Category Archives: Medicaid

Why the Mitt Romney/Paul Ryan Plan Won’t Work

What’s wrong with vouchers for Medicare for American’s under the age of 55. Maybe nothing. Maybe a lot. We are hearing that everyone would be handed a voucher that would pay for the second most expensive Advantage Plan (offered by private insurers.) We just had a system that depended on private insurers. It did not cover people with a “pre-existing condition” (that’s pretty vague, a pimple could be a pre-existing condition), or people who needed expensive long term care, or people who were too poor to buy insurance, or people who were unemployed. Eventually insurers started to place “lifetime caps” on patients who were too risky and pricey to insure. People were turned into things, like houses, trucks, cars; or disasters like fires and floods. Since private insurance companies must make a profit, they will always (and should always) try to minimize risk. How do you minimize risk in the case of human health? You make crazy rules that are more and more restrictive like rules about what we can’t do if we want to be covered (i.e. can’t smoke, can’t eat sugar, can’t eat fat, can’t gain weight, can’t drink soda) – and where will that end?
The voucher plan didn’t originally include a public option, but I hear it does now. With the newest incarnation of the plan if you wish you can keep your government Medicare insurance. Critics of this plan suggest that this is where you can expect to find everyone who can’t meet the requirements of the private health insurers. This will not make the public option look very appealing to those who are essentially healthy seniors and they will stay away from it in droves, putting private insurers right back in their very powerful and profitable driver’s seat where senior health care is concerned, and will give them, once again, a monopoly on the health care business in the U.S.
I am not against business. I am not even against profits, although I am opposed to gouging. I just can’t remind everyone enough about how long it took us to learn that unregulated capitalism, while supremely prosperous for an individual who is successful in business, will always have a tendency to abuse workers in order to buck up profits. There is no moral imperative in captialism, only the motive to turn a profit. I also am not saying that that are not moral capitalists – there are, but the practice of capitalism does not require that the Golden Rule be applied.
Interestingly enough, Gail Collins, writing on the opinion page in the New York Times, reminds us that the real loser in the Ryan plan is Medicaid, which will change beyond recognition. In the interests of smaller federal government Ryan suggests that the federal government give “block” grants to states for Medicaid and that states then devise their own Medicaid programs. Many people think this would be OK because they believe that only poor people use Medicaid. However, this is not the case. When seniors need long term care, nursing home care, care for serious or final conditions they are switched from Medicare to Medicaid. This means that any one of us could be subject to the whims of our own state’s government when our health is likely to take all the fight out of us and leave us as possible victims. Right now states are experiencing less flexibility in dealing with their financial issues than we find available at the federal level because they can’t print money. If you hand them a block of money without a lot of regulations for how it can be spent, would you like them to have control over your health care, right when you are most frightened and sick?
There is much to consider in this decision. Everyone agrees that we must do something but just because Paul Ryan has come up with a ready-made plan does not mean that it is the right plan for Americans. It will put us not just back where we started, but we would be in worse shape than previously if you add Medicaid into the picture. We have a little time to look for other options. I always wanted an all public option, but I am coming to believe that right now this would leave too many people unemployed to be an appropriate choice. In spite of the fact that Republicans see Obamacare as anathema, Obama still left the private insurance companies with a big role in our health care. Obamacare seems bipartisan in that it is a plan that requires that all parties compromise their health care views, and in that it tries to walk a middle line between public and private.

Becoming Our Own Charity

When our elected Congress people first started talking about things like “small government” and getting rid of “entitlements” because they are not part of the business of the federal government I was aghast, as I believe many of us were. I still resent that the opponents of the safety net played the “destroys initiative card” and the “creates lazy citizens card” and the “actually a form of oppression card”. If you want small government at least be honest about your motives; no need to insult the “have not’s”.
I do believe, in these times of big population, that a small government movement is inappropriate. I do not believe this is any moment, after the shenanigans of the big banks and Wall Street and the mortgage market to argue for total “laissez-faire” capitalism. This is not at all logical. “We messed up when we were regulated so you should take away all regulation.” Did you think the American people weren’t paying attention? This message that American regulations and tax codes are strangling business would make some sense if we could shrink the American economy enough to compete with China and India, et al. But why would we want to do that in the first place and could we even if we really wanted to? We are used to our creature comforts and we are accustomed to our standard of living. We cannot become a China or an India. We cannot shrink our economy enough to tempt back the manufacturers who have left us. And we cannot pretend that when they left us they did not hurt our economy, but they did not hurt it enough to make us competitive. It is not regulation that is driving business away; it is not tax codes; and it is not labor unions. It is the bottom line, it is the profit factor and it will take time for the advantage to swing back in our direction.
It is, however, quite possible that regulation and tax codes are hurting small businesses. It is possible and probable that in these straitened times, benefits like health care and pensions are hurting the willingness or ability of entrepreneurs to begin small businesses. I believe that we could work to take some risks out of business start-ups and we could do better with encouragements to venture capitalism. But, just because benefits are serving as obstacles to doing business does not mean our society can afford to do without them. Perhaps we do need to separate health care from employers. If health care is to be available to all, why should employers have any part in it? It challenges a workers right to privacy when an employer sponsors health care. Although the employer should not have any access to an employee’s health information it sometimes must be revealed so leave arrangements or similar issues can be addressed.
What seems to be true, and what I am hearing more often these day, is not that “entitlements” turn us all into deadbeats (since this is, surprise, surprise, an unpopular argument); it is that “entitlements” or our safety net is untenable. We will not be able to afford to keep it. These benefits we all rely on are unsustainable and they will bankrupt our government. I’m not sure it this is fact or hyperbole, but almost everyone from the most strident extremists to perfectly reasonable sounding moderates seems to agree that Medicare, Medicaid and Social Security certainly need some tweaking.
I keep thinking that we could set up some kind of citizen’s agency to collect and hold donations by people who wish to save these programs and to keep them open and operational for generations to come. It could be a sort of Red Cross program to rescue our safety net whenever it fell on difficult times, A Citizen’s Safety Net Emergency Fund run by financial people, economists, or CEO’s in the private sector who were directly elected by citizens in an internet voting procedure. Of course one problem with this would be to be sure our government wouldn’t “borrow” from the safety net because they knew the funds would be replaced. I’m sure that we human beings could come up with some very creative ways to abuse such an agency. Our clever brains are not always backed up by scruples. Anyway, that’s my basic idea for what it’s worth. I would leave it for great legal minds to write the necessary safe guards into the plan. We could become our own charity.