add overhead to the costs themselves, you deal directly with the services and specialists you need. This then eliminates part of the waste that is inherent in the system and eliminates the need to have docs continue to order a bunch of unneeded tests in order to pad the bill in order to get the required return that they receive from the insurance companies to begin with. You close down costs using this method. Then you indicate to Big Pharama that they need to offer the same prices to American facilities that they charge overseas. There’s a reason that costs in Europe, Canada and even Mexico for drugs are down, its because those countries don’t allow Big Pharama to rape them over costs. Yeah profits will decline and yes, the insurance industry suffers, but you have to break a few eggs in order to restore the medical profession back to the idea that it developed in the first place, treating the sick because its in the best interests of society that they be treated and not to profit on the misfortune of others. Those people currently working on denying claims can then be employed by the government in processing them instead. The only people that truly suffer would be the CEO’s and boards of these blood sucking companies that feed on something that everyone needs.
eemom
@Church Lady:
for an example, I’ll just look at the party and whistle.
fffffffwwwwwwwrrrrrpppppp.
Xenos
@eemom: Eemom, you do suck. Don’t drag your pissing matches into new threads. The rest of us quit threads when you strike up the pissing match, and then you drag us back in within minutes. That is the behaviour of a troll.
A Humble Lurker
@eemom:
Yep. Morons, trolls, paid shills, racists, sexists, purity trolls, psychos and homophobes? Hell, that’s a party.
But don’t a ONE of you motherfuckers mix up it’s and its!!!!!111!!1!
On topic, tonight was a good night. Only thing that’s going to make it better is if the GOP doubles down on the stupid just in time for the Senate vote later this week.
Kane
A gutsy Democratic underdog willing to take on the Republican establishment and fight the Republican candidate in her own back yard. Kudos to Kathy Hochul for her courage in fighting for Democratic policies and defending Medicare, and for making her opponent eat her own words. Kathy Hochul earned this victory.
kdaug
Medicare for all.
kansi
Just wondering if the “end Medicare as we know it” Ryan strategy may have some long-term, hidden value. During the health care debate, many single payer supporters referred to Medicare as a successful government program that people liked. If Medicare is discredited and “reformed,” no one could point to it as a model for further health care reforms. I think the GOP truly fears single payer programs, because it is philosophically repugnant to them, and because it would lock up Dem votes for at least a couple of generations.
Jebediah
@piratedan:
.
I could learn to live with that.
debbie
I just woke up. What time did the Republicans cry “Fraud!” and demand a recount?
Chris
@James E. Powell:
DING DING DING DING fucking DING –
We’ve spent my entire born life doing nothing but cutting taxes, cutting taxes and cutting taxes again, usually on the top 1%. Never mind that the strongest economy we ever had was in the era when the top tax rate was 90%, never mind the fact that salaries have been in a fucking flatline for the last thirty years while the cost of everything else goes up, while the rest of us still wait for that fucking money to maybe finally decide it wants to trickle down.
Rahul Mahajan over at EmpireNotes.org summarized the budget problems thus a couple months ago:
And all because the gobs and gobs of money at the top of the social pyramid have been declared off-limits.
Sly
@debbie:
Before the polls even closed.
DBrown
@Church Lady: Uh, don’t know where you are coming from but SS is fully solvent for many decades and has no need for any current fixes – as for the others, yes, they need to be addressed but the approach does not need to be privatized – that is stupid since for profit always (proven) drives up costs with negative benefits. To stop the cost climb, we need to change how MD’s are trained and how medicine is delivered; Big Pharm needs to be dealt with since they sell drugs that were mostly developed for free (tax payer paid for all R&D in Gov/university labs!) and they sell these drugs at huge profits in the rest of the world for a tiny fraction of the price they steal from the US – talk about a major area to save money not just for Medicare but all aspects of medical costs! That would go a long way – so, the fix is not as hard as anyone thinks.
Sasha
As several people have noted; the idea that people over 55 are protected is bogus. As the pool of over 55’s stars to drop, fewer health care providers will be willing to take medicare reimbursements. Well, I am already beginning to see that. I live in the Hampton Roads area of Virginia which has a huge military population. My primary care practice is no longer accepting new Medicare or Tricare patients. Tricare is the military’s dependent insurance program and if a hospital accepts Medicare, they must accept Tricare. They reimburse at the same low rates.
I don’t live in Norfolk or Virginia Beach where the majority of the bases are but this would have been unheard of ten years ago. They’re not the only practice that has done this, either.
When I lived in Cape May County NJ 15 years, there was only one pediatrician that accepted Tricare in the entire county. Maybe senior citizens are just smarter than the Republicans think because if Ryan’s plan passes, Medicare will cease to function in any meaningful way long before the over 55 crowd is gone.
patrick
why didn’t Reid bring it up for a vote BEFORE the NY-26 election in the senate?
Suffern ACE
@Sasha: I believe that the medicaid cuts will be immediately felt.
kay
@Church Lady:
A huge part of the health care debate was about how to change Medicare to keep it solvent. It was hard to get there, because business interests and conservatives dominated the debate with incoherent screeching and falt-out lies, but we started.
It is infuriating to me that conservatives and others have seized on this line that Democrats and liberals didn’t discuss health care cost controls. They did. Endlessly.
That half the country didn’t participate isn’t the fault of Democrats and liberals.
Catch up. We’ll wait for you. But don’t bitch that it wasn’t discussed. It was. You didn’t hear it because you weren’t listening.
Conservatives and others didn’t show up for any of the substantive discussions of health care cost controls. They didn’t show up because they saw a political advantage to lying constantly and dodging reality. They now see a political advantage in pretending the debate didn’t happen, but that’s not true. The debate was conducted between liberal Democrats and centrist Democrats and conservative Democrats. No one else showed up.
Don’t rewrite what happened. This was discussed endlessly and specifically on this site.
EconWatcher
Why only ten seats?
I’m not up on this stuff, but won’t this vote make many formerly safe seats competitive?
Craig
@Church Lady:
Social Security: Understand first that Social Security can meet 70% of its projected obligations from now until the end of time with no changes at all. Understand second that 70% of the projected future benefit level is actually more money than recipients get today. Gosh! Suddenly it doesn’t sound like much of a problem, does it? A fairly painless combination of slower growth to benefits and exposing some income above $106,000 to the payroll tax straightens it right out. There is no crisis in Social Security. None.
Medicare: You want to know how we fix Medicare? It’s called the Patient Protection and Affordable Care Act, which in the space of ONE YEAR cut Medicare’s projected deficits by two thirds. That’s not me talking; that’s the report of the program’s trustees: http://www.thefiscaltimes.com/Columns/2010/08/20/Tax-Burdens-of-Unfunded-Benefits.aspx You’re welcome.
PurpleGirl
@Church Lady: That list of ailments and treatments includes things that cause a lot of pain, cause loss of movement and mobility, a number of things that would lead directly to death. Are you therefore saying you would prefer those people to have died or become house-bound? Would they (or you) have had the money to afford those procedures absent Medicare? At their ages, do you really think they would be able to buy any health insurance at all? How do you get your insurance — from a job? Could you afford it absent a job? Could any of those relatives continue working in order to obtain insurance? Just a few questions.
Evolved Deep Southerner
@eemom: God DAMN, you’re cranky today. Its fucking annoying.
jibeaux
Damn, I love me some kay.
They’ll lose ten seats if they patiently, and repeatedly, continue to hang that albatross of a vote back around the necks of the people who voluntarily assumed the albatross around their necks but now are going to try to sneak the albatross off, or paint the albatross so it looks like a necktie, or insist that it’s not an albatross, or some such thing. With Dems, there’s always the concern that they’ll react to their opponent missing shots by lowering the goal.
Sorry to mix so many metaphors, I have an inner Opus.
rickstersherpa
We really have to give an ass backwards shout out to the Washington D.C. punditocracy, Politico, Brooks, Sully, Weisberg, etc. who encourage Ryan, Cantor, and Boehner with their praise to go all in on this one as all the VSPs were treating “the Deficit” and the pending on-slaught of the “invisible bond vigilantes” as an existential threat to the United States. By treating the deficit as the creation of Barack Obama to help “those” people, the VSPs had helped the Republicans roar back in 2010. Of coures, the real agenda is not solving the deficit, but preserving and creating lower taxes for rich people (if the financial stability of the U.S. was a real concern why would so many of the same people expressing the desire to cut social security, medicare, and medicaid would be be advocating a pre-emptive war with Iran and contiuning the wars in Iraq and Afghanistan indefinitely. Wars, and tax cuts for rich people, just don’t count where the “evil deficit” is concerned.
I love Eric Alterman’s mastication of Jacob Weisberg on this issue on the Nation: http://www.thenation.com/article/160783/intelligent-liberal%E2%80%99s-guide-foolish-principles
“Of course, there’s another potential explanation for Weisberg’s otherwise inexplicable attachment to this liberal “principle” of his. As a veteran of “even the liberal New Republic” in its heyday, Weisberg might have noticed that “liberals” are never so celebrated in the punditocracy as when they embrace conservative arguments, no matter how wrongheaded and illiberal they may be. Coincidentally, Weisberg says he also approves of the Ryan budget’s desire to further cut the tax burden on wealthy people like Rubin and himself (and thereby presumably shift it onto the backs of teachers, nurses and other conservative class-war targets). Funny how arguments based exclusively on “principle” tend to be consistent with the material interests of the people pushing them. But unlike Tony Kushner’s commie labor leader, they are, after all, “representing a class.”
kay
It’s just astonishing to me that people are still claiming there wasn’t any discussion of Medicare costs in the context of the PPACA.
Republicans ran their entire 2010 campaign on “500 billion cut from Medicare Advantage”. That’s a cost-control to keep Medicare solvent. Democrats put the money towards coverage for the uninsured, and that’s a cost control on Medicare, because Democrats and liberals believe they’ll save money on Medicare if they cover people prior to Medicare eligibility.
Even if you were deliberately and carefully not paying attention, that part had to come clear, right? That one number? The number Karl Rove used on every piece of direct mail?
Spork
Thanks for GP reference — made my day!
Silver Owl
I believe that today’s republicans are so stoned on their sense of self-importance and false sense of royalty that they can no longer comprehend reality outside of their fantasy world. They just don’t get people.
Marc
I see absolutely no evidence that the Republicans will back down. In a rational world they would. But there is a fanatical majority of their voters that will kick them out in a primary if they deviate from the one true path.
Prediction: they’ll blame it on a bad candidate; note that the “conservative” candidates won a majority of the vote; and double down on the crazy. The winning presidential nominee will endorse the Ryan plan. Bet on it.
Emma
Just Some Fuckhead: Anecdote is not data, but in my family, where my parents are both uber-Republicans, their dislike is based on the fact that, if the privatization passed, my sister and I would have to spend our own savings to help them make ends meet, and, since neither of us have children, who would help us if we needed it?
Sometimes family trumps generational warfare.
Georgia Pig
@Church Lady: You imply a false choice by your framing of the question, i.e., by saying “medicare is unsustainable.” The problem is that the health care delivery system in the US is unsustainable in its present form because it has way too much monopoly rent seeking, which arises from the fact that selling health care is not like selling flat screen TVs. All you have to do is compare the per capita costs of the US healthcare system with a host of other first world countries that get comparable or better outcomes and see that we have a major problem. Medicare is just a symptom of the bigger problem, not the source of the problem. Things like ACA are attempting to grapple with the problem, but the complete abdication of the Republican Party of a responsibility to provide constructive input in this process is making it nearly impossible.
NovShmozKaPop
Probably because when you put up job ads for people to devote a career in public service to doing everything possible to screw up and dismantle the government and to make the country a heaven on earth for a few rich people with no regard to the major part of the population…well, you don’t generally end up with the best and brightest, do you?
rickstersherpa
@Church Lady: The primary reasons U.S. health care costs have risen and continue to rise faster than the general rate of inflation begain with the Nixon-Ford administrations, and consolidated under Reagan. It was a deliberate policy to encourage the replacement a non-profit model of providing medical services and health insurance, from a mulitude of providers, to a for profit model, at the same time encouraging and tolerating consolidation of the industry to boost the providers pricing power. The creation of oligopolies and monopolies in providing medical devices, drugs, services, and insurance has created the pricing power that allows providers to decline to provide services for reimbursements they don’t feel sufficiently profitable. See http://medinnovationblog.blogspot.com/2011/01/lessons-of-history-health-care.html
The key to breaking this pricing power are opening competition from the outside (for example see: http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&-columns/doctor-bangkok/). Besides going overseas to treatment, immigration rules that would ecourage foreign medical providers to come her to practice should be liberalized.
Further, providing information to consumers and review of medical decisions and procedures with something like the Independent Payment Advisory Board would reduce costs, but it also means reduced income to the providers of medical goods and services. Doctors would return from the rich to the upper middle class. Also, by covering more uninsured, there will be less incentive to raise prices to cover the costs for treating those whose accounts receiveable go unpaid.
Of course, the providers and oligopolies don’t like these breaks and checks on their pricing power and will seek political fixes to preserve them.
The Raven
@Church Lady: It’s important to separate health care and Social Security. Health care is a big problem; Social Security is a small one.
Social Security is not in much trouble–the problems won’t start until, I think, 2038 or so (or is 2045, now?), and even then the system would only pay less, not fail completely. Social Security could be fixed by slight tax increases on people with incomes over $100,000.
It is largely your side of the debate that has made it difficult to fix Social Security.
Medicare and Medicaid have the same problems the rest of the health care system has, but are actually in better shape than the private insurance carriers. IIRC, Medicare costs are rising at 2.6%/year, and private insurance at 3.6%. So privatization, at least, would only make things worse. It would, especially, push expenses onto the families of elders and create family conflicts.
As you say, a large part of Medicare expenses is the expensive treatment of the chronic diseases of old age. Again, your side of the debate has worked very hard to exacerbate this problem. We wish you would stop. One thing that could easily be done would be to drive harder bargains with the pharmaceutical and medical equipment firms. It is conservatives, indirectly funded by the pharmaceutical industry, that have blocked this.
I don’t have an overall answer for the rising costs of health care. No-one does. I suspect a helpful thing would be to improve quality of care and health at younger ages and to set a goal of keeping people healthier when it makes a difference. There are currently no incentives in the system, and not many in our culture, to keep people healthy. I think it’s important to create them. This is good medicine and would improve health into old age. It might make treatment of the diseases of old less expensive, and the period where chronic diseases had to extensively treated shorter.
I suspect extending Medicare to the whole population would also have helped, by bringing more younger people into the system; mandated private insurance will not do that. On conservative financial and moral considerations, single-payer systems make more sense than mandated insurance systems: they cost less, and distribute expenses more fairly. It surprises me that more conservatives do not reason in this way: conservative ethics include both caring and frugality.
Beyond that, though, I will admit I don’t know and I do not think anyone knows. The USA is not going to lead here, since our conservatives are blocking even the things we know would work. The world will be learning from Western Europe here, or perhaps Japan. Improvements in medicine have created new problems, and we are going to have to learn as we go.
The Raven
Doug, I think the Tea Party Republicans are going to lose the next election. The new conservative coalition (country-club Republicans + conservative Democrats) seem set to dominate for the next decade.
Personally, I think this stinks. Will this coalition address unemployment? Nope. The housing crisis? Only on technical issues. The banking disaster? (Which is set to happen again, though the CFPB may help prevent it.) Nope.
…and global climate change and other international environmental issues?
We desperately need to act on all these issues, and we are instead paralyzed with fear. With luck we will at least stop doing foolish self-destructive things, but it does not appear that most of us are ready for change. That will likely wait until a coalition of women and now-younger people comes to power in 2020 or so.
Glen Tomkins
Painted into a corner
Perhaps their radicals were able to get their moderates to go along with voting the Ryan Plan, because the latter calculated that between now and November 2012, other issues would come up to supplant this vote in the minds of the electorate. Insofar as that’s the case, these moderates would not have been displeased with the prospect of the occasional by-election well before 11/12, such as NY26, to serve as a warning for their radicals to not push their agenda too hard. Plenty of time to pivot and prevent that 10-seat loss, when they wouldn’t have had that time had the lesson been delayed or muffled by not having the vote on the Ryan Plan to put it all out front early.
Of course, that would mean that NY26 has pushed their radicals into a corner. They still have a lot of momentum from their recent ascendancy with which to cudgel their moderates into going along with them, or be ousted in a primary. But the conventional wisdom is turning against them, and that threat will become increasingly more hollow as time passes. They have a lot of motivation to strike while the iron is hot, to do something now with their intraparty power, before that power evaporates.
What better for them to do than force a default? If default makes it impossible for the US to borrow on practicable terms, we may be faced with a situation where there is no choice but stiff SocSec and Medicare recipients. Sure, there’s the risk that the electorate will blame them for the fact of this post-default, but if they’re going to get hammered anyway for proposing the end of SocSec and Medicare, why not actually at least accomplish the end of SocSec and Medicare as they go down? Take it with them, so to speak. And it might not be a bad idea anyway to be out of power during this time when the realities created by the default require SocSec and Medicare to be ended. Past history shows that they will make a good show of posing as the people who prophesied correctly that SocSec and Medicare were going to cause a default meltdown, but weren’t listened to, and now it’s happened and those Ds have gone and ended Medicare and SocSec!
Jamey: Bike Commuter of the Gods
@Church Lady: “Ration health care now!”
I think you should run with that idea, Church Lady. In fact, here’s Rep. Paul Ryan’s number in DC: (202) 225-3031. He’ll surely thank you for the tip.
El Cid
It’d be great to see ads (maybe there are already) that said
EVERY SINGLE REPUBLICAN CONGRESSMEMBER VOTED TO END MEDICARE
EVERY SINGLE ONE
EVERY SINGLE ONE
Maybe a bit more artfully done. But that.
Chris
@Emma:
And that’s the wall the GOP keeps running into with this crap.
It’s one thing to attack a universal health care plan before it’s enacted, when it’s still a hypothetical and not something people can judge for themselves. It’s one thing to pull stuff out of their ass in fields that most people know nothing about (e.g. foreign policy) or to attack minority groups that most people aren’t a part of (e.g. inner city minorities).
But Medicare and Social Security are here now: they’re a very real and very crucial part of the lives of every voter out there. It’s very difficult for them to pull the same bullshit on that when everyone’s going “wait, what is this going to do to my ability to retire?” Which largely explains why attempts to strangle Medicare in 1995 and privatize Social Security in 2005 failed so hard.
kay
@Church Lady:
Conservatives could have done something else. They could have rolled out the Ryan Plan as their health care plan, because that’s what it is.
Ending Medicare and replacing it with private vouchers, and ending Medicaid and replacing it with block grants is a health care plan.
It’s a fundamental re-write of the whole system, because Medicare and Medicaid are HUGE and radically reshaping them will affect each and every person in the whole system (including the private system), in much more profound ways than the PPACA ever dreamed of doing. The Ryan Plan is a hard Right health care policy manifesto.
But they were too cowardly to say that, so they threw up a cloud of smoke and called it “balancing the budget”.
RossinDetroit
Another Grey Area would make a good theme song for this blog.
RossinDetroit
@RossinDetroit:
lyrics
shortstop
@RossinDetroit: Or “Temporary Beauty” (and hope to god that it doesn’t rain).
Bulworth
Hah, ha.
Conservatism has never failed. It has only been failed.
Glen Tomkins
@Church Lady: They say you should always deliver constructive criticism as a sandwich — praise, blame, praise — so, kudos for saying “rein in” rather than the execrable “reign in”.
I’m afraid it’s downhill from there.
Most basically, we are not at all, even remotely, in a debt crisis, so there is not even the slightest onus on the rest of us to come up with some sort of alternative plan to balance the budget. Governments, just like families, run for extended periods in the red. How many families do you know that have not carried, perhpas for decades, debt equalling more than several times annual earnings in the form of mortgages, car loans, and education loans? US debt is trivial in comparison. We’ve run much larger for much longer and had no trouble pulling up when appropriate. It’s appropriate now to be in a phase of higher debt because, according to one highly respected theory, that of Keynes, govts need to spend counter-cyclically, to spend more during economic downturns to replace temporarily the lapse in private sector demand, and do so from borrowing, because taxing into a recession could reduce private sector demand even further. Even if you don’t believe in Keynes and his remedies, well, we’ve followed Keynes before and survived the cure, no reason to think this is a crisis any worse than previous.
If there were any question of a problem of too much debt at the moment, we have the obvious, low-hanging fruit, solution before us. Go back to Eisenhower era top income tax rates. Solving this phony “crisis” by cutting SocSec and Medicare would be a very bad idea in this demand deficit depression we’re in, because money spent on these programs feeds right back into creating demand in the economy. But the excess income of the wealthy adds nothing to demand, and is the only place to go for government black ink that won’t hurt demand in the wider economy.
So, take that as the alternate solution to this debt “crisis” — top tax rates that Eisenhower approved of, under which the economy boomed. If the Rs force a phony, totally unnecessary, bankruptcy crisis, then deal with that by means-testing which creditors the US pays in full vs who takes a haircut. There’s your alternative Plan A. If you don’t like that plan, call your R friends in Congress and tell them to end the phony debt crisis. That’s your alternative Plan B. Ending Medicare and SocSec isn’t a plan at all, it’s a scheme, it’s a plot.
Two points about the supposedly inherent unsustainability of universal medical care.
Other industrialized countries do it, without bankrupting their countries, and without rationing. We tolerate costs 2-3 times what they are in these countries because we choose to tolerate monopolies and cartels in financing medical care. No other country in the world does that, for obvious reasons — it’s insanely expensive, and disrupts the delivery of a hugely important service. Adam Smith had a lot to say against cartels. Why aren’t capitalist up in arms against our current cartel-ridden system of health care financing?
Secondly, health care rations itself. The point of your list of highly invasive and extensive medical interventions your relatives have received recently may have been intended to highlight the monetary costs involved, but to me, as a physician, I could not help but be staggered by the human costs this list embodies. In general, perhaps you have an extremely unlucky family, and all of these high-human-cost interventions really were the best way for you. But that would certainly not be the average or common experience. In particular, you have my sincere condolences for the relative with lung cancer. The disease itself brings with it horrible enough human costs, one of which is that we don’t really have good and successful interventions to treat it, so there is usually little to be done. The interventions we do have are horribly invasive but marginally effective, and are therefore rarely a good idea.
I am not familiar with the particulars of your relative’s case, and perhaps it all actually happened with full and adequate counseling at every step of a chain of highly invasive and marginally effective interventions. But I have witnessed all too often that such a chain occurs as a result of patients and their families being railroaded into a course of interventions that only serves to add to the inherent human costs of the disease itself, not subtract from them. One reason, certaioknly not the only reason, we don’t do so well as other countries in terms of monetary costs, is that we don’t take so much care to keep the human costs of highly invasive interventions from exceeding the benefits they provide. We instead turn lay people loose, without a source of unbiased medical advice, to face a disorganized mob of specialists, and precisely at moments of maximum crisis and vulnerability. Again, perhaps in the case of your relative, this string of interventions was appropriate, but in most cases, it would not be, these interventions would do more harm than good, and I don’t at all mean harm to anyone’s pocketbook.
Ex Regis
To be ‘charitable,’ it’s English’s fault. The apostrophe is used for many different purposes, a few of which are shown above. Among the many things people ought to know, the rank of the correct use of the apostrophe and its near imposter the prime must surely be low. I’d rather know why there are infinitely many primes, how genes create proteins, why I can’t remember the future, etc., than worry about a punctuation anomaly that will probably disappear in a hundred years. Just as “they” is being added as a third person singular personal pronoun, just as “you” replaced “thou” as a second person singular personal pronoun (to the disgust of past perfectionists).
Hang in there eemoom. You’ll be quaint sometime in the future.
Bulworth
You really shouldn’t be mentioning this anymore. The new Repubs have asked us all to “let bygones be bygones” and don’t be so divisive about this health care, Medicare stuff. Yes, it’s true they won office largely by playing Mediscare with the PPACA and by lying about death panels. But now that they’ve won office, we’re supposed to not complain about ending Medicare.
Tonybrown74
@Church Lady:
You people are so silly sometimes.
Medicare and Medicaid are not the problem. They work as intended.
The problem is Healthcare costs. Solve that problem, solve the Medicare/Medicaid “problem”.
Chris
@Glen Tomkins:
That was a very well written rebuttal, read with much enjoyment and I thank you for it.
One point:
They are, kind of – it’s one of their many red herrings. Republicans would tell you that the cartels and monopolies in health care were caused by government intervention in the market (they’ll tell you the same thing for all the problems we had in the Gilded Age, if they ever concede those things as bad). Therefore, the solution is to get the government out of health care altogether, and just sort of pray that the market will fix itself.
(Even if you agree with their diagnosis, I do love the leap in logic in going from “this intervention by the government was wrong and messed things up” to “government intervention is bad, period.” It’s like saying “military force was used badly in Vietnam, therefore, military force inherently sucks, and rather than figuring out better ways or better times to use it, we should just not use it ever.”)
different church-lady
Dude, you’re killing me with this stuff! Knee-slapper!
Georgia Pig
@Chris:
The obvious rebuttal to this is all those systems that have lower costs and equivalent or better outcomes are heavily regulated or government-controlled systems. As is often the case with libertarian/wingnut fantasies, there is no real-world example of this mythical free-enterprise health care system that produces better outcomes at lower cost.
kay
@Bulworth:
Hah! Fat chance.
I remember everything they ever said, about anything :)
I love this, now, 2 years later. “Where are the IDEAS? Where are the SOLUTIONS?”
Where the hell were all these serious conservatives who want serious policy when they were drafting the law?
Wearing silly hats and crowing about “taking their country back”?
Chris
@Georgia Pig:
And their rebuttal to that will be that the only reason those faggy soshulist countries have low-costing health care is because they don’t pay for all the research and development that goes into creating all those new drugs that come from U.S. pharmaceutical companies. They just buy ours once they’re invented.
(And that, in turn, ignores the sheer amount of money from the U.S. federal government that goes into subsidizing that research and development. A free-market orgy it ain’t).
Edward, the mad shirt grinder
Very glad to see that it only took 4 comments before someone got the Graham Parker reference. Bruce Springsteen once called Parker his favorite singer (Springsteen sings backup on “Endless Night”)
Tsulagi
Not sure about “the stupidest,” but yeah I’d put the brilliance up there in the Schiavo range. Complete unforced error done to fluff their 27%ers with nothing gained from it while costing them long term.
eyelessgame
My fear – and it is a remote fear, amid the anticipation that we might actually have a message that resonates – is that we’re still moving the Overton window. I fear, just a little, that even if we can parlay this into some successes in 2012, it will become accepted wisdom – and thus something people will unconsciously start adjusting to – that the next time the Republicans are a majority (and someday they will again be the majority), they will eliminate Medicare. And it will be acceptable, because the nation will have become used to the idea.
Maybe that’s farfetched. But I’m just a little bit long-term nervous. (Short-term, I’m nervous that the Republicans will figure out a phrase that will counter this argument sometime in the next 18 months, and/or that no one will remember or care about this by then, but I’m even more nervous that the Democrats will totally screw up and blunt their own message.)
Bulworth
The math demands it!
Glen Tomkins
@Marc: Yes, and No
First, “No”.
Inertia rules. People usually follow their established habits, and when you get people in groups where at least a majority of them have to agree to get anything done, there’s even more power behind doing things the way they’ve always been done, because now an individual with what he thinks is a better idea has to persuade enough others to go his way to get a majority. That’s not likely, so that individual stays silent, and the group continues on its established trajectory.
This defeat in NY26 reinforces the inertial course of caution for the Rs, because it is just the latest example of the well-established principle that the social safety net is the third rail in US politics — touch it and you die. People have tried touching it in the past, and died, politically. This time out, their moderates were afraid of their teahadist radicals for awhile, afraid of being primaried, so they went along with the Ryan Plan. Now it’s failed in NY26, it continues to fail in polling, teahadist radicalism looks like it’s going to fail in the WI recalls and elsewhere at the state level, so we see the truism playing out again. They see it too, and Fox News is already starting to turn the propaganda machine around, already maneuvering to put out the word to their masses to back off. Teahadist leaders, I mean, insofar as they have true grassroots leaders, and the movement isn’t astroturf taking direction from Koch and Murdoch paymasters, will either go with the flow and back off as well, or see their following diminish to the point that they can no longer credibly threaten to primary the moderates in enough districts to matter.
I think that’s the most likely outcome here. This isn’t really new, the older players have acted out this drama before, and they will probalby revert to a familiar anti-clmactic ending to the Great Teahadist Revolt of 2011.
But, turning to “Yes”, I have to agree with you that cooler and wiser heads may not prevail in time, and things could spin out of control. The other side may blunder into a default crisis, on the force of, again, the inertia of more immediately recent events. Moderate Rs may think of the debt ceiling thing as just another hostage scenario, like that over a govt shutdown. They may be confident that the Ds will back down and pay the ransom, with no harm coming to the hostage, with no actual default. This false confidence might lead them to follow the radicals too far down the path, not fully appreciating that the debt ceiling is not a hostage to the radicals, that they don’t want ransom, they want to kill the hostage, they want default so that the US can’t continue to do what they characterize as “borrow and spend”.
You’re not going to find that many people will agree with this second scenario. The consequences are too dire, and there’s a too easy escape hatch available in the form of the first scenario, that everyone reverts to cautious type to minimize their losses, even if that means minimizing potential gains. I myself find it impossible to assign any odds to this crux, but I tend to think more about the second scenario, no matter how arguably unlikely, because thought is required only when things don’t proceed in well-defined ruts. You can just go with the flow as long as things proceed as they usually do.
Chris
@eyelessgame:
Don’t blame you. I never would’ve thought they’d be able to survive the double-fuckup of the Iraq war and the worst economic crisis in a generation, but it just made them double down on the crazy, and they’re still taken Very Seriously.
The country’s tolerance for right-wing lunacy is staggering, especially compared to the number of hoops you have to jump through on the other side of the aisle just to get as basic a message as “tax cuts don’t fix deficits” out.
Elie
@Church Lady:
..I take it that you think that the solution to the demographics is to cut the program/s? will the need for these programs disappear? What is the multiplier effect of paying providers for these services? Medicare and Medicaid beneficiaries benefit from the health care that the providers dispense, of course, but its the providers who receive income from the programs…. For social security, does taking money away from seniors impact our economy in any way — esp since the baby boomers are the largest demographic cohort coming along.
I challenge YOU to come up with a realistic alternative to your implied assertion that only cutting these programs is the effective solution…
redshirt
The real secret to understanding modern Repuglicans is they are, on the whole, stupid, and they believe they own lies, sincerely. It took me awhile to admit this to myself – “they can’t be that stupid, can they?” – but they can. They really can. Exhibit A: Sarah Palin.
Glen Tomkins
@Georgia Pig: Moral Hazard
On the whole, I would agree with your point about the non-existence of libertarian paradises in health care financing. But, as something I put forward to point up the irony of hyper-free-market enthusiasm, there are the examples of countries like France and Belgium that do health care financing through private insurers. There is govt regulation involved, but it isn’t really very tight. Doesn’t need to be. Private insurers in civilized countries have never been allowed to get the taste of human prey, so they don’t need to be kept so strenuously from eating their “beneficiaries”.
It used to be this way in the US. Before the Great Managed Care Revolution gave insurers the license to cut their costs by denying services (and pat themselves on the back for this, as a good and noble thing!), they pretty much didn’t except in cases of actual fraudulent claims. But boring old insurance that just sits back and collects premiums sufficient to cover claims it just pays automatically, isn’t very sexy, doesn’t have a nice sexy RoI. Of course, the idea of a health insurer actively and aggressively denying claims was billed at first as a necessary counter to those evil providers, who are admittedly, when allowed to agglomerate in large predatory wolf packs, quite evil in their own right. But the problem with preying on other predators is that they fight back. So the insurers ended up joining the big providers in the mutually profitable predation of patients and taxpayers and primary care providers, who are quite tasty and satisfying, if you can only get enough of them, and who can’t fight back.
Pre-managed care era, maybe the French system would have worked in the US. But not now. Now there’s nothing to be done but to kill off the private insurers. They say that once a tiger gets the taste for human blood, there’s nothing to do but shoot the beast. That may or may not be true of tigers. I have no experience of that beast. But I have 20 years’ experience with the US health insurer beast. It needs to be killed off before it kills my patients.
Georgia Pig
@Glen Tomkins:
I guess that depends on what you mean by “tight” regulation,e.g., you could have a regulatory system that is not very complicated, but has certain constraints that make it difficult for rent seekers to thrive.
Your learned insights confirm anecdotal evidence that I have seen. My mom was an OR coordinator for 35 years, and she said the culture changed completely for the worse when managed care came on in the 70’s and 80’s. Would attacking the insurers alone address the problem?
colby
To continue the Church Lady pile on…
I’m absolutely sick of the fallacy that you can’t criticize a jaw-droppingly bad idea unless you have a better idea of your own. It makes no sense, there’s no logic to it, it’s just a complete gutless dodge. And somehow, we only see it when Republicans create a complete national disaster- Iraq, the bailout, now Ryan’s budget…
In each case, the liberals said this is dumb and disastrous, and Republicans responded with, “Well, what’s your plan?” And yet, in each case, the liberals were proven right, the ideas WERE dumb and disastrous, and the liberals’ unwillingness to articulate a plan didn’t affect that one whit.
I’m not saying this as Lefty Uber Alles kinda thing; I’m saying this because the fact that I don’t have a plan doesn’t mean your plan isn’t completely fucked, or that I don’t get to say so (indeed, if I don’t have my own plan, I can claim a higher degree of objectivity about it).
slippy
Church Lady, I just want to respond to this:
With a hearty “go fuck yourself.” NO WE DO NOT NEED TO COME UP WITH AN ALTERNATIVE IDEA. We ALREADY HAVE AN ALTERNATIVE IDEA. It’s called MEDICARE.
Fucking asshole Republicans.
slippy
Church Lady, I just want to respond to this:
With a hearty “go fuck yourself.” NO WE DO NOT NEED TO COME UP WITH AN ALTERNATIVE IDEA. We ALREADY HAVE AN ALTERNATIVE IDEA. It’s called MEDICARE.
Fucking asshole Republicans.
Church Lady
@Glen Tomkins:
Thanks for your input from the perspective of a physician. As to the lung cancer patient, it was my father, and he wound up dying a little less than two years after the initial diagnosis. The course of the disease, and what he went through, was very frustrating to him and the rest of the family.
He was in generally good health, and was only diagnosed because the doctors were trying to figure out why his white cell count kept climbing even though he was on massive doses of antibiotics at the time. A chest x-ray, looking for pneumonia, revealed a very small spot, followed by a CT and then a Pet Scan, resulting in a diagnosis of Stage I lung cancer, followed by surgery for removal of part of his lung. We were told that chemo was not needed because it was caught so early and the margins were clean.
Fast forward about 15 months and an MRI they find a tumor in his lower back, which they say is from the original lung cancer, close enough to the spine that surgery is not recommended and will be treated with radiation instead. Even after radiation therapy is completed, he still feels bad. Another MRI shows cancer everywhere, in his lungs, liver, intestines, and who can remember where else it was. Of course, at this point it’s Stage IV and terminal. That is when they finally recommend chemo-not to cure him, but to perhaps slow down the progress of the disease and make the quality of his remaining life a little better. Two rounds of chemo later, the disease has continued its march and he throws in the towel and says “no more” and opts to enter hospice care. He was dead in less than two months. It was heartbreaking.
Looking back, I will always wonder if things might have been different if he had been treated with chemo after the initial surgery on his lung and he might still be alive. But, as with so many things in life, we’ll never know the answer.
Shoemaker-Levy 9
I don’t know how stupid it truly was. I think they genuinely believed they could finesse this the same way they do everything else, and given the propensity of Dems and the punditocracy to allow it to happen they had a reasonable basis for this belief. And since party leadership — meaning FOX, Rush, the Kochs, and so on — have been demanding a return on their investment the Congressfolk took a calculated risk. Let’s hope they keep rolling snake eyes.
debbie
@ Edward, the mad shirt grinder
As someone who slapped the Sparks tape cassette into my giant Walkman (the first model) every night while walking home from work, I recognized it right away. In fact, I’ve been singing it to myself for most of the day. If it weren’t in the 80s here and humid, I’d drag out the CD and play it unlawfully loud. I mustn’t get riled.
jefft452
“I am seriously asking this: what would you do to change Medicare, Medicaid and Social Security to keep them solvent, given the coming demographic changes?”
Yes, we all know Medicare is 15 years away from bankruptcy. Paul Ryan says so, just like Newt Gingrich said 20 yrs ago, and Jack Kemp said 40 years ago.
Still, its in better shape then Social Security, that’s been 15 years away from banckruptcy for 80 years now
Just Some Fuckhead
@jefft452:
I’m stealing that.
jefft452
Cool!
Now I can proudly say that I have been shamelessly plagiarized
Ps
I stole that line