More Lies
After almost 8 years the Party of NO and me too, the Republican Party through Mr. Paul Ryan has announced its sketchy version of a national healthcare plan. There is nothing unusual (maybe I should not say this, as distortion and out-right telling lies is unusual) or earth shattering being offered in Mr. Ryan’s plan. For sure, Mr. Ryan’s plan lacks many of the things the PPACA offers today. I do not want to get tied up examining the detail right now so I will move on to something else I wish to point out
Riding on the back of Mr. Ryan’s plan is a complaint, a complaint the PPACA leaves many people without coverage due to its design. As read in Mr. Ryan’s plan;
“as a result of Obamacare’s poor design and incentives, many Americans — who do not have an offer of health insurance through their employer— have fallen into a coverage gap between their state’s Medicaid eligibility and the eligibility criteria for the Obamacare subsidies.”
This statement in Mr. Ryan’s Plan is a blatant lie perpetuated by Mr. Ryan and the Republicans. 19 states did not expand Medicaid to cover their citizens up to 138% FPL. These states were allowed to do so by a SCOTUS ruling supported by Mr. Ryan and Republican. Furthermore, Republicans in their efforts to block anything done by Barack Obama made it clear they would not allow the PPACA to be expanded to cover those citizens who fell into this gap.
Maybe people are immune to the lies coming out of Congress and subsequently do not comment on such an outrageous lie fostered by Mr. Ryan. They are quick to complain about the PPACA and slow to call out Republicans for their lies about the PPACA, which is far better than what is offered by the Party of No.
Ah well run. I have heard people in HR say Obamacare was responsible for their companies moving production to Mexico….but the figures were ‘unknown’. Or a relative saying he would start a tiny business of 2 but for the burden of Obamacare. Or even the continuing chaos of for profits hospital growth and floundering cost cutting happening in health care well before Obamacare…..or the collapse of rural hospital care in parts of the US…god knows there are enough more basic and real problems in our health care system than this program.
Ryan continues to be described as a ‘wonkish’ Republican in main media, which in rhetoric might be true but in actual proposals is a joke.
Right – this is not the result of poor design of the PPACA as passed, but of the poor design of the PPACA as re-written by the Supreme Court, and then the many GOP state governments’ refusal to expand Medicaid, and also overly restrictive ‘old Medicaid’ rules in many of those states. A person must have income at least equal to the federal poverty level (FPL) to get PPACA subsidies. People below that should (in my opinion) have been eligible for Medicaid even before it was expanded, but in many states they are not. These states just do not want poor people to have health care. But when their hospitals’ profits suffer from having to treat poor people in their emergencies rooms, some of these states demand that the federal government subsidize the hospitals.
“When their hospitals’ profits suffer from having to treat poor people in their emergencies rooms….”
Why do they have to do that?
Warren:
I see where the question came from and can answer. Prior to the PPACA, hospitals were subsidized to take care of the uninsured. With the passage of the PPACA, the poor or those under 138% FPL were supposed to go on Medicaid. As a result, the PPACA started to cut back on payments to those hospitals including in those state which did not expand Medicaid. So they can either turn people away or care for them without federal subsidy. Rock and a hard place the Republicans have placed their constituency in as well as hospitals.
run
“(maybe I should not say this, as distortion and out-right telling lies is unusual) …”
on the contrary, distortion (les) are the usual subtance of political speech. they don’t like to be caught in statements that can be demonstrated to be entirely contrary to any truth, so they usually just combine arguably “truish” “facts” and hysterical innuendo to lead people to draw false conclusions… which they repeat to their friends as “truth.”
coberly:
I try to give them the benefit and you are correct I should not assume so. This plays out to people actually believing this liar.
mr ryan was asked by a reporter once to explain one of his claims. Ryan replied, “you don’t want me to get all wonkish on you.”
and this is his schtick. pretend to be knowledgeable while repeating the lies created by his sponsors think tanks.
but of course the reporters don’t want him to get all wonkish. in the first place the reporters wouldn’t know enough to see the lies and distortions and they know their readers don’t want to read anything that makes their heads hurt.
Once again, here a piece of wisdom written 200+ years ago by a “policy wonk” who led the now defunct Jacobins of Paris. Human behavior doesn’t change unless a significant bit of drama is added to the schemes we play.
“When, then, will the people be educated? When they have enough bread to eat, and when the rich and the government cease bribing treacherous pens and tongues to deceive them; when their interests are identified with those of the people. When will this be? Never.” M. Robespierre c. 1790.
Run, you just don’t understand. The poor design he’s talking about is the part of the statute that prohibits states with Repub governors or Repub legislatures from access to the Medicaid expansion.
And the poor incentives are the ones that encourage only Dem-controlled states plus Ohio and Arkansas to accept the expansion.
I know that the statute is long and complex–which I guess explains why you’re not aware of those parts of it.
Anyway, I completely agree with Ryan that this is totally unfair. I think it’s downright unconstitutional!
But it does explain why if you stand right smack on the state line between, say, Illinois and Indiana, facing, say, north, and look toward your left you won’t see any residents who are caught in that gap, but if you look toward your right you’ll see many. At least if you’re near a small town, rural area, or large metro area.
In other words, the dog ate the Repub states’ homework.
It is amazing that at this point any reputable media outlet takes anything Ryan says seriously or at face value.
Ryan and his colleagues have failed to offer one single piece of legislation that improved upon PPACA, preferring instead to repeatedly offer repeals that are nothing other than political stunts since they can’t get 60 votes in the Senate and they certainly couldn’t come close to withstanding a presidential veto.
They call themselves “conservatives” but in reality they are reactionaries steeped in denialism. It has been 80 years since elements of the New Deal passed yet a significant part of the Republican Party refuses to accept the basic safety net and labor protection elements of legislation that was both broadly popular and clearly elemental in bringing basic economic success to broad swaths of the population.
Up until Reagan all but a relatively small minority of the Right accepted the basic premises of the New Deal. What began as Goldwater taking up the cause of a disaffected fringe became ensconced as the primary driver of the Republican Party. Later iterations went even further off the deep end. Seriously, when a so called policy wonk can argue that one of his primary influences is Ayn Rand and not get laughed out of the building it’s clear that a significant percentage of the political class is no longer speaking the same language.
Ryan has consistently offered up these things he calls plans that are little more than wishlist letters to Santa or the great libertarian Unicorn. I can’t think of one instance where he has actually codified these so called “plans” in a piece of legislation, certainly nothing that had any chance of passing or being anything other than a stunt.
Ryan simply ignores the fact that SCOTUS rewrote PPACA in a way that radically changed the potential of the legislation. But of course he would because anyone who actually listens to him understands that he doesn’t give a rat’s ass about health coverage or insurance costs. What he cares about is some sort of Randian Libertarian Utopia and as such every utterance that escapes his lips ought to be met with a resounding cry of “Bullshit”.
The philosopher Michael Patrick Lynch has written extensively on the subject of Reason. His discussions are not reductionist in some ultimate utilitarian embrace of technocratic scientism but a fairly robust acknowledgement that even if we accept Hume’s position that reason is a slave to passion that as decent, (should I dare say) civilized human beings we owe each other reasons, arguments for the positions we hold.
Paul Ryan and his ilk completely reject this most basic level of human discourse in favor of a tautology. Ryan argues he is correct because he believes he is correct. He offers no evidence for the correctness of his views (he may offer made up “evidence” but that is a different game). He offers no moral justification that goes beyond a three year old’s, “because I wanna”. What he offers is a facade of certainty honed by the techniques of hucksterism buttressed by an unrelenting willingness to deny any reality that fails to match the one he has created for himself.
But he has a nice dark Irish look and blue eyes.
Indeed he does. Which is why his proposal would pay the medical bills of everyone in the gap.
Or so, let’s bet, the news media will pretend by simply not pointing out that quote that run quoted and, well, refuting it.
Wouldn’t it be nice if maybe, um, Clinton pointed out that quote and, y’know, refuted it?
And please, please do not–any of you–do not say that the public is too dumb to understand this. I mean, how hard is it, really, to understand if you’re, say, a West Virginia, Pennsylvania or Virginia resident that Delaware, Maryland and, heck, even Ohio have no such gap?
once Obama leaves office those 19 states will defect faster. That is if the law survives. That we are here talking about a potential future where the law does not survive also involves the other major political party. Schumer was effectively right that Dems did this wrong. Let’s pay for it by taxing good union health plans and obligating folks who don’t want insurance to buy it. If that later doesn’t work, well the premiums and deductibles for people who in the past have insured their families can go up enough to fund the sicker folks who’ll benefit here. Also let’s write a Medicaid expansion that half the non-nuts justices can’t permit either.
Eric:
What do you believe group healthcare insurance does?
Yeah. Which is why although Clinton can’t say so now, given her asinine statements about Sanders’ single-payer proposal, I think that one of the first things that will happen if the Dems keep the WH and win back control of both houses of Congress is a public option with subsidy for everyone who needs it, to begin in 2018, as an intermediate step toward single-payer.
And this time there will be Sanders and Warren to explain and campaign for it. And, who knows, maybe this time even our Dem president will deign to do so, too.
But I do want to point one thing out to you. Breyer and Kagan almost certainly agreed to go along with the striking down of the Medicaid-expansion “stick” incentive not because they actually think it’s unconstitutional rather than ridiculous but instead because that was the price Roberts extracted for his vote to uphold the rest of it.
Roberts, understandably, did not want the idiotic Medicaid-incentive part of his opinion to be only 5-4. And since, whether stricken down 7-2 or instead 5-4, it still would be stricken down, so it was a sacrifice that Breyer and Kagan were willing to make. Very much correctly, in my opinion.
Bev:
What is single payer and how many countries have it?
Dale, I dislike Breyer and Kagan, a lot–especially Breyer–and am planning to post on a really awful thing Breyer did in making up the deciding vote in an outrageous Fourth Amendment opinion released last Monday. Really, really awful. But not all that surprising, for Breyer.
But the Medicaid issue in the ACA case was a purely Conservative Legal Movement states’ rights issue that, truly, no one not part of the Conservative Legal Movement would have joined under normal circumstances.
Dale and I are two distinct people.
Funny.
I was trying to respond to Dale’s post posted yesterday at 11:45 p.m. I’m typing on my phone now; otherwise I would copy and paste my comment into the right place.
Sanders was talking about a Medicare-type insurance for everyone.
Bev:
Medicare is not single payer and it is in poor taste to cite it as such or as an example. You pay a yearly deductible and copays to the doctor, the hospital, and for office visits. Furthermore, Part B is only funded at 80% and there is a monthly fee dependent upon your yearly earnings (needs based). To cover the other 20% (Part B), you do need some type of insurance which covers the 20% if you are admitted and not kept for observation (another rider). Part D is insurance for prescriptions. Medicare does not cover long term stays in the hospital, vision, and dental.
What you and others really want is the government to step in and start to control the cost of healthcare which is outside of insurance and the prime driver of the cost of insurance. Of course if this happens, some of those magic bullets not demonstrating evidence based results or cost benefit may disappear or be placed in out-of-pocket costs. The VA does this now as well as Medicaid.
Very few counties on this globe have “single payer” and most have a two tiered system with public paying a majority and privately based paying the balance, and the government controlling the cost of commercial healthcare.
I don’t get it, run. Single-payer refers to the insurer, not the insured and not the payees. It’s shorthand and a misnomer, but that’s what the term means. Sanders’ actual proposal would indeed be, literally, single-payer in the sense you mean; it would cover virtually everything, and was criticized, probably accurately, as costing considerably more than he was projecting, because costs probably couldn’t be reduced as much as he was predicting.
But, yes, Medicare is single-payer as that term is generally used, because everyone would be covered by it and to the same, fairly comprehensive extent as everyone else.
It’s too serious a subject to keep playing word games about, and I don’t know why you keep doing that. But you keep doing that.
Bev:
“Single payer health care is a universal health care system where a ‘single payer’ fund, rather than private insurers, pays for health care costs.”
Medicare is not single payer as I have explained NUMEROUS times to you on many occasions. It has insurance, public, and private funding inputs. You do not know what the PPACA is about and calling for “Medicare for All” without any explanation is deception (which Bernie is guilty of in this case) as most people do not have experience with Medicare. The same as your citing of France, Germany and Australia as single payer when they are not. All three have public and insurance or private funding inputs. To my knowledge Taiwan is single payer; but Taiwan has small out-of pocket payments also. https://en.wikipedia.org/wiki/Healthcare_in_Europe
When you say Medicare, you make my teeth hurt. capeesch?
“Single payer health care is a universal health care system where a ‘single payer’ fund, rather than private insurers, pays for health care costs.”
Well, yes. Exactly. What does that have to do with co-pays, deductibles, or for that matter optional supplemental insurance? Anything? Not that I can tell.
Excellent post there by MIJ…If you were in a HSA you would have gotten burned yesterday. I got toasted in 08 and was glad the ACA came along when it did. Being on SS my wife and I do qualify for a subsidy. Ryan and Trump know this are playing games with this as they both have nothing better to offer as far as I know. The denial and refusal to do anything in the congress or senate is another reason why so many are so angry with the status quo of the establishment and now we are seeing the same thing happening in England. The people are fed up with all the lies, deception and distortions coming out of Washington and is what is fueling Trumps popularity no matter what he says. Just like in the old days my medical plan consists of a first aid kit with bandaids and some aspirin. It also consists of staying healthy and not getting a self inflicted illness in the first place…
Eric
i think you may be failing to understand something:
sure, your’re young and healthy and “don’t need insurance.”
but you MIGHT need it sooner than you think, and in any case, by paying for it now while you have the money you won’t have to pay so much for it when you become one of those people who are more likely to need it. or that’s the way it should work, and that’s the way it should be explained to people.
from my perspective, what’s wrong with “insurance” is that it helps make medical costs much higher than they would be in a system where people didn’t think “someone else is paying for it’…
and, in the case of Obamacare, it keeps the same criminals who jacked up health care prices in the first place in charge of the system.
on the whole i’d rather have the government run the system… they can incorporate competition if they design it right. and while there is always room for government corruption or stupidity, i can’t see where “private enterprise” has done any better. and while i got away with not having insurance when i was young, i don’t think that is wise either for the individual or the country.
Beverly
personally i think Roberts upheld Obamacare because it benefits the insurance and medical care industries. but they R’s needed a “don’t throw me in the briar patch” opposition to keep their voters thinking they were opposed to big government.
I have no idea what the liberal justices were thinking, but my guess is that they are not so liberal as you might think when it comes to keeping the establishment happy.
Cob,
I was staying out of this…….
Librul to the DNC power brokers is keeping Roe V Wade and the billionaires’ interest on top.
If you don’t recognize by now, ilsm, that things finally, and very suddenly, have changed, then you’re even slower to catch on than Hillary Clinton was.
And the stragglers who hadn’t yet caught on before Friday’s Brexit results came in probably finally have caught on. Most of them, anyway.
I think that contrary to the immediate CW, Brexit will actually hurt Trump, not help him. This is a guy who thought he’d benefit financially from a crashing pound because it didn’t occur to him that if financial chaos or even just a recession occurs that spreads beyond Britain, it won’t be much help for his luxury golf resort that the pound’s exchange rate has sunk. Who in his or her right mind would think this is the guy to handle economic crises, or anything else other than, maybe, a beauty pageant?
Right now the single biggest problem with ACA aside from the states that won’t take the Medicaid expansion is the way the exchanges are constructed. Constructing the exchanges wholly within state borders (even states that didn’t build an exchange and had the Feds do it are limited) minimizes the availability of risk sharing. In several states insurers are dropping out causing less competition (not necessarily a good thing in healthcare but it is the way the law is built) and large premium increases.
There is an obvious fix and one that could also be the basis of a public option. The FEHBP exchange (the one that serves Federal employees and retirees) has at least a hundred different plan offerings (some are localized or state HMOs but BCBS and several other large insurers participate).
It would be relatively straightforward (nothing about this or bureaucracy is easy but some things can be straightforward) to open what is already a national exchange to the individual insurance market. Currently Federal agencies pay about 70% of the premiums so we start with the assumption that individuals buying into this exchange will pay 30% plus some additional percentage based on the way the current premium support and subsidy sections of PPACA work.
I suspect various Federal employee and retirement groups will buck some but at the very least FEHBP offers a good model of a workable exchange. Some insurers will buck because the exchange is managed pretty well by OPM and insurers are held to some pretty tight standards. Nevertheless it is a workable and reasonable target.
Creating a nationalized exchange for the individual market and finding a way to fix the Roberts clusterf**k on Medicaid expansion would solve the two most glaring holes in PPACA. Creating some sort of early Medicare buy-in, say starting at 62 is another reasonable goal.
Ultimately though we have to come to some sort of understanding that market forces and market incentives do not work well (especially if they are your only standard) in some areas, medicine being a prime example. At the same time we must also understand that a purely bureaucratic institution comes with its own set of problems and warped and perverse incentives.
The French system is widely regarded as the best in the world, and I believe it’s pretty bureaucratic. But Germany’s, Australia’s, Taiwan’s, I believe also are considered excellent, and I assume they too are pretty bureaucratic.
Bev,
What was it Hillary “caught on” about and when did she “catch on” and how do you know she “caught on”…..?
I am working in “non Judgement” today!
The disinformation flying around in here is amazing.
Kudos to Run for trying to hold back these thoughts, like those expressed by Eric. Yeah, there is a good chance you can control costs in a system when people outside the system can access it.
It just never stops.
Amazes me people just do not seem to understand the idea of insurance.
Let’s take this “thought” that some people do not need health insurance so why should they be forced to get it?, and take it to Social Security.
It is the same thing as saying:
“I am not going to become disabled and I am going to be a billionaire so there is no need for me to pay into the program.”
geez
run
i don’t know about you, but sometimes i don’t feel very distinct at all.
Somewhere up thread Run points out that Medicare is, in fact, not really single payer and that the issue is really about cost control and access (my apologies Run if I’ve paraphrased this incorrectly).
The point is that he is correct. Furthermore because of the way our system has developed it is unlikely if not impossible that we could shift to something called “single payer”, certainly not overnight and probably not incrementally; there are simply too many moving parts and too many special interests and strong constituencies.
What we can do is expand existing systems and use elements of those systems as models going forward. FEHBP is a workable national exchange. Medicare certainly should be available for those who are 62 (particularly in occupations that take a heavy physical toll and wear out bodies early). The VA, properly funded, does a very good job of providing a broad range of care.
If we are going to give tax advantages to employer sponsored plans, which constitutes a form of embrace of that method of providing health coverage (by the way can we get away from discussing “insurance” and get to the heart of the issue which is providing a basic human right of healthcare) then we ought to recognize how that complicates the problems.
At some point we must look at intellectual property laws, I highly recommend Dean Baker’s work in this area and Jaffe and Lerner’s “Innovation and Its Discontents”.
Maybe the most important idea that must gain currency is that medical care is an area that generally does not respond well to market incentives. Markets can do some pretty wonderful things but this delusion that is promoted by folks like the Kochs that something called “free enterprise” is both a pure and perfect economic, social, philosophical, and political system is ludicrous.
I recently reread Hayek’s “Road to Serfdom” in connection with my work against a Koch sponsored economic grant at WCU. What is most striking is Hayek’s either/or, black/white. all or nothing attitude – which is odd because Hayek favored social pension and health systems. There is a meme on the Right that sees any deviation from some fantasy construction of a purely laissez faire economy and society must, by default, be a plan for despotism.
The problem with that view is that we’ve never had that laissez faire utopia and the folks the idea is attributed to like Adam Smith never advocated such a thing. At base the ideology is a reactionary one that by design preserves the privilege of the wealthy and elites.
Admittedly that’s all rather philosophical and arcane but from a practical standpoint I think FDR’s statement: “Necessitous men are not free.” pretty much sums it up. Food, clothing, shelter, education, and healthcare ought to be considered basic human rights in any civilized system.
We currently have a system that is far too complex, has too many moving parts, and too much opportunity for advantage and rent seeking built into it. At the same time we have far too people that lack access to basic healthcare. Nevertheless we have the basics of several institutions that provide examples of what a workable system could look like. The task is to build on those systems while changing the terms of the discussion.
Arguing for some sort of single payer purity is simply the flip side of arguing for some sort of free market purity. It is an exercise in demanding the perfect as the only acceptable option.
I just responded to run’s statement that Medicare is not single-payer by pointing out that the term is shorthand for a single insurer that covers everyone and does so fairly comprehensively. The term is something of a misnomer but that’s what it means.
And as I said to run, Sanders’ proposal actually would be, literally, single-payer if enacted in exactly the form he proposed.
I want to add that Medicare is not nearly the bureaucratic labyrinth that this country’s private insurance system is. Lordy. Is there anything more bureaucratic than that? Except, I guess, the immigration system. And registering to vote in this country these days, although that is deliberately bureaucratic.
well, i don’t have access to God’s dictionary
but i think for most people ‘”single payer” means “paid by the government ” and of course that means “paid by the people.”
including co-pays in the design does not alter that.
i have no idea what germany japan france etc call their systems.
obamacare is not single payer.
Yes. Exactly. What a dumb issue to be debating.
Just so we’re clear, bureaucracy is bureaucracy and dealing with Medicare’s is no easier than dealing with that of private insurers. I’ve got the scars to prove it.
These problems don’t exist in the best national healthcare systems: France; Taiwan; probably a few others. It’s a huge problem that there’s apparently no way to have systems such as those even discussed in this country.
Bev:
Nonsense. Again you have confirmed you know little about the different systems in play here and the the World healthcare systems are 95+% Two Tier Healthcare systems with Public and Private (insurance and individual input) funding. Go back and read my earlier comment. Don’t comment back to me.
sure, JackD
and i’d love to have the ol’ family doctor to deal with, and pay in chickens.
so if you have a good idea how to eliminate “bureaucracy”, let us all know.
so far I havn’t been abused by Medicare. I did watch a Dr/hospital fraud and abuse Medicare. Couldn’t persuade Medicare to do anything about it.
so we all continue to pay twice as much as the civilized world… who probably pay twice as much as they really need to.
i wonder how they do things in Cuba.
I don’t propose a solution to bureaucracy. I simply point out that under any system likely to be in place, it will be present. Why to select one or the other will depend on other issues like costs, extent of coverage, and the like.
In a large and complex system that requires a bureaucracy there will be hang-ups. It is the nature of the system – Mancur Olson wrote a great deal about the nature of incentives within institutions.
Medicare can be easy or it can be a nightmare. Getting my 94 year old mother treatment for Hepatitis C required lots of phone calls and negotiations. Sometimes I ask myself why we push certain treatments at certain ages – do we do enough of looking at probabilities; then again that sort of talk leads to DEATH PANELS! (as if some variation of rationing wasn’t at the heart of every healthcare system).
My rheumatologist, a very caring, committed and patient oriented physician who is also almost anal in completing paperwork just spent several hundred hours reviewing charts at the behest of Medicare. It seems that Medicare insists that folks using infusion drugs like Remicade must be on an exact schedule. If your regimen is five weeks then your treatment must be administered exactly every 35 days or Medicare wants an explanation – going on vacation and getting infused a day early to avoid being late; fill out an exception report; coming back from vacation and getting infused a day late – fill out an exception report.
Bureaucracy affects patients, caregivers, hospitals and others in the system so it really is hard to generalize about what its impacts are without having intimate knowledge of all the elements of the system.
Medicare seems no better nor worse than Canada (where my brother and his wife are physicians) and in some respects it beats BCBS and other insurers. There are no seamless solutions or answers in large complex systems – it becomes a matter of constant evaluation and adjustment. Unfortunately human nature is to say, “problem fixed now let’s move on”.
Mark:
Medicare is no better than the VA and they have their rules and procedures. I am not sure why anyone would believe a single payer system would be any less in the magnitude of wither present systems or private insurance. Indeed, private insurance will accept more than what Medicare, Medicaid, or the VA will. One famous example for Medicare is being kept in the hospital for observation as opposed to being admitted. The VA just changed its pharmacy regs and will not longer give you the single dose succinate version of metoprolon and has gone to the tartrate version in two doses. This is due to the cost of the former and the VA’s efforts to control healthcare cost. An indication of things to come in controlling healthcare costs.