Wednesday, August 29, 2012

It's only Medicare but I like it!

Is the Romney/Ryan plan for Medicare really that bad? This is a question that has been bothering me lately. It's easy to quote the standard talking points in opposition--the end of Medicare as we know it, thousands more in medical costs shifted to seniors, and have I mentioned VOUCHERS???

But consider: the cafeteria-style plan offerings that that the R/R proposal envisions are not much different from the insurance exchange model that the Affordable Care Act (Obamacare) calls for. And, the R/R team swears that if you want old-style Medicare, you can keep it! How bad can that be, really?

But it's probably not the ACA we should thinking about when trying to get a handle on the R/R Medicare changes. After all, the ACA is basically trying to expand the current, mostly-for-profit health insurance system to the uninsured population. The R/R proposals for Medicare, on the other hand, would shift people already with health coverage from a single-payer system to a new, private system with multiple choices of payers.

It does remind me a little of Medicare Advantage. Medicare Advantage (also known as Medicare Plus) was an effort to bring free-market efficiency to the Medicare health system by giving private health plans subsidies if they would offer HMO-type insurance products to Medicare enrollees.

With Medicare Advantage, plans could get higher reimbursements from the federal government. Suddenly, new plans were springing up everywhere, offering exercise classes and free hearing aids, adding the preventive services you find with HMOs—really it was a pretty good deal for the seniors who had that option. But some areas—especially rural or poor areas—simply did not get Medicare Advantage options.

The Medicare Advantage approach was really a bonanza for the insurance plans. Their Medicare book of business became one of their most profitable. In places like Florida and New York, where Medicare reimbursements were already higher, the plans did really, really well.

(As a sidenote, this is where the controversy over the Medicare cuts under the ACA come in. The Obama team, when looking at how to pay for the ACA, recognized that the “incentives” offered to the plans, along with some other reimbursements, looked a lot like the wasteful, bloated government spending that certain tea-partiers and deficit hawks are always complaining about. It really was a prime example of where budgets could be cut without seriously affecting the care given. So they did it. They negotiated cuts with both hospitals and health plans and found $500 billion in savings, partly by reducing those generous Medicare Advantage payments.)

So how does this relate to Romney and Ryan’s plan for Medicare? Well, it may be that the R/R team will come up with some incentives for private plans to participate in this voucher system they envision, and we’ll see another boom just like the Medicare Advantage one.

But maybe as time goes on and medical costs go up, private plans will find it better for their bottom lines to drop out of the Medicare business. Or they may start raising copays and deductibles, just as they have been in the regular marketplace.

And almost certainly, there will be Medicare enrollees who are not attractive to the private system. Those from rural, poor areas may have not choice but to stick to the traditional fee-for-service, just as in the Medicare Advantage example. And since all the wealthier, healthier seniors will now be on private plans, what will that do to traditional Medicare?

There are a lot of questions, not the least is how will R/R make all this attractive to private plans. After all, higher reimbursements would be a sure budget-buster, and they’re trying to CUT government spending.

So, we have a choice. We can stick to a proven, successful model, Medicare, cut some waste, and still have some tough choices to make down the road to ensure the system’s finances remain sound as the baby boomers retire.

Or we can try a new, untested system. One that has many unanswered questions and unclear consequences. The Medicare Advantage experiment generates mixed reviews—it hasn’t worked for everyone, and it hasn’t held down costs.

Changing a system as big and important as this one is a gamble.

I guess the question is, do you feel lucky, Gramps?

Well, do ya?



Saturday, August 18, 2012

I understand why Obama is saying bad things about Romney, but why is Romney insulting me??

Barack Obama come to office promising to change the tone in Washington, and I think we can all agree that he has failed to do that. Doesn't make him a bad president, doesn't erase the positive things that he's done, but hey, he doesn't bat 1,000. We still have a pretty ugly partisan divide in our politics these days.

This election season, many have been bemoaned the negativity of the presidential campaigns. Some say the negativity is "the worst ever." To my mind the attacks on both Romney and Obama don't hold a candle to how Sen. John Kerry was treated in 2004. And the 2008 campaign also got pretty nasty, with the thinly-disguised appeals to racism in Palin's disdain for community organizers and similar comments from Rush Limbaugh, etc. But as Obama himself has noted, handling that sort of bile is part of the job. Politics ain't beanbag, and presidential contests have often been nasty since the days of our Founding Fathers.

So let the charges and counter-charges fly. Politicians say bad things about each other, rain is wet, etc. etc.

What I want to know is, why does Mitt Romney think so lowly of me?

Romney is applying for the job of President of the United States. If he wins, he's going to play a large role in controlling our country's finances for at least four years, and his policies will affect my kids' economic future for possibly the rest of their lives.

If he wants my vote, he damn well better tell me something about his personal finances.

This isn't some ancient nit-picking like Obama's college transcripts or whether Bush flew enough hours in pilot training. It's not even a letter-of-the-law thing like Obama's birth certificate. This is directly pertinent to Romney's entire rationale for running for president. It's directly relevant to the argument this country is having over taxes.

And yet Romney is refusing to release anything close to the standard amount of tax returns for a presidential candidate. What's worse, his own father released 12 years of returns when he ran for president. Yet Romney is only releasing two (hasn't fully released even that much, yet). And when asked why, he all but says, "You don't need to know."

That's insulting.

Romney's official answer to why he's not being transparent about his finances is that the more he releases, the more ammo Democrats will have for their attacks. Well, yeah. That's called being a presidential candidate. You are under a microscope for a reason. Your record is examined. Your family is scrutinized. Your every word is picked over. If you have a problem with that, maybe you should do something else with your time.

I believe politicians should have some basic areas of privacy. But their financial background ain't one of them. For a presidential candidate to come in, say "I'm going to operate by a different set of rules," and then complain when people aren't satisfied with that just reinforces every cliche of elitism, arrogance, and regal entitlement that Romney has struggled with since Day One.

If this is the way Romney treats us when he's a candidate, how will it be if he's elected? What kind of transparency and openness can we expect from this man who wants to run our country? What kind of leadership can we expect in time of crisis, when there may be information that doesn't make his administration look good? Will he be honest and forthright with us?

We're not frickin' peasants, Mitt. We're your bosses. Give up the damn tax returns.

Saturday, August 11, 2012

Ryan to get over

OH! A surprise pick! The GOP candidate is going to shake up the race! He's selected someone who is going to excite the base!

Hey, are you feeling sense of deja vu? 'Cause I am.

But before we go any further, can we please take a moment of silence--with NO giggling!--for Tim Pawlenty? Damn, that guy must feel cursed. Always the bridesmaid, never the VP. He was *this* close with McCain, and now again this year... I wouldn't blame him if he says "screw it, I'm going to take a nice vacation this fall."

Paul Ryan is a smart guy and really I don't blame him for being obsessed with debt and deficits. As someone who thinks Ayn Rand was a fool, I can't get behind his solutions. But I think this is a very interesting pick, and he is not another Sara Palin, at least. He's been on the national stage a while, and is not going to be flustered by someone asking what magazines he's read lately.

Dems are crowing that this pick is a sign of desperation, and I think it's true if the dynamics of the race were the same as the pre-European trip, we'd be talking about Pawlenty or Portman today. But Mitt has been taking a beating, and even if you dismiss the polls as a temporary blip, you know things are bad when a candidate for President of the United States is on national TV, complaining about how unfair the other guy is being and suggesting that they call a truce on talking about each others' finances. As if, Mitt.

Conservatives, ironically, are also crowing about the pick. But I'm not sure all Republicans are. Right-leaning site Real Clear Politics, in an analysis that looks at both good and bad points to the pick, does include this line: "It opens up an Obama landslide scenario for the first time."

Still, Ryan is a talented politician. I don't think you can ever underestimate the positives that a young, handsome, energetic candidate brings to a race. We all like to think that such superficial things don't influence us, but we're probably not being honest when we do so. So maybe he can give Romney a boost. The real question is whether mainstream Americans, those mythical independents and those who are leaners on either side, will buy the austerity and safety-net slashing that Ryan is selling. Can the Romney campaign survive throwing itself spread-eagle on the third rail of politics, as one blog colorfully asked? I don't know. I know a lot of conservatives who eat that kind of crazy up with a spoon. They really think Social Security and Medicare are a bad idea and we'd be better off without them, although I don't see them sending back the checks.

But will the voters in the middle embrace the radical vision Ryan has? I have my doubts. But what is beyond doubt is that the campaign just got more interesting.

Wednesday, August 01, 2012

Romney heads back to the USA

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There were suggestions in a few of the political blogs that some of Mitt Romney's advisors did not want him to go on his recent trip overseas. "Why take the focus off the economy?" they asked. That, after all, is his strongest issue. Going overseas would just be a distraction. This isn't a foreign policy election, after all.

I'm thinking they feel vindicated after Mitt's less-than-stellar performance. It is true the media loves to jump on gaffes and little mistakes, and to be fair Mitt's mistakes were not terribly consequential, except perhaps the part about insulting the Palestinians. To say that a country undergoing occupation and economic sanctions is poor because of CULTURE is pretty strange.

But overall, it's hard to see this as being a decisive point in the election. Romney didn't come off well, but this will be a foggy memory come November. Still, it's part of a narrative that the Obama campaign can use--"Sure Romney's a great businessman, but there's more to the job than that." Given the reaction of the foreign press, it's an argument with some power.