Obamacare

It seems that Republicans want to put Obamacare front and center in the election of 2014. Republicans will try to make this work in two ways: cut money for implementation and play up any problems that come up (and there will be problems). As Greg Sargent notes, articles like this are basically saying what Republicans want to be said–when problems arise Democrats (well, anybody) should talk about them to make the law better, but if newspapers interpret this as saying the Democrats are against Obamacare then the cause is lost. As Kevin Drum notes, the way to get around this is to start playing up the benefits of Obamacare as much and as soon as possible. If they do, then it will be Republicans that will have to answer difficult questions such as: what will you do to control medical spending?; what will you do so everyone has access to healthcare? Democrats and supporters need to play up all the problems with the current system. Played right, this is a big win for Democrats.

Medicare and Medicaid spending

Hmm, this seems like it could be a big deal:

In its most recent baseline projections, CBO reduced its estimates of spending for the Medicare and Medicaid programs compared with its estimates in the August 2012 baseline. For the 2013–2022 period, projected spending for those programs is now $382 billion (or 3½ percent) below the agency’s estimates in August 2012.

…

In recent years, health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated. For example, in 2012, federal spending for Medicare and Medicaid was about 5 percent below the amount that CBO had projected in March 2010.

In response to that slowdown, over the past several years CBO has made a series of downward adjustments to its projections of spending for Medicaid and Medicare. For example, from the March 2010 baseline to the current baseline, technical revisions—mostly reflecting the slower growth in the programs’ spending in recent years—have lowered CBO’s estimates of federal spending for the two programs in 2020 by about $200 billion—by $126 billion for Medicare and by $78 billion for Medicaid, or by roughly 15 percent for each program.

If this isn’t a short-term blip then this is really good news. Healthcare costs are the driver behind increasing deficits, so if these costs start to moderate there will be no long-term deficit problem. Given that this is a good time for deficit spending, perhaps this news will mean politicians will wait to see if there really is a problem before they start making big cuts. Ha ha, sorry, that’s a stupid thought.

Cuts to Medicaid

Governor LePage is going to cut Medicaid in Maine. Here is what some LePage and some of his supporters say:

LePage has likened Medicaid to welfare and criticized able-bodied adults who receive taxpayer funded health care. His spokeswoman said he would not be interviewed. But LePage has defended his decision.

In a Jan. 28 letter to the US Department of Health and Human Services, he argued that Maine’s previous Medicaid expansion prompted people to “drop their private insurance in favor of free coverage at the expense of Maine taxpayers,” leading to an “addictive-like dependence on federal dollars.” The state’s credit outlook was downgraded recently in part because of the added burden of its Medicaid costs.

…

But LePage does have the backing of a number of constituents as well as conservative groups. William Gyorfi, a 65-year-old regular at the Governor’s Diner in Lewiston, supports LePage’s decision to cut back the Medicaid rolls. People need to take more responsibility with their finances because Maine has too many people depending upon government handouts, he said.

“This state has become a welfare state, and Medicaid is part of the problem,” said Gyorfi, a sales associate in the sporting goods department at Kmart. “You have those people who rely on Medicaid for a long time and they become addicted to it. They need to be weaned off the system.”

Joel Allumbaugh, director of the Center for Health Reform Initiatives at the Maine Heritage Policy Center, a conservative research organization, agreed, saying, “When you create these avenues for people to have free health care, where is the incentive to go out and advance yourself through your own initiative?”

The Globe helpfully provides a bit of background on a few of these layabouts:

Louis Bourgoin seems an unlikely symbol of the latest battle over health care spending. The 68-year-old retired shipyard worker is undergoing chemotherapy for liver cancer. He lives in a state once renowned for its efforts to insure the poor, and Mainers stood to benefit even more under President Obama’s health care plan.

Then the letter from the administration of Governor Paul LePage arrived. Bourgoin and his wife were told last month they were about to lose thousands of dollars in annual Medicaid benefits starting March.

He’s become addicted to living, what a leach.

“People don’t wake up and choose to be poor,” said Ramon Badillo Perez, a 35-year-old father of four who relies on Medicaid for the knee and foot problems he has developed from his two-mile walk each day to his $10.80-an-hour job managing the cafeteria at Sam’s Club in Augusta. “You work to try to get ahead, and you can’t.”

Now there’s someone who’s gaming the system because he’s just a lazy bum.

Donna Garnett, a 45-year-old living in a Portland shelter for homeless women, is among 10,000 adults without dependent children who are scheduled to be dropped next year. Her last job was as a gas station attendant in 2007, but she can no longer work because of a slew of health problems that require her to take 18 medications each day.

Garnett lives off $227 a month from her father’s life insurance. Her medications cost her $30 a month, but without Medicaid, the price will skyrocket to more than $815 a month for pills to control her asthma, diabetes, thyroid, back pain, and depression.

If she just had some initiative, she wouldn’t have asthma or her other problems.

Jennifer Webb, a 35-year-old mother of three who is at risk of losing her Medicaid benefits in March, just had ankle surgery and will require physical therapy when she is able to walk again in four weeks. By then, she does not expect to have coverage.

Her husband, a former Army sergeant, has traumatic brain injury and post-traumatic stress disorder as a result of two tours in Iraq. He had a job installing metal roofing in hopes of building enough savings to buy the home in Pittston the family is now renting, but he was laid off last week.

Obviously they have become dependent on government, first he was a government worker and now they expect government help. That’s just not American.

Healthcare costs

This article has two illuminating pieces of information, one that I knew and one I didn’t:

Americans spend more than twice as much per capita as other developed countries on health care — a crippling 18 percent of the country’s economic output, and growing.

…

America’s health care system is not much different from other developed countries in the volume of service. Our doctors prescribe more or less the same number of pills and X-rays, perform similar numbers of blood tests and surgeries, as doctors in the best European countries. While there are undoubtedly savings to be had by cutting unnecessary services (shortening hospital stays, for example), the main problem is that our system charges far more for each service — each office visit, each hip replacement, each day in a hospital bed, each dose of antibiotic. “The facile explanation is that doctors do too much,” said Peter Bach, a doctor at Memorial Sloan-Kettering who studies quality of cancer care. “But if you compare us to other countries on volume, we’re not leading in any category. The flip side is, we pay double for a lot of stuff.” (Actually, we lead in tonsillectomies and knee replacements, but his point is generally right.)

This means that the arguments on both sides are wrong to some extent–one side says that malpractice suits drive up costs because of the cost of the suits and the idea that it leads to lots of ‘defensive’ medicine; the other side claims that the pay for service nature of healthcare means unnecessary tests are run (both arguments might be true to some extent, but neither seems to be the main reason our costs are so much higher than other countries). The data seems to show that the problem isn’t the number of procedures but that each one costs much more in the US.

Gee, Medicare is relatively cheap

This story on Medicare actually really looks at medical costs:

Let’s focus on those 65- and 66-year-olds. In Medicare, they’re currently the youngest and healthiest people. So by delaying their entry into the program, says Neuman, you raise costs for everyone else already there.

The result would be that “people on Medicare pay higher premiums,” she said. “That’s because you’re taking the healthiest people out of the Medicare risk pool, leaving sicker people to pay higher premiums.”

At the same time, those same 65- and 66-year-olds would be the oldest and, likely, among the sickest people remaining in the insurance pools of the working-age population, particularly in the new health insurance exchanges.

…

To be clear, raising Medicare’s eligibility age would save money for the half-trillion-dollar-a-year Medicare program — and for the federal government as a whole. The Congressional Budget Office estimates that Medicare spending would drop by about 5 percent a year. And at the same time, federal tax revenues would increase slightly because some of those 65- and 66-year-olds would remain in the workforce and continue to pay taxes.

But overall, according to a separate study done by the Kaiser Family Foundation, the savings to the federal government would be more than offset by additional costs to states, individuals and employers — about $1 billion more in 2014 alone.

We as a society should be most concerned with the total cost of healthcare (I don’t care if I pay directly or indirectly), which means as long as we believe that people deserve healthcare we really should not want to raise the eligibility age for Medicare since that increases the total cost. On the other hand if we don’t care if people have healthcare, the choice is easy–cut Medicare and don’t worry if that means more people don’t have healthcare (and die–of course some people do think we should let them die). Now which side are Republicans on:

“I don’t think you can look at entitlement reform without adjusting the age for retirement,” Sen. Lindsey Graham, R-S.C., said on ABC’s This Week last Sunday. “Let it float up another year or so over the next 30 years, adjust Medicare from 65 to 67.”

What a surprise.

Really, the Catholic Church’s message about women is “let them die”

In the US, the Catholic hierarchy was willing to let a woman die instead of allowing an abortion. Luckily the nun who was the administrator at the hospital decided it was ok to allow the abortion–she, of course, was excommunicated. In Ireland, no one was willing to step forward and a woman died (via here via here, also see here):

Savita Halappanavar (31), a dentist, presented with back pain at the hospital on October 21st, was found to be miscarrying, and died of septicaemia a week later.

Her husband, Praveen Halappanavar (34), an engineer at Boston Scientific in Galway, says she asked several times over a three-day period that the pregnancy be terminated. He says that, having been told she was miscarrying, and after one day in severe pain, Ms Halappanavar asked for a medical termination.

This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”.

She spent a further 2½ days “in agony” until the foetal heartbeat stopped.

Now remember that Republicans in the US want to ban all abortions.

Mr. Bipartisan

There are a few things that people should remember as they decide if they will vote for Scott Brown. First, most of his campaign was based on filibustering President Obama’s national healthcare. He did not go into office trying to be bipartisan and he didn’t just vote against bills, he filibustered them. You might also think about this bit:

Brown has won the endorsement of a few law enforcement unions and is now trying to use the Cadillac tax to cut into ­Warren’s support among other union members. Warren’s campaign says she would not have proposed the Cadillac tax, but “the overall law will lower health care costs, expand ­access, and provide improved benefits to seniors.”

You might remember that Brown got sworn in early specifically so he could filibuster against the appointment of Scott Becker, a union lawyer, to the NLRB. Here’s what he said at the time:

“My first priority in coming to Washington is to create jobs and put people back to work,” he said in a statement. “Craig Becker’s theories about how the workplace should function, if ever put into practice, would impose new burdens on employers, hurt job creation, and slow down the recovery.”

The main theory backed by Becker that was a problem for most Republicans was his support of card check legislation.

You might also notice that Brown voted much more often with Republicans in his first year (see here and here), that would be until about the time that he started campaigning for this election. Now ask yourself how he’ll act if he wins this election and gets a six-year term.

Romney: Look, I’m still crazy

It looked like Mitt Romney might be pivoting to the center, but I guess he decided he needed to shore up his conservative flank because he’s back to crazy land:

Romney minimized the harm for Americans left without health insurance.

“We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’  ” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

He pointed out that federal law requires hospitals to treat those without health insurance — although hospital officials frequently say that drives up health-care costs.

Republicans must think this is a winning idea, since Bush, Ron Paul, and Rick Santorum have all said basically the same thing. Of course, Romney disagrees with his past self. There are several problems with this idea: by definition, emergency rooms are for emergencies–you’re not going to get treatment for chronic conditions there which is why people without insurance are more likely to die than those who have it; emergency rooms are expensive so it’s not the way to rein in health costs; hospitals will still try to charge the patient–there’s a reason so many bankruptcies are because of health; emergency rooms can often be overcrowded which is why people sometimes die waiting for care. Just wait a few days though, Romney will probably change his stance.

But a butterfly

Well then:

Frank O’Brien is not prevented from keeping the Sabbath, from providing a religious upbringing for his children, or from participating in a religious ritual such as communion. Instead, plaintiffs remain free to exercise their religion, by not using contraceptives and by discouraging employees from using contraceptives. The burden of which plaintiffs complain is that funds, which plaintiffs will contribute to a group health plan, might, after a series of independent decisions by health care providers and patients covered by OIH’s plan, subsidize someone else’s participation in an activity that is condemned by plaintiffs’ religion. This Court rejects the proposition that requiring indirect financial support of a practice, from which plaintiff himself abstains according to his religious principles, constitutes a substantial burden on plaintiff’s religious exercise.

RFRA is a shield, not a sword. It protects individuals from substantial burdens on religious exercise that occur when the government coerces action one’s religion forbids, or forbids action one’s religion requires; it is not a means to force one’s religious practices upon others. RFRA does not protect against the slight burden on religious exercise that arises when one’s money circuitously flows to support the conduct of other free-exercise-wielding individuals who hold religious beliefs that differ from one’s own.

Indeed, if the financial support of which plaintiffs complain was in fact substantially burdensome, secular companies owned by individuals objecting on religious grounds to all modern medical care could no longer be required to provide health care to employees.
…
Just as in Mead, plaintiffs must contribute to a health care plan which does not align with their religious beliefs. In this case, however, the burden on plaintiffs is even more remote; the health care plan will offend plaintiffs’ religious beliefs only if an OIH employee (or covered family member) makes an independent decision to use the plan to cover counseling related to or the purchase of contraceptives. Already, OIH and Frank O’Brien pay salaries to their employees—money the employees may use to purchase contraceptives or to contribute to a religious organization. By comparison, the contribution to a health care plan has no more than a de minimus impact on the plaintiff’s religious beliefs than paying salaries and other benefits to employees.

Under plaintiffs’ interpretation of RFRA, a law substantially burdens one’s religion whenever it requires an outlay of funds that might eventually be used by a third party in a manner inconsistent with one’s religious values. This is at most a de minimus burden on religious practice. The challenged regulations are several degrees removed from imposing a substantial burden on OIH, and one further degree removed from imposing a substantial burden on OIH’s owner and manager, Frank O’Brien. Because there is no substantial burden imposed on either plaintiff’s religious exercise, plaintiffs have failed to state a claim under RFRA. Count I of the Amended Complaint will be dismissed.

My guess is these organizations and the Catholic Church, seeing this argument, will now stenuously object to paying workers since they might use that money in ways that they object to.

Note: this is only one of the questions to be ruled on. The court dismissed all the other counts also.

Romney again disagrees with himself

NPR compares Romney to himself:

Yet in 2010, in an appearance on MSNBC, Romney said almost exactly the opposite: “It doesn’t make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility,” he said at the time.

…

He used even more colorful language back in 2007, talking to Fox News host Glenn Beck. “When they show up at the hospital, they get care; they get free care paid for by you and me,” he said. “If that’s not a form of socialism, I don’t know what is.”

Now he says:

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

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.

Pelley: That’s the most expensive way to do it.

Romney: Well the–

Pelley: In an emergency room.

Romney: Different, again, different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms. In my state, we found a solution that worked for my state. But I wouldn’t take what we did in Massachusetts and say to Texas, “You’ve got to take the Massachusetts model.”

So, Romney is now agreeing with Rick Santorum, Ron Paul, and President Bush that using emergency rooms is an acceptable way to provide ‘healthcare’.  There are a few major problems with this stance. The first I have noted a few times before:

The uninsured might get the emergency care, but they don’t get the routine care and they don’t get all the medications they need–so they are denied care. And studies have shown that the uninsured do have a higher risk of dying:

As medical care has improved for people with health insurance, the consequences of being uninsured have worsened, according to a new study that says the lack of coverage translates into nearly 45,000 deaths each year among working-age Americans.

The NPR article also notes another problem:

But in addition to flip-flopping, Romney is missing a key fact about the uninsured and emergency room care, says health policy professor Harold Pollack of the University of Chicago. Just because hospitals are required to see patients in the emergency room doesn’t mean that care is required to be free.

“The emergency room is perfectly entitled to send you a whopping bill,” said Pollack. “And there are many people across America who are facing significant financial problems from serious bills that they’ve received for emergency care.”

It’s only when the uninsured don’t — or can’t — pay those bills that the costs come back to the taxpayers. Pollack also says Democrats and Republicans largely agree that emergency rooms are wholly inappropriate places for most people to get health care.

“It’s just about the least cost-effective way you can get your medical care. And we also have really damaged the institution of emergency department care by expecting it to take on these burdens it’s not really designed to assume — to provide primary care to low-income people,” he said.

In essence it means that if you don’t have insurance either you will be stuck with a huge bill or you will go bankrupt. Lovely system that.

Two Americas

This is extremely worrying:

The decline among the least educated non-Hispanic whites, who make up a shrinking share of the population, widened an already troubling gap. The latest estimate shows life expectancy for white women without a high school diploma was 73.5 years, compared with 83.9 years for white women with a college degree or more. For white men, the gap was even bigger: 67.5 years for the least educated white men compared with 80.4 for those with a college degree or better.

There really are two Americas and the difference isn’t just monetary, there is also large differences in health–people with less education have decreasing access to a good-paying job, less access to healthcare, almost no access to a pension outside of Social Security. There have suggestions that the retirement age for Social Security should be increased which would make the retirement age higher than the average life expectancy of this group (really we would need to see the breakdown of life expectancy at different ages to see how bad this really is). Fun times.

Income and insurance

The Census Bureau has a new report out about income, poverty, and insurance coverage. Here are some highlights:

Insurance:

• The number of people with health insurance increased to 260.2 million in 2011 from 256.6 million in 2010, as did the percentage of people with health insurance (84.3 percent in  2011, 83.7 percent in 2010).
• The percentage of people covered by private health insurance in 2011 was not statistically different from 2010, at 63.9 percent. This was the first time in the last 10 years that the rate of private health insurance coverage has not decreased. The  percentage covered by employment-based health insurance in 2011 was not statistically different from 2010, at 55.1 percent.
• The percentage of people covered by government health insurance increased from 31.2 percent to 32.2 percent. The percentage covered by Medicaid increased from 15.8 percent in 2010 to 16.5 percent in 2011. The percentage covered by Medicare also rose over  the period, from 14.6 percent to 15.2 percent. The percentage covered by Medicaid in 2011 was higher than the percentage covered by Medicare.

oh and the percent without insurance in the 19-25 year age group went down by 2.2%–thanks Obamacare.

Income:

• Median family household income declined by 1.7 percent in real terms between 2010 and 2011 to $62,273. The change in the median income of nonfamily households was not statistically significant.
• In 2011, real median household income was 8.1 percent lower than in 2007, the year before the most recent recession, and was 8.9 percent lower than the median household income peak that occurred in 1999. The two percentages are not statistically different from one another.
• Income inequality also increased between 2010 and 2011 when measured by shares of aggregate household income received by quintiles. The aggregate share of income declined for the middle and fourth quintiles. The share of aggregate income increased 1.6 percent for the highest quintile and within the highest quintile, the share of aggregate income for the top 5 percent increased 4.9 percent. The changes in the shares of aggregate income for the lowest two quintiles were not statistically significant.

so the economy is still quite weak–unemployment is still a bigger problem than the deficit. And there is no class-warfare in the US but one group seems to be winning.

Poverty:

• In 2011, the family poverty rate and the number of families in poverty were 11.8 percent and 9.5 million, respectively, both not statistically different from the 2010 estimates.
• In 2011, 6.2 percent of married-couple families, 31.2 percent of families with a female householder and 16.1 percent of families with a male householder lived in poverty. Neither the poverty rates nor the estimates of the number of families  in poverty for these three family types showed any statistically significant change between 2010 and 2011.

That’s pretty pathetic, maybe we can start talking about poverty in the US?

GOP: let ‘em die

I’m exaggerating a bit, but that’s ok according to Aaron Blake:

As with “You didn’t build that,” the Romney campaign’s attacks on “It worked” will be criticized for being out-of-context, lowest-common-denominator politics.  And as with “You didn’t build that,” “It worked” is going to … well … work.

…

There’s a lot of controversy these days about campaign tactics and what crosses the line. Obama’s team has been crying foul for two weeks now that “You didn’t build that” has been taken badly out of context by Republicans.

The problem is, the gray area is just too gray. Fact-checkers are great (especially our Glenn Kessler), but as long as either side has an argument to justify its attacks, the history of politics dictates that it’s all fair game.

…

Romney may be attacked in the days ahead for running an out-of-context campaign, and some objective reporters might even say it has gone too far.

But the fact is that these two comments further clarify a picture (or caricature, depending on where you stand) of Obama that’s already out there. And plenty of — nay, almost all — people who don’t dissect this stuff as much as we do are going to take the pulled quotes at face value.

Is it warm and fuzzy? No. Does it work? Yes. And that’s why they do it.

Blake doesn’t think much of Obama:

So obviously Democrats’ policies — on taxes or otherwise — aren’t that great.

You and I might think this line is taken out of context, but Aaron Blake is fine with it.

Anyway, here’s the piece about Republicans and healthcare insurance (the last is Michael Cannon, head of health policy at the libertarian Cato Institute):

Wallace: “What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?”

McConnell: “That is not the issue. … The question is how can you go step by step to improve the American health care system? It is already the finest health care system in the world.”

Wallace: “But you don’t think that 30 million people who are uninsured is an issue?”

McConnell: “Let me tell you what we’re not going to do. We’re not going to turn the American health care system into a Western European system. That is exactly what is at the heart of Obamacare. They want to have the federal government take over all of American health care.”

…

“Conservatives cannot allow themselves to be browbeaten by failing to provide the same coverage numbers as Obamacare,” Sen. Orrin Hatch, R-Utah, told a conference at the conservative American Enterprise Institute. “To be clear, it is a disgrace that so many American families go without health insurance coverage. But we cannot succumb to the pressure to argue on the left’s terms.”

…

People need to have the freedom not to have insurance if the marketplace is to function properly, he says. “Because if they don’t have freedom, if the government is requiring them to purchase health insurance either from a private company or the government, then the government gets to define what health insurance is, and that stifles a lot of innovation in the health insurance and health care delivery markets, and we’re suffering under that sort of regulation right now,” he says.

Basically they’re saying that Free Markets are more important than everybody having access to healthcare. To be fair, sorry Aaron, they probably believe that a truly Free Market might bring this about, but if it doesn’t that’s the way it must be.

Medicaid and mortality

A study (this is a pay site) has found (go here for the Boston Globe write-up):

Our study documents that large expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties.

This was a ‘natural’ experiment, because they were able to compare states that expanded their Medicaid coverage to states that did not. There are two major problems with the study: there was no randomization; they did not have access to individual data, so they could not see what happened to people whose coverage changed. The first problem makes it very difficult to show causality since there will always be unknown confounding factors (perhaps the Medicaid expansion was part of a general push by the states to improve healthcare and other parts of the campaign actually drove the mortality reduction, for example). The second one means that they can’t tell if the reduction occurred in the affected population and makes it difficulty to find a difference (the authors of the study note: A relative reduction of 6% in population mortality would be achieved if insurance reduced the individual risk of death by 30% and if the 1-year risk of death for new Medicaid enrollees was 1.9%–so the study barely finds a possible 30% reduction in mortality for those affected). Still, they did find:

Our secondary analyses provide a plausible causal chain for reduced mortality that is consistent with previous research, with eligibility expansions associated with a 25% increase in Medicaid coverage, 15% lower rates of uninsurance, a 21% reduction in cost-related delays in care, and a 3% increase in self-reported excellent or very good health.

It’s also consistent with studies that have found that the uninsured have an elevated risk of mortality.

There is a study on Medicaid that is randomized, but it’s not complete yet.

You can trust us

This is a truthful and misleading statement:

The law picks up the entire cost of covering more people for the first three years, and then drops to 90 percent, with states covering the remaining 10 percent. It is a great deal, proponents argue, especially compared with the current Medicaid rates, in which Washington pays as little as half of the costs.

But a few GOP governors at the meeting said they suspected a bait-and-switch in which states would agree to the expansion only to see Congress cut some or all of the funds, leaving governors on the hook and potentially bankrupting budgets.

‘‘At any whim they could just pull the money,’’ Governor Jan Brewer of Arizona said. “So yeah, I’m a little gun-shy.’’

Here’s what she should say: if my party takes control of government we’re going to cut aid that goes to the poor and middle-class including Medicaid, assuming we don’t just get rid of or gut the law.

Shocking news about Republicans view on national healthcare

Like Kevin Drum, I am shocked, shocked I tell ya, that Republicans don’t mean what they say:

Congressional Republicans, who once promised to “repeal and replace” President Obama‘s healthcare law, for now have all but given up pushing alternatives to the sweeping legislation the president signed in 2010.
In the last year and a half, House Republicans have sent the Senate just one 36-page bill designed to limit medical malpractice lawsuits, despite pledging to develop detailed legislation to slow rising healthcare costs, help Americans keep their health plans and broaden access to insurance.
And as the House prepares to take its 33rd vote to repeal all or part of the Affordable Care Act, senior Republicans say they will not try to move a replacement plan until 2013 at the earliest.

I wonder why they don’t put together real proposals?

Such scrutiny proved embarrassing for House Republicans in 2009, when they proposed a detailed alternative to the healthcare legislation that Democrats were developing at the time.
The nonpartisan Congressional Budget Office concluded the GOP proposal would have left more than 50 million Americans without health insurance and reduced costs for healthy people while raising them for the sick.
Similar study of the House Republicans’ 2011 budget plan indicated that a proposal to make Medicare beneficiaries shop for commercial insurance with a government voucher would leave seniors paying thousands of dollars more for their healthcare.

In other words, their proposals would be hugely unpopular. Better to leave things vague or say nothing about it. Of course, if they’re elected, this is what they’ll do.

The Morrill Act

Charles Pierce notes that there was quite a big anniversary this year:

On July 2, 1862, President Abraham Lincoln signed into law what was known as the  Morrill Act. The new law authorized the creation of what became known as  “land-grant colleges,” the purpose of which, as described in the Act was:  “…without excluding other scientific and classical studies and including  military tactic, to teach such branches of learning as are related to  agriculture and the mechanic arts, in such manner as the legislatures of the  States may respectively prescribe, in order to promote the liberal and practical  education of the industrial classes in the several pursuits and professions in  life.”

This was one of the most important pieces of legislation to ever pass, bringing college education to the masses. As Pierce notes, the arguments against the act are similar to the ones against national healthcare:

Democratic Senator Clement Clay of Alabama was by far the most eloquent to stand  against it. He insisted that the land grants were a “magnificent bribe” to  encourage Alabama to “surrender to the federal power her original and reserved  right to manage her own domestic and internal affairs.” He argued that public  lands were never meant to support such arrangements. This was followed with a  long, vivid picture of judicious forefathers building limitation after limitation  into the Constitution concerning the powers of the Federal Government. With the  last stroke of his brush, Clay asked if one could believe that such a careful  limitation was only a sham, that through deliberate intent or stupidity these  great men had provided a means to circumvent their careful limitation of federal  power.

Change a few words and this is the argument against Obamacare–I wonder if we can charge plagiarism? I can’t imagine that this type of legislation could pass today.

The rich are different

This quote is all over for good reason:

A New York City donor a few cars back, who also would not give her name, said Romney needed to do a better job connecting. “I don’t think the common person is getting it,” she said from the passenger seat of a Range Rover stamped with East Hampton beach permits. “Nobody understands why Obama is hurting them.

“We’ve got the message,” she added. “But my college kid, the baby sitters, the nails ladies — everybody who’s got the right to vote — they don’t understand what’s going on. I just think if you’re lower income — one, you’re not as educated, two, they don’t understand how it works, they don’t understand how the systems work, they don’t understand the impact.”

They don’t understand that Romney’s plan to cut taxes for the rich and cut regulations on the people who crashed the world economy are for the poor. Don’t they listen to their betters?

And this (via this post by digby) is more of the same:

In South Carolina, the law would add about 500,000 people to Medicaid, said Tony Keck, whom Haley appointed to head the Health and Human Services Department.

“We simply can’t support this,” Haley and Keck said in a July 3 statement. “We are not going to jam more South Carolinians into a broken program, a program that stifles innovation, discourages personal responsibility, and encourages fraud, abuse and overuse of services — and that, by the way, costs us billions of dollars.”

Republican governors of Louisiana, Florida, Iowa, Mississippi, and Texas also oppose the plan to boost the scale of the health-care program. Texas Governor Rick Perry said today he won’t do anything to implement the president’s law. In his state, about 25 percent go without health insurance, the nation’s highest rate, according to Census Department figures.

“I stand proudly with the growing chorus of governors who reject the Obamacare power grab,” he said.

…

Keck, South Carolina’s top health official, said the state’s illnesses are driven by poverty and that money poured into Medicaid would best be used elsewhere. Keck said he and Haley favor block-grant funding that would hold the state accountable for set outcomes, such as lowering obesity.

“We should spend our money getting more people jobs with health insurance,” Keck said. “If we’re going to talk at all about targeting the uninsured, it has to be with a completely different system than Medicaid.”

Again they give the argument that it’s better not to help the non-rich (it’s funny how Keck is saying that Republican would be for stimulus and how they would use block grants to help the poor, well it would be funny if they weren’t in power). As digby says, Republican governors are deciding that they’d rather have some people die than use money from Obamacare even if the state would actually be financially better off if they go into the program.

Freedom from consistency

Here’s a quote (via here):

“Women want to make their own decisions when it comes to their health care, with the support of their families and their doctors. It’s preposterous to suggest the government would do a better job at deciding what is best for us and our loved ones.”

Now if you heard that quote and knew nothing else, you would probably think this is someone who is arguing that abortion should be legal. But no it’s:

Penny Nance, president of Concerned Women for America, a conservative, anti-abortion women’s advocacy group.

That’s one very confused person.

Health care is constitutional

I was worried, but the Supreme Court has ruled that the Affordable Care Act is constitutional. President Obama should now make this one the central themes of his campaign, noting that Romney wants to get rid of it and has nothing to replace it with. Romney wants to go back to the old financial regulations that led to the current recession, he wants to go back to the old broken healthcare system, he wants to make enemies (of Russia and China among others), and he wants to back to President Bush’s agenda. Democrats should look at the bill now that it has been upheld and work to make it better.

Anyway, this is something to savor.