Relevant and even prescient commentary on news, politics and the economy.

More On the Real Reason Healthcare Insurance Companies Are Now Encouraging Obamacare Enrollment

In light of some of the comments to my post yesterday arguing that that the real reason that healthcare insurance companies are now madly encouraging Obamacare enrollment is fear of a pro-public-option or pro-single-payer political juggernaut, I want to make clear that by single-payer I do not mean Medicare-for-all.   Single-payer would be, in essence, “the public option” extended to everyone rather than limited to the 5% of Americans who have private healthcare insurance through the non-group (i.e., non-employer-provided) market.  It is not tax-funded identical-for-all healthcare insurance, which is what Medicare is.  I do think that eventually this country will have Medicare-for-all-type healthcare insurance, but not in the near term.  If single-payer works well, then of course that would be the longterm solution, with no need for Medicare-for-all.

I also want to make a point about federalism as it relates to the ACA insurance-market exchanges and, especially, to Medicaid and, for that matter, to any other federal social-safety-network program.  I said in my post yesterday what I think is obvious: that federalism has been a disaster for Obamacare.  But I want to point out that the only reason that Medicaid works under current pre-Obamacare Medicaid is that that program came into being and was effectuated before the hard-right turn of the Republican Party.  Ditto for food stamps.  The really weird, but successful, argument by rightwing governors and state attorneys general to the Supreme Court in the ACA litigation on the Medicaid-expansion provision in the ACA is that, well, y’know, now that traditional Medicaid has been a part of each state’s law for decades, and is popular, it would be politically impossible for state legislators to end that program–the result under the ACA as the statute was written, if a state refused to agree to the ACA Medicaid expansion.  This, they argued–successfully!–meant that the ACA was effectively coercive of state  legislators and therefore infringed upon state sovereignty.  On that “ground,” the Supreme Court struck down that part of the Medicaid portion of the ACA.

That’s also known as the  conservatives-having-their-cake-and-eating-it-to theory of constitutional law.  The argument was so deeply hubristic that its actual success is stunning and outrageous.  But I have no idea why anyone would think that federalism must be a part of a national healthcare insurance law. It does not.

As for whether or not the public will catch on that the main problems with the Obamacare-exchanges-and-private-policies part of the Act is a failure of the healthcare insurance market and of the healthcare market itself–a question that several commenters raised–well, that was what my post was about.  Yes, the public will catch on, once the Dems have a smart, committed, knowledgeable and articulate spokesperson with a high enough national profile to educate them about it.  I expect that that will happen fairly soon.

Finally, although this should be the subject of a separate post, a hallmark of the current Supreme Court is how many really weird, outlandish rightwing arguments the current conservative-legal-movement five-member majority have made the law of the 50-state-soverign-lands.  As I said in an ignored post here last weekend, the Court’s neo-federalism-on-steroids jurisprudence has quietly but profoundly and thoroughly upended federal-in-relation-to-state constitutional law as it had existed since the post-Civil War era. This is a deeply dangerous juggernaut.

I wish more readers would read that post.  It does deal with really important stuff. Honestly.

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In the Short Run, We Are All Dead. At Least According to That New Oregon Medicaid Study.

Well, we AB types–readers and writers, alike–are familiar with John Maynard Keynes’s famous line that “In the long run, we are all dead.”  By which he either meant that economists, if they are to be useful, must try to predict and recommend short-term government policies that avoid or help end current, severe economic downturns, rather than just predicting long-term economic results, or instead he meant that since he was gay and had no children, he didn’t care about the long-term economy and wanted economic policy to concern itself only with the here-and-now and never with the long run.

It’s a fielder’s choice, if you ask me.  Which is why you shouldn’t ask me.  And you shouldn’t ask Niall Ferguson either.

Conveniently, in the very same week in which high-profile economists are debating what Keynes meant, we learned that a study of the effects of access to healthcare insurance (in that case, through Medicaid) shows that access to healthcare does not reduce cholesterol levels, blood pressure, or blood-sugar levels, over a two-year period among people who have elevated levels of one of another of these ailments and who were not previously receiving medical treatment for them because they had no insurance. At least it did not in Oregon, where the study took place, for the sampling involved.

The study is being widely interpreted as showing that healthcare insurance does not improve actual health, and has lead some people to suggest that this means that we should not have healthcare insurance at all, whether publicly or privately financed.

But that’s ridiculous. Or at least it’s insufficient as a response.  What the study obviously shows is not simply that we shouldn’t have healthcare insurance but that we shouldn’t have healthcare. We should not have medical care.  At all.  No doctors, no hospitals, no prescription drugs, no medical devices.  None of it.  We’re spending huge amounts of money on healthcare, and now we know that it doesn’t improve health!

In the long run, we are all dead.  And if you have no access to healthcare and have, say, a heart attack, a stroke, cancer, a diabetic coma, or a serious physical injury, you may well die without medical attention even if you would have lived if you’d had medical attention. In the long run, we are all dead, and in the short run those who have a life-threatening illness or injury and no access to medical care may be too, even if access to medical treatment might have lengthened that run quite a bit.*

So we need to end the medical-industrial complex, because, after all, how much difference is there, really, between the long run and the short run?  Lipitor, insulin, and blood pressure medications are okay, I guess, if you have nothing better to spend your money on.

But even if you don’t, why throw your money away on stuff like that, when those things don’t even improve your health?  And, as for the government and Medicaid, and Obamacare, and Medicare, and all that: Well, what’s that line about, families are tightening their belts, so the government should, too?

At least now we’ve finally found the way to stop healthcare inflation.  End healthcare itself.

*Paragraph rephrased and clarified after initial posting, to avoid possible misinterpretation.

___

UPDATE:  This post, though obviously satire targeted at the rightwing’s conclusions about the study, also is intended to raise what seems to me a critical medical question that, to my knowledge, no one else has asked: Does the study indicate that the treatments for high cholesterol, high blood pressure, and early-stage diabetes are ineffectual?

It may be that the diet recommendations given to these new Medicaid patients–less salt, low sugar, lower-cholesterol diets, respectively–weren’t adhered to by most of the patients.  Or it might mean that, once diagnosed with one or another of these illnesses, those in the study who did not get Medicaid nonetheless changed their diet somewhat in light of the diagnosis.  Or it might mean that the medications that were prescribed for the Medicaid recipients who did obtain medical treatment are less effective than thought–which strikes me as something that should have been the headline takeaway, but obviously was not.

If there’s some other possible meaning to the study’s results, what is it?  Seriously.  If these treatments are medically ineffective, isn’t that something that the public should be told?  And if the treatments are effective in the general population, then why would these very same treatments–specifically, the medications–not work with the Medicaid recipients in the study? And, why aren’t these the questions that the pundits are asking?

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Medicaid Austin Frakt, Aaron Carroll and Kevin Drum are Good for the USA

by Robert Waldmann

An important study of the effect of Medicaid on health was published in the New England Journal of Medicine.  The study was based on a genuine experiment where some people were given Medicaid and other people weren’t based on a lottery.  Unfortunately, the results were communicated with a NEJM  press release and not just the published article.  The results as received by the press is that Medicaid did not cause significant effect on recipients’ health (except for significantly lower depression) which was interpreted as the study providing evidence that Medicaid does not improve health.

This means that somehow someone rejected the alternative.

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Rep Marsha Blackburn’s snow job. Explains how Social Security money flows

I was watching C span Washington Journal this morning.  Rep Marsha Blackburn was the guest.  I got to listen to her explanation of how the Social Security funds flow and just had to post the clip.   Copied from the transcript of the clip:

THEIRS MONEY THAT GOES TO MEDICARE AND SOCIAL SECURITY AND I THINK IT IS JUST IS SO INAPPROPRIATE THAT THE FEDERAL GOVERNMENT DOES NOT USE THAT AS A TRUST FUND BUT THEY MOVE IMMEDIATELY TO THE GENERAL FUND AND STACK UP IOU’S THAT ARE SITTING IN A CABINET IN WEST VIRGINIA.

What she says should not be allowed to stand and if C-span were half of what it used to be, she would not have had the following go uncorrected.  Thus I leave it to the Angry Bears to correct her here and thus document her ignorance of the subject. 

I have not watched this lady before.  I could not help but think she is just a more polished version of Sarah Palin. She is totally capable of pulling off what we used to call a “snow job” when writing their essay.

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The "Fiscal Cliff" and the Coming Retirement Crisis of the Middle Class

On January 1, Congress approved a tax and spending bill to avert the so-called “fiscal cliff” combination of tax hikes and spending cuts that would have created deflationary pressure on the United States (though Yglesias questioned the conventional wisdom of whether it would necessarily cause a recession). Let’s take a look at the deal in some detail, then proceed to the gruesome details of what will happen around the Ides of March.

From Think Progress, here are some of the more critical parts of the deal.

1) The Bush tax cuts expire on only about 0.7% of households, those earning more than $400,000 per year as an individual or $450,000 for a couple. This brings in $600 billion over 10 years. Since rich people don’t spend as much of their income as the poor and middle class do, this is less deflationary than a tax increase on the middle class, as I discussed in November.

2) With the expiration of the temporary 2% payroll tax cut, 77% of households will see their taxes go up. Indeed, every single income group will, on average, see their taxes increase, as shown below (via Matt Yglesias):

1357144024996

Since this hits the middle class more directly, the deflationary consequences are larger than they would be for an increase in taxes on the rich. On the other hand, this strengthens the long-run funding of Social Security, an issue I will return to shortly.

3) Unemployment insurance is extended for two million workers. This will get spent and have a definitive stimulative effect on the economy.

However, the second shoe of the fiscal cliff, the automatic cutbacks known as the “sequester” was simply postponed for two months, which is the same time that the Treasury Department will run out of creative ways to keep the country from exceeding the debt ceiling, which it hit on December 31.

Combining these two negotiations, the debt ceiling and the sequester, will be an extremely high-stakes battle where the middle class has a lot to lose. The big problem here is that some Tea Party Republicans really do want to use the debt ceiling to take the economy hostage and force cutbacks in Social Security, Medicare, and Medicaid. Despite the fact that Republicans lost the Presidency as well as both Senate and House seats (with a majority of the votes cast for the House going to Democrats), they see their gerrymandered House majority as giving them license to wreak havoc.

The consensus among most commentators (Krugman, Klein, and Yglesias, for example) is that the fiscal cliff deal will work out okay as long as the President does not cave in to the Republicans’ threats over the debt ceiling.  I agree as far as that goes. But, as Yglesias points out, there is nothing great about what Klein says is the most likely scenario, where the President gets $1 trillion in new tax revenue for $1 trillion in cuts over 10 years. That is still $2 trillion in austerity measures at a time when unemployment is barely below 8%!

The looming problem rarely mentioned, even in the context of the Republican campaign against Social Security, is that my children’s generation (Generation X, if you will) faces a retirement crisis that many of my generation will avoid, based on the end of pension plans. According to one Social Security Administration report, the percentage of private-sector workers with a traditional defined-benefit pension plan fell from 38% in 1980 to 20% in 2008. Over the same period, private-sector workers who only received defined contribution plans rose from 8% to 31%. Note that this means that 49% of private-sector workers are not covered by any pension plan at all. Moreover, while governments have more commonly provided defined-benefit plans than private employers have, they are under attack in many states.

Let’s do the math. With 49% of private workers having no pension, and another 31% having an on-average less generous defined contribution pension, how will seniors support themselves if Social Security is cut? Hint: It won’t be pretty.

Get ready for a bumpy March.

Cross-posted from Middle Class Political Economist.

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Let’s try to stick to the real world when we talk about Medicaid,

The Incidental Economist addresses election snippets that keep on going, just like in the movies.  Read the whole thing:

Let’s try to stick to the real world when we talk about Medicaid, by Aaron Carroll:

(Note: Paul Krugman cites here. Tyler Cowen responds here. I respond to Cowen’s response here.)

Tyler Cowen had a piece in the NYT this weekend on Medicaid. He doesn’t seem too thrilled with its use in the ACA’s coverage expansion.

… I have to admit that his article set me off a bit. It could be that he didn’t have space in the NYT for more nuance. Perhaps he’ll provide it on his blog. In particular, I’d love him to address some of the points below…

I get a bit annoyed by blanket claims that doctors won’t accept Medicaid….
I get a bit annoyed when people just claim government programs are “unpopular”…
I get a bit annoyed at the blanket acceptance of the awesomeness of the free market in health care, when there is no phenomenal evidence of its success…

Look, I get that people may not like the political implications of those systems. They may not like the governments that produce them. They may not like the lack of choice  inherent in such systems. They may not like the potential  limitations within them for making money, and therefore for innovation. But we need to stop making stuff up about them.

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Health Care Thoughts: Another Major Event

by Tom aka Rusty Rustbelt

Health Care Thoughts: Another Major Event

On the 23rd the Obama administration will publish the administrative regulations for Medicaid expansion.

http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/REG-03-16-12.pdf

As reported by Modern Healthcare, eligibility will be simplified to an income test as a percentage of the federal poverty level. This may expand Medicaid by as many as 17 million recipients by 2016. There are a number of administrative issues addressed, many focused on simplifying and streamlining processing.

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Town Hall Meetings on the Ryan Budget Raise Concerns

Various congressional representatives held town hall meetings recently, and the news channels and print media were abuzz with the lively give-and-take, including shouting matches. See, e.g., House G.O.P. Members Face Voter Anger Over Budget, New York Times, Apr. 26, 2011; Republicans facing tough questions over Medicare overhaul in Budget Plan, Washington Post, Apr. 22, 2011.

The issue–the House’s adoption of the Ryan budget proposal and its clear agenda of overturning New Deal safety nets embodied in the current understanding of Medicaid, Social Security and Medicare.

Those at or near retirement are worried that the Ryan proposal will hurt everybody. The Ryan proposal comes with frequent disclaimers about protecting the already older population and needing to act now to protect our grandchildren, a clear effort to massage the message to appeal to current grandparents. See, e.g., House G.O.P. Members Face Voter Anger Over Budget, New York Times, Apr. 26, 2011 (noting Webster’s statement that “not one senior citizen is harmed by this budget” while implying that it is necessary to prevent grandchildren from “looking at a bankrupt country”); Congressional Republicans go home to mixed reveiws, CBS.com, Apr. 26, 2011 (noting North Carolina GOP Rep. Renee Ellmers’claim that “If you’re 55 and older, your Medicare and Social Security will not change”).

But the Ryan proposal clearly envisions mechanisms that would likely lead to decimation of these programs–either through turning them into limited vouchers (Medicare proposal); turning the funds over to the states to use as they see fit (Medicaid proposal) or limiting benefits (Social Security proposal) in ways that will –probably sooner rather than later– hurt everybody.

  • These proposals take place in a context of expansive, concerted attacks on these “entitlement” programs, often failing to acknowledge the historic support for these programs or their foundation in the recognition that federal support is required to protect against the abject poverty and humiliating degradation that accompanied the Great Depression;
  • Benefits for elderly and sick Americans are cut to provide savings to offset some of the loss of revenues from tax cuts for Big Business and the wealthy, both of whom already pay relatively low taxes, in what hardly seems a bargain to the working poor, the elderly or in fact the overwhelming majority of Americans who are not in the top 15% income or wealth distribution. (This in spite of Ryan’s claim that there is no huge tax cut for big corporations and the wealthy–he asserts that the proposed 25% rate is “in exchange for losing their tax shelters”. See, e.g., CBS.com Evening News coverage of Paul Ryan holding Wis. town meetings, at http://www.cbsnews.com/video/watch/?id=7363939n&tag=related;photovideo )
  • In spite of the high cost for the vulnerable poor and elderly of these budget proposals, they don’t appear likely to achieve their proffered rationale of reducing debt and deficits–in fact, the CBO has said that the Ryan budget proposal will result in higher deficits and bigger debt burdens over the next decade.
  • It appears shortsighted to wring one’s hands about a “bankrupt country” while considering only one potential solution, especially when that solution is highly detrimental to the most vulnerable populations, and without considering the full facts regarding the amount of debt, the ability of the U.S. to weaken the dollar further to aid unemployment and debt payment, the ability of the U.S. to raise taxes judiciously rather then merely cutting spending, or the ability of the U.S. to let the tax law play out as it is currently slated to do (with the Bush tax cuts that were extended 2 more years over their originally intended short life due to sunset in 2012). As Jim Johnson, a former Ryan supporter who has “grown increasingly disgusted” with Ryan noted, “[Ryan] says Medicare is unsustainable. I’m thinking, ‘Yeah, it’s because medical costs are out of control.’ …Why isn’t he attacking it at that level?” Congressional Republicans go home to mixed reviews, CBS News.com
  • Any voucher system for health care will inevitably fail to cover increasing health care costs, resulting in rationing even the most basic health care by socio-economic class–the very problem that Medicare, Medicaid, and the limited health care reforms undertaken by the last Congress were intended to address. The Center for Budget and Policy Priorities concluded that out-of-pocket medical costs would skyrocket for low-income seniors; the Washington Post’s Fact Checker Glenn Kessler (in GOP Lawmakers tout Medicare reform by stretching a comparison to the health benefits they receive, Apr. 29, 2011) notes that the CBO analysis concluded that the Ryan Medicare system would pay only 32% of health care costs by 2030, compared to 70-75% if traditional Medicare remained in place.
  • Addressing the problems in the U.S. health care system solely by market means that put the onus on health care recipients to seek cost-savings has failed miserably over the last forty years and cannot help but fail more spectacularly when the Medicaid backup is weakened and the nature of health care needs is such that one of the best antidotes to market problems (the only one permitted in radical market thinking that objects to regulatory safeguards)–informed consumers who can review options and select among competing providers–is simply not applicable. Car accident victims don’t shop for surgeons; cancer victims don’t know enough to select based on price; etc.
  • The Ryan proposal appears one-sided in its decision to cut spending on potentially vulnerable populations rather than to address the means through which health care is provided or to consider ways to control profit-taking in the health care system. The market ideology of the proposers leaves many options that might work better off the table (single payer; tax on excessive compensation; revamping the non-profit hospital system; attaching strings to the R&D and other tax expenditures in the tax code; using the clout of a national system to negotiate better doctor and drug pricing for Medicare and Medicaid, etc.);
  • Many of those states that would acquire more control over the use of Medicaid funds are controlled now, as is the House, by people who have announced their intent to cut taxes on the wealthy and business while cutting or taxing pensions and health benefits for public employees and cutting funds available for Medicaid and other poverty-directed programs; it is not a difficult leap to see the interrelationship of these trends;
  • Plans to cut benefits for those who may enjoy them in the future pave the way in at least two ways for decisions shortly thereafter to cut benefits for those who currently enjoy them: first, by creating lowered expectations; second, by creating an unfair disparity that supports an “us against them” attitude between the current elderly and those who will get lesser benefits in the future. (Note that this resembles the way the right has encouraged an “us against them” attitude of private workers, who have been deprived of union benefits through the harsh anti-union tactics used by Big Business, against public employees, who have generally benefited in the past from more reasonable attitudes towards unions fostered in legislative bodies that have, in the past, understood the nature of the bargain that public employees make (which might be summarized as ‘work hard, get paid less than you could in the private sector, and accept later benefits in pensions and health care for lesser salary/percs now).

Is is surprising that left-leaning activist groups like Move-On point to the Ryan budget proposal as a “naked, unapologetic attack on working Americans for the sake of Big Insurance and the riches of the rich” (quote from Move-On email on this matter)?

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What Will We Tell the Doctors?

“The practice of medicine was accepted to be a chancy way to make a living, and nobody expected a doctor to get rich, least of all the doctors themselves.”  – Lewis Thomas, The Youngest Science, p. 4 (Penguin, 1995 edition, quote via Google Books)

Lost in the discussion of Paul Ryan’s “plan” is the group of entrepreneurs that will be most harmed economically by enacting it: doctors—most especially general practitioners.

I was speaking with David Warsh last week at Kauffman, and pointed out what “everyone knows” but no one will say: U.S. doctors net about twice as much money as doctors in the rest of the civilized world. (As a ballpark, $200K in the U.S. and $100K elsewhere.)  And until you can solve some of that, you won’t really make much of a dent in the High Cost of Medicine.  David noted that solving that “isn’t going to happen.”

Paul Ryan’s plan is a large step toward making it happen—just not in the way David (or I) would have expected it to happen.

Let’s sidebar the usually Capitation v. Fee-for-Service discussion, which will only have an effect at the margin.  Assume that doctors net, say, $25 per patient (net of paying for office staff, supplies, waste disposal, etc.).[1]  If they schedule four patients per hour ($100)[2] for eight hours a day ($800) five days a week ($4,000) for a fifty-week year ($200,000), they make their salary.

Note the assumptions I made: the per-patient return is certainly variable (standard MC/MR curve), so the real return is based on volume and where that volume falls on the MC curve.  So long as a doctor can schedule to see 160 people a week—8,000 visits a year—they are continually busy and receive optimal returns.

But the market is not perfect.  I am of an age where a few visits a year is strongly suggested.  Tom or Rebecca, by contrast, go in once (if at all) and otherwise when they are unhealthy.[3]  It seems intuitive that, given search costs (think labor markets), a doctor’s practice is marginally more profitable with more repeat patients. Customer retention is therefore of enhanced value in the current equilibrium.[4]

But shifting the burden of payment while not capping insurance margins is also an easy first-order solution: fewer insured people, certainly; higher margins, probably (positive, maybe not significant), shifting of funds toward the sector that reduce overall consumption, and—inevitably—fewer doctor visits for the older and most likely to need care.

Note [4] above becomes relevant on the supply side; the relationship is weaker if still positive.  But the discretionary spending is reduced; Fee-for-Service fades except in the “concierge” segment of the market.  Capitation becomes the rule, and the model that has become prevalent—insurance companies guaranteeing doctors a salary—become the rule.

But visits to the doctor have declined, due to those most in need having the least ability to pay and therefore dropping off the insurance rolls.

So the insurance company doesn’t expect the doctor to make 8,000 separate treatments a year.  Or they do, but find at the end of the year that they were mistaken. The next year they offer to pay based not on 32 patients a day, but rather 30. And, given the frictions in the market, the majority of doctors agree, preferring the certainty of $187,500 a year to the risk of treating the uninsured, who are now a much riskier group.

And then the multiplier effect comes in.  Recall that there are fixed costs as well; doctors’s returns mirror the standard MC/MR curve.  So the actual loss begins gradually, but becomes steeper as the years go by—convexity effects appear.

Eventually, doctors have to right-size their practice. The current trend toward Vertical Integration may mitigate effects in the short term. But eventually—probably within 15 years, though it may take 20—doctors will find that their salaries (“net capitation fees”) are significantly closer to those of their European and Canadian peers.

Coincident to its effect on the poor and the elderly, Paul Ryan’s plan will speed the convergence of doctors’s salaries in the world.  The aspiring doctor in the Harvard Class of 2037 may well look at Lewis Thomas’s thoughts of one hundred years previous and say, “Nothing ever changes.”

The question that remains today is “What will we tell the doctors?”

[1]When I looked a few years ago, my doctor was paid $41 for my $125 office visit from insurance, and I had a $15 copay.  If you can’t figure out how $56 gross can become $25 net, go into a heavy-service industry, such as restaurants or doctoring, and look at their cash flows.

[2]Note that there is no inherent need to conform to the schedule, assuming the patients are not time-constrained.  That is, one can spend longer with patients—more than eight hours in a day—and maintain quality of care at the expense of leisure time.  This is a fairly simple equation and is left for when this isn’t a blog post.

[3]Again, the equation to show when the marginally-unhealthy choose to visit the doctor is left as an exercise. All we need for blog post purposes is to know that the choice is dependent on several factors, including disposable income and out-of-pocket cost.

[4]This is in no small part, at the margin, due to the support of the current Medicare/Medicaid system.

[5]Contracts still require both parties to consent, and the 6.6% decline is the net result—one might assume that some insurance companies will reduce their margins to pay doctors more.  One might also assume a pony with a pointy thing sticking out of its forehead with equal likelihood. There may well be a chimera of hope—though the scenario only extends the timeframe instead of ending the process—but it will not be sustainable, though it may be iterative (which would further attenuate the process).

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Whatever happened to the Guns or Butter premise

by Run

Whatever happened to the Guns or Butter premise?

Naomi Freundlich at Maggie Mahar’s Health Beat Blog discusses the passage of the $26 billion state aid package and why it does not go far enough in securing healthcare for those who qualify for Medicaid. Passage of $26 billion State Aid Package Is Merely a Stop-Gap Measure For Medicaid Woes.

To get this past the Senate, the bill was stripped of $12 billion Food Stamp Program and closed loopholes in incentives which encourage employers to move jobs overseas to make it revenue neutral. While it is good to see Congress start to close loop holes for companies and individuals who utilize them to their own benefit and not for what they were intended, you have to wonder what were they thinking when it came to the food stamp program. In the midst of a mediocre job creation economy with no end in the near term, the millionaire Senate balances the budget on the backs of the poor who depend upon Food Stamps . . . 41 million citizens in 2010 . . . to get Senator’s Snowe and Collin’s votes. The kicker here is the Senate playing Education off against healthcare and food stamps. Education, healthcare, or food ???



Even with the adjustments, the always neatly groomed, with the Edwards haircut, and nattily dressed John Boehner calls it a pay off to Union bosses and liberal special interests. Ohio did register its uninsured numbers at 13.9% of the population which many would probably qualify for Medicaid if unemployed long enough. Then there is Joe Barton of Texas complaining about the extension also. Yep that is Texas, the number 1 amongst all of the states with the highest number of uninsured at 26.9%. Hey at > than 1 in 4 residents without healthcare what could John really say other than:

“There is no emergency!”

Maybe there is no emergency for Rep. John Barton who is covered by the congressional healthcare plan and maybe we can blame the number of uninsured in Texas on illegal and legal Hispanic immigrants? Wonder what was he thinking?

“80 percent of those the Gallup organization or the Census Bureau would count as uninsured are actually U.S. citizens. “If we took all the immigrants out of Texas—legal and illegal—we would still have the highest uninsured rate in the country,”

says Eva DeLuna, a budget analyst at the Center for Public Policy Priorities (CPPP), an Austin-based think tank. Texans are Mostly Likely

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