No one could be that stupid? Could they? Updated

There are two notions, both dangerous, lurking in the 2012 election.  They are as alive and well in Nevada as they are in Florida, or any other “swing” state. They are both wrong.

The first is that the Republicans really truly wouldn’t think of doing something so idiotic as to actually transform the Medicare program from a defined benefit framework to a “coupon care” program in which seniors would have to beat through marketing bushes to find health insurance corporations willing to sell them policies.

The Medicare Malaise

Haven’t we been listening?  Republican have been trying to stop or privatize the Medicare program since 1964. [Politifact]  They called it “socialized medicine” then and they are still calling it “socialized medicine” now.  Fast forward to 2012 — the Ryan Budget Plan first called for transforming the Medicare program to a voucher (premium support) plan and later changed the plan to allow people to opt for the traditional program.

Tweaking the plans allows the GOP to rebuff charges that they are “eliminating” the Medicare program — however, what’s left after a significant number might opt for private insurance plans would be the least healthy and wealthy among us, making the traditional program all but unsustainable.

Secondly, the “option” idea so beloved by the Republicans is already available under the Medicare Advantage banner.  An elderly person can, and many do, purchase highly profitable  Medicare Advantage policies from private health insurance corporations.  By adopting the Romney/Ryan scheme the “choice” essentially moves from being able to chose between traditional Medicare and Medicare Advantage plans to being a “choice” between private health insurance corporation policy offerings in the long run.  The Romney/Ryan plan offers current seniors their choice between traditional Medicare and Medicare Advantage-like policies — but makes the choice much less likely and more expensive for those soon to reach retirement age.

Every election since 1964 has contained some Medicare element incorporated into the dialogue and the conversations have remained almost identical.  Medicare is either “socialized medicine,” or it’s a “government take over;” what hasn’t changed is the GOP intention to transform it into a so-called “free market” program to the benefit of health insurance corporations and their Wall Street allies.   This isn’t a line of attack they dreamed up for the 2012 elections. It IS the expressed intent of a party which appears to have fewer and fewer moderate members each election cycle.   Moderates who might have been counted upon to keep the transformation of Medicare at bay have been losing ground in the GOP.  The extremists who believe the Free Market Fairy will be able to sprinkle enough dust to justify privatization are the ones at the helm.

The extremists lead us to the second topic about which we should be listening more closely.

Are you listening ladies?

No one would be dumb enough to really call for a Personhood Amendment to the U.S. Constitution — would they?  They certainly would.  No one in this day and age would be arguing about “legitimate” rapes? Surely not. Oh, yes they are.

A Rape Is A Rape — Or is it?

“Richard Mourdock, the Republican candidate for the U.S. Senate in Indiana, said in a debate on Tuesday that “even when life begins with that horrible situation of rape, that is something that God intended to happen.” [NBC]

“Trying to distance himself from the “legitimate rape” comment that Rep. Todd Akin (R-Mo.) made last week, Pennsylvania Senate candidate Tom Smith (R) stirred up further controversy by comparing a pregnancy caused by rape to “having a baby out of wedlock.”  [HuffPo]

“Vice presidential candidate Paul Ryan says that he personally believes that rape is just another “method of conception” and not an excuse to allow abortions.”  [OTB]

Missouri Senatorial candidate Todd Akin’s classic: “First of all, from what I understand from doctors [pregnancy from rape] is really rare,” Akin said. “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” [Atl]

One major candidate making a fool of himself is an outlier, two is unfortunate, three is a trend — and four is an indicator that these candidates, all male and all Republican, have little regard for women’s health, and less regard for women’s choices.  This isn’t a recent bloom of this particularly nasty philosophical fungus.  Let’s return to October 2009.

Senator Al Franken (D-MN) sought to insert an amendment into the Defense Appropriation Act to prevent the government from doing business with contractors who would not allow employees to take rape cases to court 30 — yes, THIRTY — U.S. Senators voted No. [Sen 308]

Alexander (R-TN)  Barrasso (R-WY)  Bond (R-MO)  Brownback (R-KS)
Bunning (R-KY)  Burr (R-NC)  Chambliss (R-GA)  Coburn (R-OK)  Cochran (R-MS)  Corker (R-TN)  Cornyn (R-TX)  Crapo (R-ID)  DeMint (R-SC)  Ensign (R-NV)  Enzi (R-WY)  Graham (R-SC)  Gregg (R-NH)  Inhofe (R-OK)
Isakson (R-GA)  Johanns (R-NE)  Kyl (R-AZ)  McCain (R-AZ)
McConnell (R-KY)  Risch (R-ID)  Roberts (R-KS)  Sessions (R-AL)  Shelby (R-AL)  Thune (R-SD)  Vitter (R-LA)  Wicker (R-MS)

What does it say about the Republican Party when four of its candidates for major offices in 2012 and thirty of its Senators in 2009 have medieval (or earlier) political stances on rape?  *The Franken Amendment passed and was signed into law — no thanks to the Dirty Thirty who opposed it.

What does it say about a political party when it controls the House of Representatives and passes 55 bills with topics running the gamut from de-funding Planned Parenthood to restricting abortion rights to weakening domestic violence provisions?  [TPM]

What does it say about a political party when its standard bearer’s campaign refused comment on the House Energy & Commerce minority report on “anti-women” bills was released in September?  Or, when its standard bearer can’t be relied upon to answer even a simple question about support or opposition to legislation calling for equal pay for equal work?

Sometimes the obvious is the honest.  Voting for the Republican candidates in 2012 is hazardous to women’s health — if they are elderly, or approaching retirement age and expect Medicare to be there for them.   It is just as hazardous if the woman in question is young and facing the prospect of diminished health care services like the loss of affordable treatment at Planned Parenthood clinics, or  if Republicans can repeal Obamacare and its provisions for cancer screenings.   It is truly hazardous to the health of women of child bearing age who having been raped must assume the cost of taking the pregnancy to term, and then bear the responsibility for raising the child — or the trauma of both the rape and the act of releasing the child for adoption.

Did it occur to the Republican candidates, who so easily dismiss the controversy about ill-informed or downright brutal remarks on rape and its potential consequences by saying they were “misunderstood,” that they’ve yet to offer any legislation dealing with the economic burden placed on the women under consideration?  Much less the social, and psychological burdens which must be carried for a lifetime?

If the comments made during this campaign season by major Republican candidates, and the actions of Republicans in the Senate, and the actions of the House of Representatives during the 112th Congress, aren’t enough to convince any sentient person that the GOP means what it says — there isn’t much more to speak of — until they actually do it.  And, they’re getting closer each election.

We’d all be much better off if this stops before we say — “I didn’t  think they’d really DO it.”

UPDATE: Think Progress helpfully adds more names to the roster of Republican candidates who share these antiquated and uninformed views:  Rep. Steve King, Rep. Roscoe Bartlett, CT Senatorial Candidate Linda McMahon, PA Senatorial Candidate Tom Smith, WI State Rep. Roger Rivard, and OH State Rep. Jim Buchy.

See also: Sally Kohn, Salon, August 24, 2012.

Chalkboard Talk: Obama – Romney and Medicare

Sources and References:  An Economic Sense, “Romney’s and Ryan’s Confusion on Basic Accounting: Medicare Costs,” August 16, 2012.   The Hill, “Gibbs: Ryan should thank Obama for strengthening Medicare,” August 19, 2012.  Christian Science Monitor, “Romney says Obama robbed Medicare,” August 16, 2012.  New York Times, “Patients would pay more if Romney restores Medicare savings,” August 21, 2012.  Washington Post, “Van Hollen: The Romney Ryan Plan Medicare Plan would have immediate cost increases for Seniors,” August 18, 2012.  Kaiser Health News, “CBO: Seniors Would Pay Much More For Medicare Under Ryan Plan,” April 5, 2011.   Washington Post, “Paul Ryan’s budget keeps Obama’s Medicare cuts – full stop,” August 14, 2012.

The Vague Factor: “

On “60 Minutes,” Romney said: “I don’t want any change to Medicare for current seniors or for those that are nearing retirement. So the plan stays exactly the same.”

Still, it’s unclear if that means a guarantee of no future cuts for those remaining in traditional Medicare, or if Romney is merely saying that the overall design of the program will stay the same.”

Good question, especially since Governor Romney has managed to turn vague political rhetoric into a form of modern performance art.

Suppressed Laughter: Muddling the Medicare Issue

There are those who find the Democratic charge that the Republicans would end Medicare as we now know it risible, but there are some very practical reasons for stifling the guffaw.

Let’s start with the proposition that the current Medicare program is a very popular single-payer system for providing health insurance coverage to individuals in the United States who are over 65 years of age.   Let’s also accept that a single payer system like Medicare has helped reduce the financial strain on our elderly.  [CMS pdf]

Additionally we can find historical data indicating that those elderly citizens who have annual incomes of $40,000 or less spend a higher percentage of their income on health care than those more affluent: [CMS pdf]

We also know that the elderly have moved from a demographic group less likely to have health insurance coverage to the one in 2000 most likely to be covered:

“Prior to Medicare’s enactment, about half of America s seniors did not have hospital insurance. By contrast, 75 percent of adults under 65 had such coverage, primarily through their employer. For the uninsured, needing hospital services could mean going without health care or turning to family, friends and charity to cover medical bills. More than one in four elderly were estimated to have gone without medical care due to cost concerns (Harris, 1966). Today, Medicare covers nearly all of the elderly (approximately 97 percent), making them the population group most likely to have health insurance coverage.”  [CMS pdf]

At this point it ought to be reasonable clear that if (1) we want elderly Americans to have affordable health care insurance, and (2)  especially want those at the lower end of the income scale to secure affordable health care insurance, then by those standards the current program is successful.

If It Ain’t Broke Why Fix It?

Across the philosophical divide:   One important facet of current conservative thinking holds that any government program which offers services to individuals  in the form of a social safety net “creates dependency.”   The proponents of this argument rely on philosophic arguments almost as arcane as the extensions of Anselm of Canterbury’s Scholasticism before Abelard arrived to rescue the scholars.

Theoreticians are invited to weigh in on discussions bounded by such definitional perimeters as the following from the libertarian Cato Institute:

“The central idea behind the theory is that government officeholders, as individuals, have strong incentives to alter important political transaction costs facing the public and facing others in government in order to secure more of what they want with less resistance. As economists use the term, transaction costs are costs to individuals of negotiating and enforcing market exchange agreements, including information costs, negotiation costs, enforcement costs, and the like.”

One is pretty much left to imagine what “and the like” might mean.  However, the message is clear – government office holders have an incentive to promote their programs and to minimize the resistance to those projects.  This assumes that people are naturally resistant to efforts by their own government to assist them, and that all government services must be resisted.  In other words, in order for this argument to work in general terms we’d have to assume that everyone is naturally a radical libertarian.

We’d also have to assume that the populace doesn’t want the government to “alter important transaction costs” on its behalf.   This is a hard point to sustain given that most citizens don’t appear to be enthusiastic supporters of personally negotiating defense contracts — which if we were to extrapolate the localism of the initial argument to its illogical extreme would be required to reduce “Constitutional level political transaction costs.”

Culturing Dependency:   The current arguments from the radical Right, framed philosophically as described above, march to the next milepost — that citizens are naturally “free” (individualistic) and any government programs which provide services to the elderly (or indeed anyone else) create a dependency on government action at the expense of individual “freedom.”

All we have to do to subscribe to this position is to completely ignore the preface to Robert’s Rules of Order:   “Where there is no law, but every man does what is right in his own eyes, there is the least of real Liberty.” (Henry M. Robert)

There are also some uncomfortable questions raised by this proposition.  Does hiring a local police force create a dependency on my part for the protection of my life and property?  Does having a local fire department make me dependent on government for fire suppression, rescue, and EMT services?  Does having a Department of State make me dependent upon government for the implementation of foreign policy?   Does having a Department of Commerce make me dependent upon government for statistical reports on my economic environment?

Splitting Differences:  If the answers to the questions above are equivocal, then it’s probably because there are some definitions of “legitimate” and “illegitimate” government services involved.  If a person defines government as only responsible (legitimate) for national defense and foreign policy, then only government programs in those realms are legitimate.  If, however, we see government as formulated for We The People, life gets a bit more complicated:

 ”…of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Now we add “establish Justice, insure domestic Tranquility, … promote the general Welfare…” to the list of legitimate concerns of our government.  It’s time to come back around to the main argument.  If Medicare is a popular single payer system for promoting the availability of health insurance coverage to elderly individuals, and if it is successful in that regard, then why argue that it’s illegitimate?

The Magic Market:  The “market” in whatever form it may take is supposed to be the ultimate form of human transaction — the most efficient, the most efficacious, the most Free.  Except when it isn’t.   We’ve had an unpleasant taste of what happens in unregulated, or poorly regulated, financial markets.  Unfortunately, the after-taste is still lingering.  We are now told by the radical Right that an unregulated health insurance market will meet the needs of elderly Americans for their health insurance coverage.  Probably not.

The first point to acknowledge is that the Romney/Ryan plan for Medicare essentially changes the Medicare program from a single payer system to a voucher plan which “incentivizes health insurance corporations to provide coverage for elderly people.”    This is not “Medicare as we know it,” it is Medicare as the Insurance Corporations would like to have it.

The insurance corporation argument is underpinned by the notion that medical care is a commodity which can be purchased by a consumer from a provider, and this is true up to a point, but it’s a point that is very quickly reached.   The problem, as Professor Krugman points out, is that medical care isn’t bought and sold like a loaf of bread.   A person making up a list of groceries may include bread, but if the price of a loaf is too high then it’s logical to skip the purchase or substitute another commodity.  The market works.  However, if a quintuple  by-pass is needed then price is not the determinant of the “purchase.”  The result of “gee, I don’t think I can afford that right now” is poor health or even death.  The Magic Market doesn’t work in this instance.

The second problem with the Magic Market solution is that no one is shopping in the ambulance.   The victim of a motor vehicle accident or a heart attack, even if fully conscious, isn’t saying “Get me to the cheapest Emergency Room,” he’s saying, “Get me to the nearest Emergency Room.”

The third problem with the Magic Market solution is that the health insurance corporations themselves aren’t subject to it.  Under the terms of the McCarran-Ferguson Act of 1945 health insurance corporations are exempt from anti-trust laws.  This is both good and bad news; the bad news is  they may collude to limit access to their products or divvy up regions as sales territories.   The good news is that they are able to share information which might serve in some cases to reduce premium costs.  [KaiserNews]  Either way, the policy purchaser is dealing with a provider which is not subject to the same “free market” forces as the consumer.

The fourth problem inherent in the current privatization of the Medicare program is that it hasn’t worked.  Medicare Advantage was supposed to be the insurance industry version of the original Medicare program, and IF the free market worked the way the ideologues on the Right predicted, then we’d expect massive consumer shifts to the privatized version.  Hasn’t happened.  Altogether too many Medicare Advantage policy holders are there because their employers, many in the public sector, have been pressured into adopting Medicare Advantage plans.  [HealthBeat]*   If the Free Market worked as predicted, then the pressure would not be necessary.

Finally, the “free market” Medicare Advantage plans can hardly be called “private” when the companies offering them are getting an $8.9 billion subsidy from the Medicare program.  [TP]  Further, if the private market-driven plans can produce lower health care costs, then why haven’t they? [Incidental Economist]

Stop Laughing

If the current Republican calls to eventually replace the original Medicare program with a “market-driven” plan are (1) philosophically dubious, (2) politically questionable, (3) grounded in doubtful Constitutional theory, (4)  and premised upon illogical and indemonstrable market behavior; then why would challenging the practicality of such a plan be laughable?

Arguing that Medicare will still be existent even if privatized into a program run by insurance corporations is roughly analogous to contending that an orange is still an orange after it has been reduced to juice and pulp.   The result may be many things — but it’s not an orange.   Nor, would our original Medicare program be the same Medicare which now serves half of our elderly citizens who live on $21,000 per year or less.  [AARP]  Still suppressing that guffaw?

References: “Medicare – A Profile, 35 years of Medicare,” HCFA, July 2000. (pdf)  Charlotte Twight, “Medicare’s Origin,” Cato Journal, Volume 16, No. 3.   Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care, American Economic Review, December 1963 (pdf).  Paul Krugman, “Why Markets can’t cure healthcare,” New York Times, July 25, 2009.  *Desert Beacon, “Medicare Disadvantage,” August 22, 2012.  AARP Fact Sheet: Who Relies on Medicare – Profile of the Medicare Population (pdf).

Medicare Disadvantage

The level of misinformation concerning the Affordable Care Act and the Medicare program is approaching Shark Jumping Territory, and therefore it is probably high time for some serious, fact based, commentary.

The total cost of the Medicare Program, Part A, Part B, Part C, and Part D was $549 billion in FY 2011.  [Trustees Report 2012 pdf]  The specific numbers are as follows:

Medicare Part A pays for hospitalization, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B pays for physician’s services, outpatient care, medical supplies, and preventative services.

Medicare Part D pays for prescription drug plans.

Medicare Part C is not part of the original Medicare program, and covers Medicare Advantage Health Insurance, described by the DHHS as follows:

“A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”  [Medicare.Gov]

If we take the spreadsheet out one more column and show the percentage of the expenditures for Medicare for each part the numbers look like this:

The Cuts are Coming! The Cuts are Coming!

My nomination for the most confusing and obfuscating charge made by the Romney-Ryan Campaign is that “cuts in Medicare go to pay for Obamacare.” This first relies on a visceral reaction disassociated from reality that Medicare is Good and Obamacare is Bad.  In fact, what the Affordable Care Act DID was to cut over-payments to private health insurance corporations in Part C in order to cover the expenses (notably the infamous do-nut hole in Part D coverage).

In short, the Affordable Care Act (Obamacare) cut funding for over-payments to private health insurance corporations in order to apply those funds to …. Medicare.   A more complete explanation is provided by Medicare Advocacy:

“The greatest amount of savings in Medicare, about $130 billion over 10 years, [iv] will be achieved by reducing overpayments to private Medicare Advantage (MA) plans. These are the insurance plans that contract with the Centers for Medicare & Medicaid Services (CMS) under Medicare Part C to provide benefits to those who voluntarily enroll. MA plans must provide all of the guaranteed benefits under Part A and Part B; they may provide additional benefits with moneys they receive in excess of the cost of providing the guaranteed benefits.

For all intents and purposes, the Medicare Advantage programs were an experiment by the private health insurance companies to say, “The Private Sector can offer the same benefits as Medicare — only better, and the Market will prove it.”  Except that it didn’t.

One advocacy group for seniors enrolled in Medicare Advantage health insurance plans summarized the problems:

“The idea behind the plans is to provide better services and lower out-of-pocket costs. However, it doesn’t always work that way, according to the Medicare Rights Center. While the plans must provide a benefit “package” that is at least as good as original Medicare’s and cover everything Medicare covers, the plans do not have to cover every benefit in the same way. For example, plans may pay less for some benefits, like skilled nursing facility care, and offset this by offering lower copayments for doctor visits.”

The results? Problems such as –  (1) Care can cost more than it would under original Medicare.  (2)  Private plans are not stable and may suddenly cease coverage.  (3)  Members may experience difficulty getting emergency or urgent care.  (4) Because plans only cover certain doctors, the continuity of care is often broken when the plan drops a provider.  (5)  Members have to follow plan rules to get covered care. (6)  Members are restricted in their choices of doctors, hospitals, and other providers.  (7)  It can be difficult to get care away from home.  (8) The extra benefits offered often turn out to be less than promised.  (9) People with both Medicare and Medicaid can encounter higher costs. [ElderLaw]

Despite the obvious problems listed above, and the disparity between administrative costs between the original Medicare and the Medicare Advantage private plans, Congress barreled along offering incentives and allowing accounting advantages to encourage enrollment in the privatized “Medicare” experiment. [HealthBeat]  However, the practical problems aside, the major fiscal problem with the Medicare Advantage experiment came with over-payments associated with MA plans.

Under the funding mechanism in effect before enactment of the Affordable Care Act, MA plans were paid, on average, 9 – 13% more than the traditional Medicare program to provide the same coverage. These extra payments resulted in Medicare Part B premiums being $3.35 higher per month for all beneficiaries in 2009, and resulted in the federal government (and taxpayers) spending $14 billion more than it would have had Medicare Advantage plan enrollees remained in the traditional Medicare program.”  [Medicare Advocacy] (emphasis in original)

No one should be arguing that paying 9-13% more for the Same Thing is sound financial thinking.   Nor should taxpayers be footing the bill for an experiment that costs $14 billion more than it would have if people had remained in the traditional Medicare program.  So, how does Obamacare (ACA) fix this problem?

“The Affordable Care Act phases in changes to the MA overpayments, starting with a freeze in payments to MA plans for 2011. Payments will be based on national county benchmarks, with plans being paid a fixed percentage of traditional Medicare costs. As a result of this payment formula, plans in some lower-paid counties, generally rural and suburban areas, will continue to receive payments that exceed the traditional Medicare amount, while plans in higher paid counties, many of them large cities, may see substantial reductions.[vi] Rebates (an amount plans receive if they bid less than the county benchmark) will also be reduced. The new payment structure also provides for an increase in payments by up to 5% for plans that receive four or more stars on the CMS star rating system. [Medicare Advocacy] (emphasis added)

In other words, IF a Medicare Advantage insurance plan measures up to what would be available to seniors under the traditional Medicare program, and IF it avoids the nine issues listed above — the corporation would be subsidized for offering the plan — if not, then there’s no reason for taxpayers to be subsidizing plans that fail to meet the criteria.  Further, the ACA (Obamacare) requires that Medicare Advantage insurance policies sold must use premiums paid in to provide health care services:

“It also requires Medicare Advantage plans to pay at least 85 percent of the premium dollars they collect for medical claims. However, it also makes it possible for Medicare Advantage plans to receive higher payments if they demonstrate that they are providing high-quality care to enrollees.” [HealthAffairs.Org]

Thus, when a health care insurance corporation sells a Medicare Advantage policy, 85% of the premiums paid in must pay for — health care.  Not executive compensation, not advertising, not corporate sponsored retreats, not executive entertainment, not administrative expenses, not towels for the executive washroom, or fuel for the corporate jet — health care.  If the traditional Medicare program can function on a rate of 1.42% administrative costs for expenses, then it seems reasonable that a private corporation could administer its MA programs for 15%.

Hysteria

Get a grip.  Obamacare (ACA) will not send doctors leaving their practices in droves.  Nor will it leave Granny to the mercies of an imaginary Death Panel.  Why, for example, would hospitals agree to savings from cuts to their reimbursement under the Obamacare (ACA) provisions?  Jon Healey explains in the Los Angeles Times:

“The Affordable Care Act also tries to slow the growth of Medicare by prodding healthcare providers to deliver higher-quality care. Two examples: It reduces payments to hospitals that readmitted Medicare patients shortly after they’d been discharged, and that had an excessive rate of hospital-acquired maladies. And it cuts the extra Medicare payments to hospitals that treat a lot of patients who can’t pay their bills, on the reasonable assumption that the act will extend insurance coverage to millions of uninsured Americans.”

More people covered (so fewer very expensive visits to the Emergency Room) and more quality control so that patients aren’t re-admitted for the treatment of bed sores they incurred during the initial admittance, and everybody wins.   More patients get better care, and the hospital isn’t out the expenses of people who land in emergency rooms sans insurance and run up bills the hospital has to swallow.

For the umpteenth time — the Affordable Care Act (Obamacare) saves some $700 billion over the next decade or so, and uses that money to SUSTAIN MEDICARE PROGRAMS FOR BENEFICIARIES.   The cuts, the savings, whatever we will to call them are on the “providers” side — like not paying insurance corporations to sell MA policies which may or may not be as good as traditional Medicare enrollment, or not paying hospitals for sloppy care which results in Granny going in again.

Jon Healey’s final assessment is on target:

“In other words, the Affordable Care Act reduces the amount that Medicare takes from the Treasury for the sake of subsidizing a different group: the non-elderly working poor and lower middle class. Ryan can argue that we shouldn’t help those people afford insurance, but he can’t honestly say the law steals anything from the Medicare trust funds.

In fact, the law brings more money into the Medicare Hospital Insurance trust fund — an estimated $318 billion over 10 years — by hitting upper-income households with a 0.9% payroll-tax surcharge and a 3.8% tax on investment income. As someone with an intimate knowledge of the federal budget and the way money flows in and out of the Treasury, Ryan knows this. But he’s hardly the first pol to let the facts get in the way of a good applause line.”

Amen.  A little Fact-Checking provides immediate refutation:

  “The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue. Under the new law, Medicare will remain a wildly popular, public single-payer health insurance system that provides comprehensive coverage to millions of Americans.”  [Time]

So, hold your applause for the Romney-Ryan Line.

References and Related Reading:  The 2012 Annual Report of the Trustees of the Federal Hospital Insurance Federal Supplemental Medical Insurance Trust Funds, (pdf) Annual Report, April 23, 2012.  “The Trouble With Medicare Advantage,” Health Beat, July 9, 2008.  Medicare Rights Center, “Medicare Advantage – Some Plans Too Good To Be True,” Elder Law Answers, summary.  “Health Care Reform Does Not Cut Medicare Benefits,” Medicare Advocacy, October 28, 2010.   “What Is Medicare,” Department of Health and Human Services, summary information.  Jon Healey, “Obamacare ‘raids’ Medicare, not exactly,” Los Angeles Times, August 21, 2012.  Ezra Klein (Sarah Kliff post) , “Obamacare won’t cut benefits,” Washington Post, August 15, 2012. David Pinar, “MediScare,” Tucson Citizen, August 15, 2012.

Fact Checking the Romney-Ryan attack on Medicare:  Kate Pickert, “Fact checking Obama’s Medicare cuts,” Time Magazine, August 16, 2012.  Adwatch, “Obama defends Medicare policy,” Boston Globe, August 17, 2012.

The Endless Loop: Amodei, Heck vote to repeal Patient Protection and Affordable Care Act — Again

Here comes the Endless Sound Loop!  The votes are recorded on H.R. 6079 the latest bill in the House of Representatives to call for the repeal, defunding, diminution, or restriction of the Affordable Care Act.   [roll call 460]  Nevada’s own Joe Heck (R-NV3) weighed in. [video here] Representative Mark “Me Too” Amodei (R-NV2) voted for the symbolic and stage managed repeal.

Poor Representative Heck (R-NV3) still thinks there was a Cornhusker Kickback included?  He must have missed the memo when it was removed before passage.   His objections? The Affordable Care Act has “failed to deliver on all its promises.”   Really, many of the sections of the bill have not even been implemented to date.  Somewhere in the midst of the  word salad, Representative Heck tries to focus on how the Affordable Care Act hurts Medicare.

Let’s review:  The Affordable Care Act Does Not Hurt Medicare.

#1. “The life of the Medicare Trust Fund will be extended as a result of reducing waste, fraud and abuse, and slowing cost growth in Medicare, which will provide you with future cost savings on your premiums and coinsurance.”  [FactSheet]

If you want a bill that would imperil the Medicare Trust Fund, try the Republican provision in their budget to cut $160 million from discretionary funds for fraud prevention and enforcement.  [TCF 2011]

And here I was thinking that the Republicans were all for the reduction of waste, fraud, and abuse of public funds….

#2.  We don’t want to forget that House Republicans have an ax in this budget fight.

“This vote came after a parade of Republicans went to the House floor today bashing Barack Obama, the Democrats, and the health law for cutting $500 billion from Medicare — one of their central attacks on Dems for two straight cycles now — despite supporting those very same cuts in their own budget, the Paul Ryan plan.”  [WaPo]

#3.  What’s this about “discriminating against Medicare Advantage policy holders?    Let’s be clear — the federal government has been giving health insurance corporations a tax payer subsidy for offering Medicare Advantage insurance to senior citizens.  Oil companies, insurance corporations, it seems the House GOP has never met a corporate subsidy it doesn’t like.   And the Republicans kept giving the insurance corporations more:

“Republicans in Congress began boosting their payments, to the point that Medicare Advantage gets paid 114 percent what Medicare gets paid to care for a patient.”

And it’s important to remember that those free perks do not account for the whole of Medicare Advantage’s overpayments. Rather, economists have estimated that for every extra dollar we pay the program, 14 percent is passed on to seniors and 86 percent goes to profits or other costs. In other words, we’re getting only 14 cents of obvious value for every dollar of overpayment. [WaPo] (emphasis added)

It’s not “discrimination” (one of the GOP buzz words du jour) to try to reduce program costs by reducing tax payer subsidies for highly profitable private insurance plans.  If someone wants a Cadillac Medicare Advantage Plan, fine, they should buy it — just not expect the taxpayers to pay the insurance company to offer it.   And here I was thinking that the Republicans were all for saving the taxpayers money….

Let’s Review: The tax on medical equipment is not the Biggest Tax of All Time on Everybody.  Here’s the analysis from the medical device manufacturing folks as the Patient Protection and Affordable Care Act was being finalized:

“Under the compromise, the medical device industry fee in the PPACA was repealed and replaced with a different version of the provision known as an “excise tax.” In this new provision, the magnitude of the medical device tax was lowered from 2.9% to 2.3% annually, and was delayed two years, until 2013. [...]

But this change created a deficit in the overall bill that Congressional leaders were not willing to accept unless additional offsets were found. In exchange for these changes, the tax was extended to a larger base, namely Class I medical devices, with little discussion or opportunity for public comment or scrutiny. The vast majority of orthotics and prosthetics, as well as durable medical equipment, are Class I medical devices. [NAAOP]

The House GOP appears to be trying to have it both ways — first, demand that revenue be found to pay for additional coverage for more Americans, and then loudly bemoan one of the ways offered to achieve the “payfor.”

Somewhere Rep. Heck got the idea that 1,000 jobs will be lost in Nevada because of the medical device excise — no source for this information was provided in the Congressman’s remarks.

Here’s What They Voted To Repeal

1. Allowing parents to keep their children on their health insurance plans until the kids are 25.

“6.6 million young adults, including 3.1 million who were previously uninsured, would lose the option of staying on their parents’ health plans if the health care law were repealed.” [HHS]

2. A law preventing health insurance corporations from dropping policy holder’s coverage if the person become ill or injured.

“Without the Affordable Care Act, the insurance industry could return to retroactively canceling coverage for a sick patient based on an unintentional mistake in their paperwork, putting at risk the 15 million people purchasing coverage in the individual market.”  [HHS]

3. A law preventing health insurance corporations from discriminating against women just because they are women.  Being female is no longer a “pre-existing condition.”

4. A law preventing health insurance corporations from spending any more than 20% of premium dollars collected from policy holders for CEO compensation, administrative costs, and other overhead. Premiums collected must be spent for medical and health care.

5. A law providing increased and affordable access to preventive medical services — pap smears, prostate cancer screening, breast cancer screening, vaccinations for children.

“Approximately 54 million Americans who gained private coverage for recommended preventive services without cost sharing would lose this benefit with the repeal of the health care law.” [HHS]

“The repeal of Affordable Care Act would force 32.5 million people on Medicare to pay more for preventive care like mammograms and colonoscopies.” [HHS]

6. A law  providing affordable pre-natal and child wellness visits with a family physician.

7. A law providing cost relief for senior citizens who purchase prescription medications, and one which closes the infamous ‘donut hole’ by 2020.

“Repeal of the Affordable Care Act would end the 50% discount on brand name prescription drugs for seniors and people with disabilities who hit the donut hole.  This discount saved 5.3 million seniors more than $3.7 billion through May 2012.” [HHS]

8.  A law preventing the insurance companies from discriminating against people who have pre-existing medical conditions.  Some 67,000 Americans could become uninsurable.

The Pre-Existing Condition Insurance Plan has provided insurance to Americans who have been locked out of the insurance marketplace because of a pre-existing condition – and its more than 67,000 enrollees would likely return to being uninsured with the repeal of the law. [HHS]

There’s more here.  And, more commentary from NV Progressive here.

For most members of the tax paying public — at least those who are deficit hawks as opposed to deficit chicken hawks — here’ s the bottom line:

Repealing the Affordable Care Act would increase the deficit by $100 billion over ten years.  It would also shorten the life of the Medicare Trust Fund by eight years.

Representatives Heck and Amodei marched along with the GOP/TeaParty contingent, armed with slogans, buzz words, and slippery syllogisms, and voted to increase the federal deficit and shorten the life of the Medicare Trust Fund.  Representative Shelley Berkley (D-NV1) had the good sense to vote “no.”