Romney's plan to cover the uninsured: emergency room?

Mitt Romney’s specific plan for taking care of those without health insurance?

Scott Pelley to Mitt Romney on insuring the uninsured, 60 minutes, September 23, 2012

“SCOTT PELLEY: Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?

MITT ROMNEY: Well, we do provide care for people who don’t have insurance, people — we — if someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance and take them to the hospital and give them care. And different states have different ways of providing for that care”.

Romney should know better.  That’s why he invented the health care system in Massachusetts; it was a very expensive way to go.

The cost shift of expensive ER care to the Hospital goes , not to the State, but to the already insured and to the federal government’s programs for Medicare and Medicaid.  It is why we in the US pay 2 and a half times per person for health care than in other industrialized countries. The shift, the cost absorbed by the already insured ads up to $1000 per family per year , and also accounts to the shortening of the life of Medicare since it increases the general cost of health care,  the services of which are reflected in the costs of Medicare.    That is why the Simpson Bowles Debt Reduction Commission concluded that the cost of Medicare and Medicaid would be reduced if Obamacare was retained and the repealing Obamacare would add to the deficit and Obamacare would reduce it.

A person who treats the ER as their primary care physician does not get any  checkups, too, or preventative care..  For major illness, usually the patient arrives at the ER very sick and ends up having the most expensive care because of the   seriousness of their advanced condition…hospitalization, surgery and end of life treatment.  It is no wonder that the US has one of the worst death rates in the industrialized world.  Those who have insurance get good care; those who do not are more likely to die younger.  The result is a very bad average.  

We hear the GOP accusing Obamacare  taking $716 billion out of Medicare.  The inference is that the cuts go into thin air or benefits are reduced.  Wrong.  About $250 billion is ending the subsidy to private insurers for Medicare Advantage which, strangely enough, is continuing without the subsidy. The private insurers were being paid 17% more to administer Medicare than what the government could do itself….and it resulted in no advantage to senior care and the insurers got the only advantage.

From an article written by Sarah Kliff in the Washington Post, 8/14/22: “ By 2010, the average Medicare Advantage per-patient cost was 117 percent of regular fee-for-service. The Affordable Care Act gives those private plans a haircut and tethers reimbursement levels to the quality of care administered, and patient satisfaction.

The Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion.

The rest of the Affordable Care Act’s Medicare cuts are a lot smaller. Reductions to Medicare’s Disproportionate Share Payments — extra funds doled out the hospitals that see more uninsured patients — account for 5 percent in savings. Lower payments to home health providers make up another 8.8 percent. ….It’s worth noting that there’s one area these cuts don’t touch: Medicare benefits. The Affordable Care Act rolls back payment rates for hospitals and insurers. It does not, however, change the basket of benefits that patients have access to…”

That $716 in savings is reflected in Medicare’s future costs and improvements to the Medicare system.   The result: seniors will save on the average of $600  the a year since the  Medicare donut hole for prescription drugs will be covered by Obamacare, Medicare’s life is extended 8 years,  and the deficit problem will get some relief. Repealing Obamacare would eliminate all of these savings, reinstate the donut hole ,  eliminate the savings to the system, and continue providing the uninsured with very expensive health care.

(Sources for much of this can be found at the Kaiser Family Foundation web site and at www.AARP.com; Much of this also is a repeat of my prior blog postings with sources documented then)

Hope vs Back to the future; what would it have been like if the GOP won in 2008

My Column in the Sky Hi News on line edition today: The GOP presidential contenders are putting their eggs in one basket: The voters are feeling so much pain, anyone would be better than Obama. Oh?

Some in the GOP seem to yearn to return to the time of John Adams, when Abigail could run the farm and cash flow was only a nagging problem because she could raise their own food, sew her own clothes, and pay the doc in chickens.

That bucolic life is long gone thanks to the industrial revolution, the intertwined world economy, urbanization, an economy driven by middle income consumer spending, and expensive life-saving medical technology. “Each to his own and each on his own” has moral and economic implications. To what extent should we be our brothers' keeper? Is it good for the economy to leave one half of Americans near or in hopeless poverty?

To compensate for tax cuts, ground wars, and stagnant income, we plunged ourselves into deeper government and personal debt. Starry eyed, we put our money in unregulated investments based on questionable mortgage loans until the economy imploded in 2008.

When I hear voters wistfully say they just want it like it was before, for which “before” are they yearning? — the latter 1700s or the bubble of the early 2000s?. Most of the GOP's roadmap to prosperity is the bubble model that replicates their previous route that led to prosperity for the few, a col de sac for many, and eventual disaster for all.

Low taxes and less regulation did not lift the boats of the middle class much from 2001-2007, while the upper incomes soared, per the Congressional Budget Office. Job loss and recession began nearly the year before the crash of fall 2008. The theory that wealth trickles down to the middle class did not work well in practice.

The GOP is not about applying balm to middle income pains. They want to repeal help for Elm Street to aid Wall Street and Fifth Avenue, with more tax breaks to an already robust financial sector and the comfortable rich, repealing health care and Wall Street reform, and weakening consumer protection.

We can imagine a GOP future by going back to their past.  What would it have been like with a Republican or a Mitt Romney controlling Washington for the last three years instead of having the reforms and policies Obama supported and instituted? The financial sector would still be free to hoodwink investors and homebuyers, one bank failure could still bring down other banks, and we would still drown in the cost of more or indefinite ground wars. There would have been no pressure on banks to refinance responsible homeowners, and the housing market would be seeking an even deeper bottom. Detroit would have gone bankrupt; 1.4 million jobs would have evaporated as the industry would have moved abroad. The 2009 stimulus would not have been passed and another 2.3 million jobs would have been added to the unemployment count.

The Ryan plan would have passed so future seniors would pay $6,000 more a year for Medicare. 30 million citizens  could never hope to afford health insurance. Sending kids to college would have become a fading dream, with shrinking access to student loans, and continued unrealistic burden of paying back them back.

Simpson Bowles debt reduction plan would have been completely ignored because it recommended GOP no-no's   of reducing military spending, continuing cost saving Obamacare, and raising taxes on the rich, the very recommendations embraced by Obama.

In his State of the Union address, Obama gave us a new vision of “hope,” a fair shake for the future for the middle income. With all economic indicators zigzagging upward, he can rightfully claim he has indeed turned around the economy, if not yet cured it, and that a Republican future would be a leap back to the policies from whose consequences we are now trying to escape. 

Charting a course back to confidence in the economy

my column published in the online version of  the Sky Hi News 8/17/2011; Another, edited version appeared in the print edition

 

The United States has a confidence problem ... a big one. It lost it two weeks ago when the debt ceiling debate came to an end, and the thorniest issues are still hanging fire since they were tossed to a committee.

There is a way out of the loss of confidence, but it will take some guts to do it.

The first step of any recovery is to admit the problem. The world has lost faith we can govern ourselves to solve the economic mess. Consumers have lost confidence that the economy will ever improve enough that they can stop planning for possible job losses and be able to spend for more than the bare necessities.

Corporations sitting on $1.3 trillion in cash will not invest until consumers start buying again. Investors are deer caught in the headlights, not knowing which way to jump so they freeze in place.

Voters have no faith that Congress can come up with a plan to reduce the deficit. Both the far left and the far right have lost confidence that President Obama is leader enough to give them the solutions they demand and absorb the political blows that result on their behalf.

We can thank the Tea Party for the largest contribution to causing the problem. This minority within a party fabricated a crisis by threatening to prevent the U.S. from being able to pay its debts. For them it was simply a strategy to force their hard line views on the majority. Their taking the threat to the brink caused a moderate earthquake as the stock market ran amok and fears of a double dip recession were revived as economists here and abroad trembled in the aftershocks.

Imagine if the Michele Bachmanns of the world had their way and the U.S. had defaulted. The markets and investors would have reacted as if it were a 9 on the Richter scale.

The left has also contributed to the loss of confidence. Its reaction to the crash was to blame President Obama for not making rousing speeches in defense of keeping the status quo on entitlements or tying up decisions while the conservative leaning Supreme court ironed out the intent of the 14th Amendment. They joined their brethren's litany on the right in condemning Obama for failed leadership. That is the most self-defeating strategy possible.

Someday the left will realize that they do not have enough votes in Congress to leverage their proposals and that joining the GOP in a feeding frenzy of attacking a Democratic president will not be the path to changing the balance in Congress or keeping the White House.

What can restore confidence? For one: Let's stop equating compromise with failure and let's cut the president some slack so he can make some grand bargain that will make the economy better. The left should stop cutting him off at the knees even if it tweaks entitlements a little.

The right may have to suck up some revenue increases. So be it; what we need is a credible plan that investors, business, and especially consumers feel will give them confidence that the future will be better .

The Simpson-Bowles plan to reduce the deficit has gotten the most votes of confidence from economists. Yes, it proposes raising some revenue and reforming some entitlements, but so what. It has the best chance of working.

Let us also reform the tax structure, simplify it, eliminate loopholes, reduce the top rates and make it fairer to small business and the middle class. Some incentives to encourage companies to hire the unemployed and more breaks for those willing to invest in infrastructure may help in the short term.

If the Democrats and President Obama were to take the lead in advocating a plan along these lines, my guess is 2012 will look a lot better for them.

Giving credit where credit is due

I was half amused and half incensed at the response of some Republicans who reacted to the Bin Laden killing by completely ignoring any role the President played in one of the most historical and  risky military actions of years.  It is  similar to the GOP's  strategy regarding the budget debate. Pres.Obama presented a serious plan for debt reduction and the GOP just acted as if it was  tree falling in the woods and no one was there to hear it. Could it be they fear some  side by side comparisons with Obama as a leader  and a budget proposal more acceptable to voters than theirs?

Obama may have not landed in the helicopter, risked his life in a shoot out, but  he participated in the planning,  gave the kill order and the order to proceed and watched the raid unfold in real time. GOP leaders immediately sprang into action dissing the President’s responsibility for the success or ignoring the president and only praising the Seals and intelligence forces A picture is worth a thousand words and it was clear from photos and reports of the situation room that fateful  Sunday  that the President was the Commander in chief of the operation The tension in the room, Obama biting his knuckles and veins on his temple visible, Hilary Clinton’s intensely focused eyes and hand over her mouth said much.   President’s counter terrorism adviser John Brennan called on CNN “ one of the most gutsiest calls of any president in recent memory. “
The call was both risky and gutsy.  The US was conducting a military action within a country that was neither sanctioned or informed in advance and that country was a critical ally, but a shaky one. The evidence was not firm that Bin Laden was a) even in the compound b) there was a double of thim there c) if killed, his body or proof of identification could be made d) and  aBlackhawk down and another screw up such as  Carters’s failed attempt in the Iran hostage crisis would probably have ended Obama’s political career. 
The episode will allow Obama to redefine himself as a poker faced strategist who could be deadly effective if achieving his goals, an unusual leader who did not fit into the standard mold. In the run up to the  probably the most defining moment of his political career, he relaxed as he threw comedic barbs at potential GOP candidates in a DC gathering  and ridiculed their “birther” insinuations, having yanked the rug out from under them by producing his long form birth certificate earlier in the week. He did more than a Bush flyover of the devastation  of an epic natural disaster. ,He showed immediate and sympathetic on the ground attention to the victims and mobilized immediate aid.  He was highly visible at a planned space launchings. If anything, he showed he could walk across the street and chew gum at the same time cool as a cucumber, bearing the stress of decisions and historic risks  he knew would come to a head within days.