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Maggie Mahar
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Maggie Mahar is now following The Century Foundation
Nov 7, 2011
Peter-- What we pay in is a percentage of our income. If we followed your suggestion,low-income Americans(who also are the sickest)would receive less medical care. And they dont' have savings to fall back on. They never earned enough to be able to accumulate a nest egg.
Chris,Barry Chris: Thank you. You write:"I think one of Don Berwick and IHI's main contributions has been to change the conversation from 'complications' (inevitable and just part of doing business) to 'errors and harm,' which can and should be reduced. See" Exactly.And I urge readers to go to the Hartfound Foundation link. Calling an "adverse event" a "complication" makes it sound as if it cannot be prevented (an act of Nature) . But as some hospitals have shown many adverse events can be avoided--by improving the "systems" that hospitals use. It is very important, I think, that Berwick and other reformers want to move away from the "shame and blame" culture of trying to blame one (or a few)individuals. I've been trying to point toward that solution in Parts 1 and 2 of my recent malpractice posts. I'll be expanding on the theme in Part3. Barry-- It's good that your CEO is concerned about workers' safety. But ... he isn't running a hospital. Also,in his company, if workers are injured, they call in sick-- and are not as productive. His company loses money. By contrast,a hospital doesn'tlose money if a patient is injured. Worst care scenario--the patient sues. But only a tiny percentage of patients injured by adverse events sue. Andif they do, the hospital's insurer pays. For a hospital, patient injury doesn't hit the bottom line the way a high rate of worker injury does in heavy manufacturing. The hospital business is one of the few businesses, where you can botch the service you promised to provide, and still get paid. Moreover, your customer has to pay you to repair the damage.. What is important is that minority of hospital CEOs list "safety"as one of their major concerns. As Levy points out, doctors,nurses and other health care workers in many hospitals are frustrated that they can't get the administration to back safety programs. At many hospitals, the administration refuses to back nurses who speak up when they see a doctor ignoring safety standards (i.e. "Excuse me,doctor, but we really should have a "time-out" before beginning surgery.) If the CEO doesn't back them up,nurses won't dare speak up.And many CEOs won't speak up because these doctors are "rainmakers"who bring in many lucrative cases. (This is what doctors and nurses tell me.) Of course, as you say, deciding to choose expanding a cath lab over palliative care is a financial decision.That's preicsely the problem: the decision is money-driven. It isn't based on what would be best for patients. By expanding the cath lab, a CEO can expand the number of angioplasties that his hospital does. The fact that medical evidence shows that 50% of angioplasties are unncessary doesn't bother him. The fact that palliative care makes dying much easier doesn't really interest him. (As doctors have explained to me) And,if he's an MBA, (rather than someone with a medical background) he probably doesn't read the studies which show that,in fact, palliative care can save hospitals money. More importantly, palliative care saves all of us money. Too many hospital CEO's engage in "silo-thinking"--"How can I make money for my hospital-- and thus hike my bonus for next year?" Of course, over the past two decades a great many U.S.CEOs have made decisions based on what would please Wall Street on a short-term basis, and thus lift the value of their stock options while boosting their bonuses. If you don'tbelieve me, ask Warren Buffet about this. This short-term thinking is terrible for any corporation, but when the institution is a hospital, it is both tragic and criminal. People die.
Joe Says-- Thank you very much. But at the end of the day, I don't need to be encouraged to "call it like I see it." That is what I have been doing my entire life. (For better and for worse. Doesn't always work out well, but this is who I am.) No one at The Century Foudation, except Naomi, reads my posts before they are pubished. (Naomi puts them online and and embeds the links) No one in management at TCF has ever suggested that I shouldn't say X or Y, or that I should promote Z. I choose the topics and write the posts. I know that I can write anything that I can back up with evidence. That is what makes this a wonderful job. And this is what inspires me to work as hard as I do.
Barry-- You may be well be right about the table; I hadn't noticedhow line 4 changed. I'll have to ask Paul Levy. But the fact he called 2009 a "great disappointment" still suggests that safety and quality were not moving up on the list of priorities at that point. And the fact is that, overall, patient safety has not improved in hospitals in recent years. This is suprising-- given the IOM report of 2000, and given the concern about malpractice suits. But as the most recent survey that Levy cites indicates, hospital CEOs still don't see safety & qualtiy as a top priority. Many deny that there are any safety problem at their hospitals. I totally understand that a hospital needs to stay in the black in order to have adequate staffing, etc. But those who consider patient safety & quality a priority will make staffing a priority. Those who dont' will expand their cath lab (a revenue center) before they hire palliative care specialists. (Medicare may save money on palliative care but the hospital may well make more money on keep the beds in its ICu filled. A Manhtattan doctor at a brand-anem hospital explained to me that his hospital didn't have pallative care because the CFO was more interested in expanding the cath lab--which would be a "profit center." And what Paul says about younger doctors and mid-level hospital workers being very frustrated that they can't get hospital administratoin to pay attention to patient safety is very true. Since I've began writing the book (in 2003) I've been hearing the same thing, over and over. But hospitals are very political places. Nurses, residents, younger doctors, mid-level hospital workers -- most are afraid of bucking their hospital's administration. And with good reason. Hospital CEOs enjoy enormous power. And if you are labeled a "trouble-maker" you will have a very hard time finding another job.
Barry-- If you look at the table, you will see that both patient safety and quality disappeared. This is why Levy calls this "a great disappointment." Until about 18 months ago, Paul Levy was the CEO of a prestigious hospital in Boston. He's giving us the inside story. Yes, some hospital CEOs are paying more attention to safety. But as he reports, when he talks to people at hosptails around the country, younger doctors, nurses and others are saying : How do we get our hospital administration to pay attention to quality and safety." Compared to patient quality and safety, "finances" are of no importance. There is no reason for a hospital to stay open if it is not putting quality of care and patient safety first. Would you want your child to be in a hospital where the CEO open admittedly: "We're mostly concerned about profits and costs. Patients--and their safety-- are much less important." Yes, some CEO's are making great strides toward making their hospitals safer. But many (probably most) are not. This is why the stats showing preventable medical errors and infections are rising. "No margin, no mission," is an easy excuse that a great many non-profit hospitals use--wile their top administrators are piad millions. (I know this is a small amount in the larger context, but it sets a tone for the institution.) These same hospitals also have been wasting tens of millions on contruction projects that are not needed. I would urge you to start reading Levy's blog. It is eye-opening.
Richard K.-- I agree that Obama was making a political decision, not an economic decision. O. genuinely believes that it's important to reduce the deficit at this time. I guess he believes this because the polls tell them that this is what the American public believes. In fact, it's important to reduce the deficit but NOT NOW. This economy needs stimulus. By cutting govt spending you are going in the oppositie direction. With less government spending, you have fewer jobs, which, in turn, reduces consumption. Unless consumption picks up the private sector won't create jobs. So cutting spending in an effort to reduce the deficit is a terrible idea. The thing to do at this point is to spend money in constructive ways that will create jobs. This in turn will lead to higher tax revenues, and those revenues will help reduce the deficit. (You also need to raise taxes near the top of the income ladder.)
Richard K. Thank you. I think the president should have let the conservatives take us to the brink --- and over the brink. As Volcker pointed out, we would continue paying interest on our debt. We have no choice. But we would have stopped sending out SS checks, and pay to the military. That would have lasted about 36 hours. The public protest would have been enormous. I realize the delay would have caused some hardship, but I'm sure landlords would have understood and waited 2 days for late rent. Banks and credit card companies could be told that they couldnt' charge interest for late payments, etc. And Republcians would have taken the blame. Yesterday I was talking to a former membe of the Obama administration who pointed out that during the debt debate, Obama was trying to negotiate with crazy people. "You can't negotiate with crazy people he said. All you can do is give them some rope "and wait for them to self-destruct."
Barry, Barry, while your suggestion sounds very fair, it assumes that we are all starting on a level playing field. You write: "The AARP could only recommend cuts in Social Security and Medicare benefits. The wealthy could suggest how their taxes could be raised in ways that would do the least economic harm." Mosts of the seniors that AARP represents cannot afford cuts in Social Security or effective Medicare benefits. (And seniors are not in a good position to recommend what ineffective benefits should be cut-- they are not doctors.) Most Seniors cannot afford higher co-pays. And as I explained in an earlier posst, shifting eligibiilty to 67 would not save money and would hurt the poorest seniors. Should we "means-test" Medicare and Social Security? Only if we want to undermine public support for both programs. These programs are so popular in large part because they cover everyone. When the wealthy don't get the same benefits they become less interested in supporting a program. (This is why the wealthy are not terribly interested in paying higher property taxes to support smaller class sizes in public schools. They don't send their childen to those schools.) If we means-tested Medicare, it could soon become a "poor program for the poor and middle-class"--not unlike Medicaid. As I have pointed out in the past, median income among seniors is $20,000. Many have much less. And they have little wealth. In other words most seniors just don't have much to "give up." And both Medicare and SS need the support of those wealthy seniors who do have something to give up. We might better ask those wealthy seniors to make a contribution in another way-- taxes on wealth (perhaps a VAT on luxury items, or higher inheritance taxes at the top.) The wealthy, on the other hand, do have more than they need. Tax rates at the top are at historic lows. And the notion that raising their taxes might hurt the economy is part of Reaganomics--disproved long ago. When George Bush Sr. lifted taxes, the economy was not hurt. (Though conservatives howled.) America's wealthy have become super-rich, while American's middle-class become less and less middle-class. They're slipping down the greasy poll. Bottom line: some people have something to give up; some don't. Poor children have nothing to give up. Rather than asking everyone to make an equal contribution, we need to redistribute wealth and income from those who have more than they need to those who have far less than they need. Finally, the physician who asked every specialty to point to areas of waste in that specialty was not asking them to think about what would be good for patients-- fewer back surgeries for instance-- rather than what they could give up. In other words, he was focusing on the quality of care. Everytime we try to improve the quality of care we also save money. But that's a byproduct of reform-- not the main agenda, at leaset from the point of view of this physician.
Dr. Rick-- Thank you. And yes, I think the coverage of this debate, along with the coverage of the endless bickering on HC reform has left many voters depressed and disgusted. Washington just doesn't seem to care about what we care about-- unemployment, inflation in the price of food, gasoline, electricity etc., the fact that owning a home is becoming a receding dream, the fact that so many U.S. children now go to bed hungry. When I say "Washington doesn't seem to care about" I am including President Obama as the leader of our govt' in Washington. For a long time, I have felt that progressives should support and encourage the president. He inherited a horribly difficult situation. Now, I feel that progressives should urge the Democratic party to find a new, sronger candidate. The coutnry needs someone who possesses the politically savvy of LBJ, the charisma and common touch of Bill Clinton, and the fearlessness of FDR, who said of his conservative opponents "I welcome their hatred." Today's conservatives-- the folks who would love to slash uneployment bnefits, Medicare, Medicaid, Social Security-- are very tough Or at least they think they are tough. We need someone in the White House who knows how to cut them off at the knees. Mitch McConnell, the Tea Party foks-- these are not people to fear. They are small-minded, frightened people.
NG-- A great many Americans admire celebrities. The super-rich count as celebrities (Trump, et. al.) For reasons I don't entirely understand, Americans identify with them. And a great many Americans actually believe that maybe someday they will win the lottery, or whatever, and become famous. Ot that their children will. Thus they want to protect the class system in this country. They also believe the myth that people who amass great wealth (CEO's paid $7 million a year etc.) are working hard than the rest of us, are in some way making great contributions to society and so "deserve" their great wealth. Over the course of my career as a financial journalist I've interviewed a great many very powerful CEOs. Only a handful are brilliant, creative, hard-working. Most are just people who are very ambitious and know how to cimb a corporate ladder. Finally, if you look at voting patterns you will find that African-Americans are more likely to vote in their own economic interest than white Americans. African-Americans know that our system is stacked against them-- that their kids are not getting a good education in our public schools, that most politicians care primarily about the rich, etc. Most white Americans dont' want to believe that. They think that the U.S. is the best country in the world.
Steve H. and Joe Says: Joe, I too am ready for a third party. But Steve H. is entirely right: a third party wouldn't have the campaign contributions that it needs to run its candidates. Elections in this country have become very, very expensive-- in part because they drag on for so long, and TV advertising is enormously expensive. In theory, we could shortent he elections and pass a law saying that no one could begin advertising until, say, two months before the event. But at this point, the networks, cable stations, etc are extremely dependent on the money that comes in during our long campaign season. So t his will never happen.
Valerie-- I totaly agree. Congress has other things to talk about- namely, unemployment and the economy. This partisan bickering is distracting legislators from the real problems.
Valerie-- I totaly agree. Congress has other things to talk about- namely, unemployment and the economy. This partisan bickering is distracting legislators from the real problems.
Don, Run, Everyone-- Let me add that I agree with Don that Medicare Part D is underfunded. We must negotiate with drug companies for discounts on drugs, and set up a formulary of drugs that Medicare will cover, excluding over-priced drugs that provide little or no benefit to the patient. (If a few patients would benefit, Medicare would cover the drug for them, just as Kaiser and the Mayo Clinic (that also have formularies do). But Medicare shoudl not cover these low-benfefit drugs for all patients.
Run 75441, Don, Everyone Everyone Don & Run 75441-- Please see run75441's comment -- July 31, 2011 at 10:54 AM These are all excellent ideas.
Panacea-- The Century Foundation has done a great deal of work on SS and I know the people who have done that work. That is why I speak with such confidence about Social Security. But in fact, it is not my area of expertise. This is why you should look at "run75441"'s comment, just above yours and read the links he recommends. I also know him (via e-mail) and his writings. He, too, is very intelligent and truthful.
Barry-- You write: "In its most recent quarter, HCA pointed to fewer surgeries among Medicare patients as one of the more significant causes of its earnings shortfall." This is significant. You also point out that "While the economy is certainly a factor, I think there are numerous other drivers at work as well." I agree. The recession is the most obvious factor, but as you say, there are so many factors that affect healthcare spending. You write "there are lots of silver pebbles that can contribute to lower healthcare costs." Absolutely. That is what I like about the Afforable Care Act (ACA) so many silver pebbles, even if some of them are small. This is why so few people understand what the ACA is likely to do. It is such a very long document- literally hundreds of provisions that affect Medicare. Understandably, 99% of all people don't have the time to read all of this or take it in, unless it is their job (as it is my job.) But the benefits of the ACA are in the details. Over the next 2 1/2 years, as health reform rolls out, people will begin to really see the benefits. Over the next 10 years, as all of the reform provisions are implemented, everyone should see the benifits. Perhaps we will screw up implementation. Perhaps people will play the system and undermine the reforms. We can't know. But it seems to me that all that we can do is make a good-faith effort to follow through on what the Medicare Payment Advisory Commission has been recommending for years- recommendations that form the backbone of the Affordable Care ACt. Also, over the next 13 years, I am sure that we will revise--and, I hope, improve the Affordable Care Act. Reform is a work in progress. Anyone who says that this cannot happen is morbidly cynical. (I'm cynical, but not morbidly.)
Panacea, & HealthBlog Panacea--I agree. Congress already has damaged the economy; probably at least one of the credit rating agencies will downgrade our credit rating. China (which is our biggest lender) is very upset at what it sees as "reckless" behavior by our politicians. If they start selling and at some point may begin selling Treasuries (as some of their officials think they should). If they do that, interest rates in the U.S. would go up. (Though China would be hesitant to sell too many Treasuries because when interest rates on Treasuries go up, prices go down, and since they have a huge amount of their reserves invested in our Treasuries, they wouldn't want to see prices drop sharply.) Health Blog-- the polls show that the public is with the President on this one. The public does not trust the far-right Republicans. Most voters favor higher taxes for those earning over $200,000 and most voters do not want to see Medicare or Social Security cut. The Tea Party Extremists represent a small minority, and they are doing great damage to the Republican party which will probably lose votes as a result of what has been going on this week.
Ruth-- First, the government is not broke and entitlements are not unfunded. The government is not broke-- we have been raising the debt ceiling, regularly, for some time. This time, the Tea Party conservatives and some Republicans decided to turn a regular event into High Drama. As Former fed chairman Paul Volcker said in a Bloomberg interview today, "none of this was necessary." He has seen the debt ceiling raised many, many times. Jim Grant, one of the smarter people on Wall Street told Bloomberg that this is debt-ceiling crisis is "contrived" -- it's a political event, not an economic event. On the entitlement programs: Social Security is in very good shape. With very slight fixes, Social Security will be fine for many years to come. Don't let the fear-mongers scare you. Medicare does need reform -- basically we need to bring Medicare spending growth down to roughly 2% a year, so that it parallels GDP growth. But as the Medicare Trustees report -- Affordable Care Act has made it much less likely that Medicare will become "insolvent" at some point down the road. And even then, "insolvent" does not mean that Medicare is broke: it would mean that Medicare wouldn't have enough money in the hospital trust fund to pay all of its hospital bills (as I recall, it woudl be able to spend 89% of hospital bills, which means we probably would have to raise Medicare taxes to cover the gap, and the most recent Medicare Trustee's report is farily hopeful that this won't happen. We have quite a few years for the reforms in the Affordable Care Act to kick in-- enough breathing room that we should be able to avoid a problem. The fear-mongers want to say that Medicare is going broke because they would like to privatize it--giving seniors a voucher, sending them into the prpivate insurance market, and wishing them "good luck." This means many seniors just wouldn't get the care they need. Instead, we need to reform Medicare, cut the waste, and make sure that seniors are receiving needed care--and that we're not overpaying for it. It appears that Medicare spending already is slowing. And under the reform bill it will certainly slow further. (See CBO analysis of the reform bill.) And see my response to Barry. That said, the size of our debt is NOT GOOD. Our problem is that we have built up a huge amount of debt-- so much that the interest on that debt is growing by 18% a year. We accumulated much debt during the Bush administration, thanks to the wars in the Middle East, and fat tax cuts for the very rich. Those tax cuts will expire Dec. 31. It's not likely that conservatives will have the votes to prevent them from expiring. (The majority of voters are against tax cuts for people earning over $200,000 a year.) Democrats won't have to do anything-- just stand there, and wait for them to expire. It happens automatically unless Republicans are able to overturn the law that calls for expiration. And at last we are winding down the wars in the Middle East. . . The other big problem in this economy is that we are consuming more than we produce. It is hard to increase production because the cost of living in this country makes products that are manufactured here very expensive-- too expensive for consumers in Asia, and even for many consumers in Europe. Meanwhile, consumption at home is slowing because real unemployment (including discouraged workers no longer looking for work and those working part-time jobs because they cannot find a full-time job) hovers around 17%. If you don't have a job, you can't consume as much., But rarely than reducing unnecessary consumption (the stuff that fills our closets, medical overtreatment, etc.) high unemployment means that children are not getting enough to eat, famlies are losing theirr homes, and poverty is climbing. Yes, we need to cut back on overtreatment-- unnecessary tests and treatments. But we don't want the poor to cut back on necessary care. In the end, we all would pay. Ultimately, the government will have to put people back to work by creating jobs. There are plenty of things that need to be done: we need more public school teachers (and smaller classes), more nurse practitioners, more people cleaning up our parks, more people working on finding alternative sources of energy, more people to staff non-profit hospices, nursing homes and community homes for those who need long-term care; more people repairing our bridges, roads and schools, more people building parks and playgrounds where all of us can exercise safely. These are govt jobs-- and they are not "make-work." These are things that need to be done. To pay workers to do these things, we may need to raise taxes. Taxes rates for wealthier Americans are at historic lows. Letting the Bush tax cuts expire will be a beginning. If we solve the unemployement problem, the economy will begin to turn around. People who have jobs pay taxes, and contribute to govt revenues. They contribute to Medicare and SS through payroll taxes. And, if they have jobs with decent pay, they will be able to send their children to college. That's how you grow the wealth of the nation--by investing in human beings.
Barry & Sidney Barry- I looked at the CBO monthly review and I have a call in to the person who does their numbers. (Update, I talked to somene; they get the numbers from Treasury. These Treasury numbers also show Medicare spending slowing. They don't know why.) . S&P uses as much hard data as it can get , and has a pretty good track record of predicting what CMS will tell us 1 to 1 1/2 years later. This isn't to say it's a perfect forecast, by any means, but it is as Blitzer said "pretty good." He is, as you may well know, a very smart guy, has been around for years, and when he says this is not a blip, I believe him. Also, I don't see how S&P would have any vested interest in projecting lower Medicare spending. In Washington, you never know. There are those who have a stake in claiming that Medicare spending is still rising by 6% to 8% a year-- and will always rise by that amount. (John Goodman made that argument on the Health Affairs blog in May.) You're right that private insurers outlays also have been slowing , but not nearly as much. We know why they're slowing: the recession. People are putting off or just not doing elective surgery. Physicians have told me that traffic is even down in ERs. See Naomi's post on this today. Many unemployed people are not taking their prescriptions-- they can't afford them. (And with true unemployment-- including discouraged workers adn those working part-time who need full-time jobs-- in the high teens, we're talking about a great many people. By the way, when I looked at CBO's monthly report I was startled to see govt spending on unemployment benefits Down 22.9% over the past 12 months. We know that the number of unemployed has not fallen significantly, so I take this as a measure of how many long-term unemployed are no longer eligible for benefits . . . I suspect that, going foward, private insurers' outlays will begin to fall as they try to "manage care". But right now, according to S&P, their spending is still increasing at an unstainable rate . . . Monday (or maybe this week-end) I'll be running charts showing the difference between private insurance outlays and Medicare outlays. The fact that private insurers' outlays also are declining sugggests that hospitals are Not cost-shifting to make up for lower reimbursements from Medicare-- at least not to the degree many people assume. Finally, yes the cost of nursing home care, & home health care accounts for a huge chunk of CMS outlays. And as I've written recently, for-profit nursing homes have been reporting high double-digit profit margins on Medicare pattients. Meanwhile home health agencies have been reporting 18% profit margins. There's a huge amount of fraud in both areas-- as well as fraud among for-profit hospices. CMS is stepping up fraud investigation in these areas, and under the Affordable Care Act it plans to slice annual "updates" (essentially inflation increases ) to nursing homes, home health agencies and hospices as well as hospitals by 1% a year for 10 years. Compounded, that will represent huge savings. Meanwhile, more and more seniors are receiving palliative care in hospitals and hospice care at home-- a far less expensive (and painful) way of dying than in an ICU. And this trend will only continue. MedPAC recommended no update for home health agencies this year, and I think CMS followed MedPAC's advice. My guess is that we will see more of this going forward. This helps explain why Medicare inflation is slowing. Under the Obama administratoin, Medicare has been following more of MedPAC's recommendations-- not paying for preventable readmissions, etc. Under the Bush administration, CMS director McClellan wanted to use MedPAC's recommendations, but the Bush wouldn't let him. (McClellan has talked openly about his frustration and is now quite clearly on the side of the reformers.) I actually think that we could do more than "break the curve" of Medicare inflation. It is possible that, over time, we could reduce Medicare spending as a percent of GDP by a point or two. This assumes that GDP grows by 2% to 3% a year . . . Of course, over time we will have more seniors, but that will happen very gradually--the boomers will age, as they were born, over decades. And upper-middle class and upper-class boomers are much healthier than their parents were--as are some middle-class boomers who quit smoking when they were young, eat less meat, exercise more, etc. The problem will come in 20 years or more, when we discover that those healthier boomers are living longer, and more and more of them are developing Alzheimer's or some other form of senile dementia. At about age 75, the incidence of Alzheimer's begins to rise very sharply. People really should be careful about what they wish for . . . Sidney-- The big spending increases are in interest on debt--up 17.8% a month. See That debt was accumulated during the Bush administration, thanks to the wars in the Middle East, tax cuts for those earning more than $200,000, etc. As you may recall, at the end of the Clinton administration we had a surplus. As for entitlement programs, we have more poor children in the U.S. (as a percent of the population under 18) than any other developed country in the world. Every night, a huge percentage of U.S. children go to bed hungry. (See recent news reports.) Public schools in some areas have cut or eliminated their school lunch and breakfast programs for low-income children. Meanwhile, median income for people 65 and over is $20,000. This means half of all seniors are living on less than $20,000-- often much less. "Income" includes social security, dividends, pay from full-time or part-time work-- every penny that comes into the house. Many of these seniors have high co-pays for prescriptions as well as deductibles and co-pays for hospitalization, etc. Many do not own their own homes.They are paying rent (or still paying a mortgage) plus utilities, and food (both energy prices and food prices have been soaring recently) transportion (gas prices are, of course, up). Inflation is very hard on people living on a fixed income, and Social Security's cost of living adjustments have been slim to non-existent. Perhaps you are proud to live in a country where the very rich enjoy tax cuts while childhood poverty climbs. I am not.
Carol- Yes, there's a lot of hypocrisy going around.
Peter, Mike M Peter if the parents die because they don't have accesss to healthcare, the children would become orphans. (Btw-- contrary to the conventional wisdom, emergency rooms do not have to treat poor people unless they are unconscious or incapable of walking. As long as they are ambulatory the ER can turn them away if they don't have insurance or cash. So if you are very poor and don't have Medicaid, you may not get care. In Money-Driven Medicine I write about a man who had been badly beaten-- his jaw was fractured. Two ERs turned him away before the third one treated him. . Medicaid is health insurance for the poor. Originally, it was supposed to be for all poor people but many (about half) of all states decided not to cover adults unless they had children. This meant that homosexuals suffering from AIDS could not get care unless friends could raise the money to pay for their medication and hospital bills. Sometimes they couldn't. Back in the 1980s, my husband and I knew people who were in that situation and died. (SCHIP is the program that provides health insurance for children only.) Mike M.-- I, too, was somewhat concerned about the commission. But note that under Reid's plan, he has already put together savings equal to what is needed to lift the debt ceiling so that we don't default on our debt. Any cuts that the commission suggests would be extra. Then, the Senate would have to approve the cuts the Comission recommended. (As far as I can tell, the House wouldn't have a vote.) I cannot imagine the Senate endorsing serious cuts to Medicare or Medicaid benefits or reimbursements if it wasn't absolutely necessary to avoid default, and under Reid's plan, it wouldn't be necessary. The AARP and most seniors would be against cutting Medicare--or lifting the eligiblity age to 67. (As I explained in an earlier post, that saves no money, but just shifts the burden, so that everyone's insurance goes up.) As for Medicaid, it's hard to imagine the Senate slashing health care benefits for the poor while keep the Bush tax cuts for the very rich. . . Under Boehner's plan, on the other hand, I believe that the Commission's cuts would be needed to complete the second step of the process.
Hoyt-- Today, Bloomberg News pointed out that "Republican House Speaker Boehner, , House Majority Leader Eric Cantor, House Budget Chairman Paul Ryan and Senate Minority Leader Mitch McConnell all voted for major drivers of the nation’s debt during the past decade: Wars in Afghanistan and Iraq, the 2001 and 2003 Bush tax cuts and Medicare prescription drug benefits. They also voted for the Troubled Asset Relief Program, or TARP, that rescued financial institutions and the auto industry. "Together, a Bloomberg News analysis shows, these initiatives added $3.4 trillion to the nation’s accumulated debt and to its current annual budget deficit of $1.5 trillion. "
Gregory-- Polls also show that when it comes to the deficit debate, the public supports the president. And I agree, people are very frustrated with the gridlock in Washington.