Editore"s Note
Tilting at Windmills

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April 5, 2011

MEDICAID IN THE GOP'S CROSSHAIRS.... The Republican plan to effectively eliminate Medicare will certainly dominate much of the budget debate in the coming months, but let's not overlook the significance of the GOP plan to gut Medicaid by turning it into a block-grant program.

House Budget Committee Chairman Paul Ryan (R-Wis.) wants Americans to think of his Medicaid plan as "welfare reform." That's politically clever, I suppose -- most people have been conditioned not to like "welfare," and to love "reform" -- but as Matt Yglesias explained this morning, it's a scam.

[P]eople are supposed to think Medicaid is that "bad" kind of government spending, the one that goes to shiftless black folks not hard-working Americans like you and me and Paul Ryan. [...]

This is mostly a program for the elderly and the disabled. It's the main way we finance long-term care in this country. If you don't directly benefit from it, you very likely have a parent or grandparent who does and whose financial needs will simply tend to fall on you if the program is cut. Meanwhile, in terms of the "welfare" aspect of Medicaid by far the largest set of poor people it covers are poor children. Is Ryan's view that these kids should have worked harder to have rich parents? Poor kids tend to struggle with a lot of problems and are in many ways disadvantaged in the competitive economy by the time they're out of diapers. It seems to me that investing in their basic health care is a no brainer way of leveling the playing field somewhat and ensuring that the country is making the most of our human resources.

It is a no brainer unless you consider Ayn Rand's silly novels an economic blueprint.

The key takeaway here is that House Republicans believe seniors, people with disabilities, and low-income children have had it too easy, for too long. It's time to show these ne'er-do-wells some "tough love," slashing their health benefits, and directing those funds where they belong -- in the hands of millionaires and large corporations in the form of tax cuts.

Ezra Klein also had a good piece this morning, walking us through the practical consequences for the House GOP plan on Medicaid.

[P]erhaps cutting it wouldn't be so bad if there were a lot of waste in Medicaid. But there isn't. Medicaid is cheap. Arguably too cheap. Its reimbursements are so low many doctors won't accept Medicaid patients. Its costs grew less quickly than those of private insurance over the past decade, and at this point, a Medicaid plan is about 20 percent cheaper than an equivalent private-insurance plan. As it happens, I don't think Medicaid is a great program, and I'd be perfectly happy to see it moved onto the exchanges once health-care reform is up and running. But the reason that's unlikely to happen isn't ideology. It's money. Giving Medicaid members private insurance would cost many billions of dollars.

That's why it's well understood that converting Medicaid into block grants means cutting people off from using it, or limiting what they can use it for.... There's just not another way to cut costs in the program. You can, of course, work to cut costs outside of the program, either by helping people avoid becoming disabled or making it cheaper to treat patients once they become disabled or sick, but those sorts of health-system reforms are beyond the ambitions of Ryan's budget.

One can try to rebrand cutting care for the elderly, people with disabilities, and low-income children as "welfare reform," but that doesn't change the callousness of the policy.

Steve Benen 10:05 AM Permalink | Trackbacks | Comments (23)

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Comments

One of the primary uses of Medicaid is to fund nursing home stays for the "indigent." That word is in quotes because a whole industry has grown around hiding granny's assets so she can pass them on to her family and not blow them on a nursing home stay. I have to believe that a whole bunch of rich people would be unhappy at this turn of events. Certainly, the lawyers who make a living at this will fight block grants tooth, claw and fang.

Posted by: Bob on April 5, 2011 at 10:11 AM | PERMALINK

I notice Ryan also cuts taxes for the rich. With all the cuts to welfare his budget doesn't balance until late in this century or early in the next.

Ryan's roadmap is a Koch brothers wet dream.

Posted by: Ron Byers on April 5, 2011 at 10:14 AM | PERMALINK

So ... Democratic politicians will be all over this, right? They'll take a stand, vow to protect the safety net, right? And then they'll get massive electoral gains in 2012.

Nah, just kidding. They'll praise Ryan as courageous, then cave, then blame the voters for kicking them out in 2012.

Posted by: Tom Allen on April 5, 2011 at 10:14 AM | PERMALINK

Trying to eliminate Medicare and Medicaid, as well as roll back ACA, makes perfect sense for Republicans.
It cuts entitlements from people who need them, thus hurting them, it halts and turns back progress, and it provides corporations with another income stream.
That's a Conservative TRIFECTA!!!

And, if the Supreme Court says ACA is unconstitutional (which, with this court anything is possible - as long as their corporate masters approve), then going to single-payer (aka, Medicare/Medicaid) also becomes impossible.
BINGO -a pre-emptive strike!

The Conservative won't be happy until they roll this country back to the early 1900's, the Gilded Age, before women and blacks could vote, and unions and taxes made the playing field more level.
And I said before, that, for them , is 'Happy Days!!!"

Posted by: c u n d gulag on April 5, 2011 at 10:18 AM | PERMALINK

Oh, don't you worry. There'll be a whole bunch of exemptions carved out for taking care of the middle-class elderly and their nursing home care. But since that will cost more, the poor and vulnerable will just have to sacrifice even more. Expect to see someone in the current Congress propose to repeal the law requiring emergency rooms to treat all comers regardless of their ability to pay. They're going to do it.

Posted by: jonas on April 5, 2011 at 10:20 AM | PERMALINK

Monday dawned with two topics greatly in evidence across the lefty blogosphere. One, Obama's reelection ads were washed over everything, and two, the curtain was being pulled away from the republikan's plans to destroy Medicare.

Obama was asking, "Are You In?". And of course I'd vote for a Democratic spore over a republikan anything, so I guess I'm "in". But my letter to whitehouse.gov asked Mr. Obama if he was in. He's pretty busy, but this Medicare crap takes very little explaining to push back against.

This would be one of the easiest things in the world for Obama to get out in front of. And one of the most energizing for his potential supporters. My question to Barack Obama is his own to us... Are you in? And how "in" are you? Will we be able to tell? Thus far it's been difficult.

Posted by: burro on April 5, 2011 at 10:28 AM | PERMALINK

I do like the description of Ryan's plan as "lighting the fuse to blow up Medicare in 10 years".

Of course, with ACA repealed, the private insurers will be able to jack up rates, exclude people with pre-existing conditions, and use "recission" tactics to avoid covering people who get sick.

Because on GOP Magic Sparkle Rainbow Unicorn Island, only *bad* people get sick after age 65, and they should have saved up a $100M nest egg, the slackers.

Posted by: Snarki, child of Loki on April 5, 2011 at 10:28 AM | PERMALINK

This fight is going to blow up in the Republicans' faces like nothing they ever imagined - it'll make the public pushback in Wisconsin look positively benign.

Case in point: A neighbor of mine who pays little attention to national politics. I called her yesterday and told her about this, and said, gee, isn't your mother on Medicare? And she said yes, it's a good thing, too, since she's had several hospitalizations.

So I pointed out to her that what her mother has now, she won't be able to draw upon. THAT most specifically got her attention!

Posted by: blondie on April 5, 2011 at 10:34 AM | PERMALINK

"This fight is going to blow up in the Republicans' faces like nothing they ever imagined - it'll make the public pushback in Wisconsin look positively benign."-blondie

-only if the poor start to show up at the polls. . .

Posted by: DAY on April 5, 2011 at 10:40 AM | PERMALINK

"It's the main way we finance long-term care in this country. If you don't directly benefit from it, you very likely have a parent or grandparent who does and whose financial needs will simply tend to fall on you if the program is cut."


Jeebus on a pogo stick, that alone should wake up the Teabaggers when they realize taking care of Mom with Alheimers will be their responsibility and it will likely bankrupt them. But knowing them, they'll enthusiastically endorse it because FOX will tell them what a great deal gutting Medicaid will be.

Posted by: LRM on April 5, 2011 at 10:41 AM | PERMALINK

Obama excoriated Bush and Cheney over Guantanamo and the planned military trial of Khalid Sheik Mohammed who planned the attack of September 11, 2001. Now that Obama has done an about face - how do liberals characterize the man? Why avoid the issue?

Posted by: mhr on April 5, 2011 at 10:43 AM | PERMALINK

It's instructive that a post on the evisceration of medicaid gets comments focused on the risks to Medicare. This alone is a good indication of the problem, and why Democrats may well be fooled into accepting a "compromise" that "saves" Medicare while accepting deep damage to Medicaid.

It's also great that people are focused on the nursing home component of Medicaid and elderly people in poverty... but this, arguably, is why "block grants" will look attractive to some as a solution. Block grants, with few rules, will probably protect the nursing home component at the expense of care for poor people, poor children and some of the poorest with disabilities. While the latter may get some sympathetic press, and children will, of course, make a great rallying cry, the likelihood of gutting any support for poor adults who just need an insurance program (already poorly funded and barely supported) is very real.

As I said in a previous comment, a lot of the reasoning behind this plan goes to the fight over the ACA, when Democrats failed to muster support for reforming and expanding Medicaid in ways that needed to happen to make reform real - really fixing Medicaid's reimbursement rates (which are lower than Medicare's, as Ezra points out), and properly funding the program, probably at the federal level, to standardize benefits and levels of coverage.

The failure to properly fund and expand Medicaid last year, and to use dreamy, unrealistic numbers to prop up the cost of health reform has gotten us to this point. And the easiest answer - for Republicans, but also for many Democratic leaders - is to simply gut Medicaid in the name of fiscal sanity. Though the cuts will be unpopular, as part of a larger deal and sold as a way to protect other, more sacred programs (Medicare for the left, and many Pentagon cuts for the right), a lot of this is likely to pass. And it's appalling. And I doubt the left has the will, or the way, to either force Democratic leaders to really stand up for the poor, or replace them if they fail to accomplish that. Despite a lot of left wailing, the fact is that Democrats stopped standing up for poverty issues some time ago. Finding a way back to that is probably not going to happen in time to salvage something that really shouldn't happen here. I hope I'm wrong, but I doubt it.

Posted by: weboy on April 5, 2011 at 10:45 AM | PERMALINK

Poor kids tend to struggle with a lot of problems and are in many ways disadvantaged in the competitive economy by the time they're out of diapers. It seems to me that investing in their basic health care is a no brainer way of leveling the playing field somewhat....

Yes, but if you're an avowed Randian, as Paul Ryan is, "leveling the playing field somewhat" is a really horrifying bug, not a feature.


Posted by: Steve M. on April 5, 2011 at 10:51 AM | PERMALINK

(Yay to what Tom Allen says, above.)

You know, Obama is bound to have to go on TV soon either to announce a shut-down or that he's caved in to the forces of darkness yet again. Here's a morning mental tickle to contemplate:

Just imagine the Senate grows a pair and says "no" to the ridiculous House C.R. reportedly up for approval today. The government has to shut down. Obama goes on national TV and at long last does an FDR.

He blows the whistle RIGHT NOW on the Rand Paul/GOP budget by warning all Americans that it is now out in the open: the Republican plan is to privatize Medicare and abolish Medicaid. He says he won't be a party to that. Obama then explains what the GOP proposals mean to Granny in the nursing home or retarded children in independent living classes, etc. Using the superior research resources of the WH he even illustrates the true impact of these proposals by citing what they would do to specific, named relatives of the GOP leadership. ("Grandma Boehner out there in Easy Acres Nursing Care would have to live the street... Little Mitch McConnell IV, the autistic great-grandson of a Republican senator, would be expelled from special ed class for not paying his tuition.")

Then, the president gives a stem-winder explaining that he knows the GOP hates him even more than they hate the middle class or the poor. Channeling FDR, he says he welcomes their hatred. So long as he has a breath left, he will gladly absorb the impact of their hatred as long as they leave the most needy, defenseless and vulnerable alone. And yadda yadda yadda.

Christ, Obama could wind up getting reelected by acclimation.

Ain't gonna happen though. Senate Dems are too chicken-s**t and Dear Leader isn't motivated to even try -- unless, of course, it's Wall Street bankers who need saving.

Posted by: John B. on April 5, 2011 at 10:52 AM | PERMALINK

here's a close look at reality. none of this Ryan shit is going to happen. There is no justification for any of it. His strategy is identical to a used car salesman's. How much for that car? Oh i'll take 25,000. Hows a bout I give ya 20? why I don't know let me ask my corporate masters. guess what that offer is perfectly ok.

Posted by: Gandalf on April 5, 2011 at 10:55 AM | PERMALINK

My mother had the great misfortune to suffer a catastrophic stroke. She had the greater misfortune to survive. She ended up pretty much an animated head on a dead body and "lived" like that for years, of course in a nursing home. We were very careful and very picky about choosing a facility, but we were severely limited because many didn't accept Medicade, and once the money ran it you were out right along with it. My mother's money didn't last long (we were allowed to keep enough for burial expenses) and she ended up on Medicade.

My story isn't unusual or strange, and scheme will resonate with the public on a visceral level far beyond the Republicans' and tea baggers' wildest imaginations. I still say 2012 will be a blood bath for the Republicans.

Posted by: SaintZak on April 5, 2011 at 11:19 AM | PERMALINK

Ryancare sounds like no care and death panals to me!!

Posted by: iyoumeweus on April 5, 2011 at 11:34 AM | PERMALINK

It seems to me that investing in their basic health care is a no brainer way of leveling the playing field somewhat and ensuring that the country is making the most of our human resources.


For those who are still too self absorbed to notice what the Republicans are doing to the other half of the population, the intention is to force women to produce surplus human resources so that the increased waste won't matter to the bottom line.

Posted by: thebewilderness on April 5, 2011 at 11:47 AM | PERMALINK

Today's republicans are the most disgusting creatures. If it's not about the rich white person then they happyily go a long with finding ways to kill them.

Posted by: Silver Owl on April 5, 2011 at 12:55 PM | PERMALINK

-only if the poor start to show up at the polls. . .
Posted by: DAY

~~~~~~~~~

And if they do, they'll be asked for their proper voter ID, and when they don't have that, they'll be turned away...

Posted by: Hannah on April 5, 2011 at 1:17 PM | PERMALINK

"It is a no brainer unless you consider Ayn Rand's silly novels an economic blueprint."

I'd rather consider Ayn Rand's Life the the blueprint,,,

Consider the Objectivist Ayn Rand who received
Social Security payments from her
Social Security Retirement account,,,
and
The Self-Sufficient Ayn Rand that received
medical treatments courtesy of ,,, Cough Cough,,,
Fucking MEDICARE !
for her ouch ouch
fucking diseases.

Posted by: cwolf on April 5, 2011 at 5:10 PM | PERMALINK

Don't be so sure that we poor people won't show up to VOTE.

And, definitely, don't be so sure we won't be fully LEGAL, despite the Republicans' intimidation attempts. In Kentucky, you do have to have a valid photo I.D. to vote, like a driver's license, or state-issued I.D. Which a LOT of poor Kentuckians already have.

Posted by: knightphoenix2 on April 5, 2011 at 8:55 PM | PERMALINK

Hmmmmm (WARNING....sarcasm ahead)

too bad we don't have a Democratic President to speak out against these Tea Buggers

Maybe when we get a Democratic President he'll champion social programs and find revenue by ending tax cuts for the rich

I hope Jerry Brown doesn't take his lead from the Bozo in the White House

Posted by: Antivirus Software Alert on April 6, 2011 at 11:24 AM | PERMALINK
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