Campaign for America's Future News » Health Care for All

What About The Children?

Digby — Mon, 01 Apr 2013 16:32:07 +0000

“We must embrace the need for modest reforms—otherwise our retirement programs will crowd out the investments we need for our children.” President Obama, State of the union address, 2013

Is that really true?

Here’s Dean Baker:

The Very Serious People in Washington have been running around arguing that the country should be very worried about the aging of the population. The story is that we face an enormous crisis because the ratio of workers to retirees is projected to fall from 2.8 to 1 in 2013 to just 2.0 to 1 over the next two decades. This declining ratio is supposed to mean that our children will face an enormous burden in supporting a rapidly growing population of retirees.

While this projection produces much hand wringing and head nodding among the Very Serious People (VSP), fans of arithmetic know that it provides little basis for concern. The reason for the lack of concern is often given by the VSPs themselves. When pushing the scare story they often throw in the tidbit that the ratio of workers to retirees used to be 5 to 1 back in the 1960s.

Of course the country is far richer on average today than it was in the 1960s even though we have much lower ratio of workers to retirees. The secret is productivity growth. Output per worker hour is more than twice as much in 2013 as it was in the 1960s. As a result, we can both have a larger share of output diverted to supporting retirees and have higher living standards for both workers and retirees.

The same story holds going forward. In 20 years average output per worker is conservatively estimated to be more than 40 percent higher than it is today. This means that even if workers were to see an increase in their payroll tax of 2 or 3 percentage points (almost certainly more than would actually be the case – we can also raise the cap on taxable wages) they would still have much higher after-tax wages in 2033 than they do today.

Furthermore, the longer-term story looks even brighter. After 2030 the demographic picture actually improves slightly as us pesky baby boomers die off and then is projected to worsen very gradually through the rest of the century as the life expectancies continue to rise.

This means that the gains of productivity growth will be able to go to active workers in these decades with no additional burdens due to demographics. That would mean wages could rise by another 15 percent by 2043 and another 15 percent on top of this by 2053. There is nothing close to the story of impoverishing our children pushed by the VSPs.

Unfortunately, we do have a problem, but it’s not because the old people are sucking up all the money by living too long. It’s something else entirely:

At this point alert readers are jumping up and down yelling that most workers have not been seeing the gains of productivity growth over the last three decades due to the upward redistribution of income over this period. If this trend continues then workers will have little increase in before-tax wages to offset any tax increases that might be needed to support Social Security.

This is completely true and precisely the point. The real threat to our children’s living standards has nothing to do with the possibility that Social Security might require additional tax revenue in the decades ahead. The threat to their living standards is the risk that the upward redistribution of the last three decades will continue for the decades into the future. If this proves to be the case, then the top 1-2 percent of the population will get almost all of the gains of economic growth and most of our children and grandchildren will see nothing.

The demographic argument is misdirection. The wealthy elites are trying to get people to believe that the problem is that that workers just can’t contribute enough to keep up with all the takers (which they themselves are too, when they expect to collect in their old age.) But they are. The problem is that the wealthy are keeping it all for themselves.

Krugman hit this yesterday too, from another angle. He points out that the argument for austerity has switched from being an immediate crisis that requires us to cut spending immediately or face Armageddon to a long term crisis that requires us to cut spending over the long term or our children will face Armageddon:

… Pundits who spent years trying to foster a sense of panic over the deficit have begun writing pieces lamenting the likelihood that there won’t be a crisis, after all. Maybe it wasn’t that significant when President Obama declared that we don’t face any “immediate” debt crisis, but it did represent a change in tone from his previous deficit-hawk rhetoric. And it was startling, indeed, when John Boehner, the speaker of the House, said exactly the same thing a few days later.

What happened? Basically, the numbers refuse to cooperate: Interest rates remain stubbornly low, deficits are declining and even 10-year budget projections basically show a stable fiscal outlook rather than exploding debt.

So talk of a fiscal crisis has subsided. Yet the deficit scolds haven’t given up on their determination to bully the nation into slashing Social Security and Medicare. So they have a new line: We must bring down the deficit right away because it’s “generational warfare,” imposing a crippling burden on the next generation.

What’s wrong with this argument? For one thing, it involves a fundamental misunderstanding of what debt does to the economy.

Contrary to almost everything you read in the papers or see on TV, debt doesn’t directly make our nation poorer; it’s essentially money we owe to ourselves. Deficits would indirectly be making us poorer if they were either leading to big trade deficits, increasing our overseas borrowing, or crowding out investment, reducing future productive capacity. But they aren’t: Trade deficits are down, not up, while business investment has actually recovered fairly strongly from the slump. And the main reason businesses aren’t investing more is inadequate demand. They’re sitting on lots of cash, despite soaring profits, because there’s no reason to expand capacity when you aren’t selling enough to use the capacity you have. In fact, you can think of deficits mainly as a way to put some of that idle cash to use.

Yet there is, as I said, a lot of truth to the charge that we’re cheating our children. How? By neglecting public investment and failing to provide jobs.

So, once again, fixing problems that don’t exist while ignoring the ones that do.

Selling the Store: Why Democrats Shouldn’t Put Social Security and Medicare on the Table

Robert Reich — Fri, 22 Mar 2013 16:02:48 +0000

Prominent Democrats — including the President and House Minority Leader Nancy Pelosi — are openly suggesting that Medicare be means-tested and Social Security payments be reduced by applying a lower adjustment for inflation.

This is even before they’ve started budget negotiations with Republicans — who still refuse to raise taxes on the rich, close tax loopholes the rich depend on (such as hedge-fund and private-equity managers’ “carried interest”), increase capital gains taxes on the wealthy, cap their tax deductions, or tax financial transactions.

It’s not the first time Democrats have led with a compromise, but these particular pre-concessions are especially unwise.

For over thirty years Republicans have pitted the middle class against the poor, preying on the frustrations and racial biases of average working people who can’t get ahead no matter how hard they try. In the Republican narrative, government takes from the hard-working middle and gives to the undeserving and dependent needy.

In reality, average working people have been stymied because almost all the economic gains of the last three decades have gone to the very top. The middle has lost bargaining power as unions have shriveled. American politics has been flooded with campaign contributions from corporations and the wealthy, which have used their clout to reduce marginal tax rates, widen loopholes, loosen regulations, gain subsidies, and obtain government bailouts when their bets turn sour.

Now five years after the worst downturn since the Great Depression and the biggest bailout in history, the stock market has recouped its losses and corporate profits constitute the largest share of the economy since 1929. Yet the real median wage continues to fall — wages now claim the lowest share of the economy on record — and inequality is still widening. All the economic gains since the trough of the recession have gone to the wealthiest 1 percent of Americans; the bottom 90 percent continue to lose ground.

What looks like the start of a more buoyant recovery is a sham because the vast majority of Americans have neither the pay nor access to credit that allows them to buy enough to boost the economy. Housing prices and starts are being fueled by investors with easy money rather than would-be home buyers with mortgages. The Fed’s low interest rates have pushed other investors into stocks by default, creating an artificial bull market.

If there was ever a time for the Democratic Party to champion working Americans and reverse these troubling trends, it is now — forging an alliance between the frustrated middle and the working poor. This need not be “class warfare” because a healthy economy is in everyone’s interest. The rich would do far better with a smaller share of a rapidly-growing economy than a ballooning share of one that’s growing at a snail’s pace and a stock market that’s turning into a bubble.

But the modern Democratic Party can’t bring itself to do this. It’s too dependent on the short-term, insular demands of Wall Street, corporate executives, and the wealthy.

It was Bill Clinton, after all, who pushed for repeal of Glass-Steagall, championed the North American Free Trade Act and the World Trade Organization without adequate safeguards for American jobs, and rented out the Lincoln Bedroom to a steady stream of rich executives.

And it was Barack Obama who continued George W. Bush’s Wall Street bailout with no strings attached; pushed a watered-down “Volcker Rule” (still delayed) rather than renew Glass-Steagall; failed to prosecute a single Wall Street executive or bank because, according to his Attorney General, Wall Street is just too big to jail; and permanently enshrined the Bush tax cuts for all but the top 2 percent.

Meanwhile, over the last several decades Democrats have allowed Social Security taxes to grow and its revenue stream to become almost as important a source of overall government funding as income taxes; turned their backs on organized labor and labor-law reforms that would have made it easier to form unions; and then, even as they bailed out Wall Street, neglected the burdens of middle-class homeowners who found themselves underwater and their homes worth less than what they paid for them because of the Street’s excesses.

In fairness, it could have been worse. Clinton did stand up to Gingrich. Obama did get the Affordable Care Act. Congressional Democrats have scored tactical victories against social conservatives and Tea Party radicals. But Democrats haven’t responded in any bold or meaningful way to the increasingly concentrated wealth and power, the steady demise of the middle class, and further impoverishment of the nation’s poor. The Party failed to become a movement to reclaim the economy and our democracy.

And now come their pre-concessions on Social Security and Medicare.

Technically, a “chained CPI” might be justifiable if seniors routinely substitute lower-cost alternatives as prices rise, as most other Americans do. But in reality, seniors pay 20 to 40 percent of their incomes for healthcare, including pharmaceuticals — the prices of which are rising much faster than inflation. So there’s no practical justification for reducing Social Security benefits on the assumption inflation isn’t really eating away at those benefits as much as the current cost-of-living adjustment allows.

Likewise, although a case can be made for reducing the Medicare benefits of higher-income beneficiaries, as a practical matter their savings are almost as vulnerable to rising healthcare costs as are the more modest savings of middle-income retirees. “Means-testing” Medicare also runs the risk of transforming it into a program for the “less fortunate,” which can undermine its political support.

In short, Medicare isn’t the problem. The underlying problem is the sky-rocketing costs of health care. Because Medicare’s administrative costs are a fraction of those of private health insurance, Medicare might be part of the solution. Medicare for all, or even a public option for Medicare, would give the program enough clout to demand health providers move from a fee-for-service system to one that paid instead for healthy outcomes.

With healthcare costs under better control, retirees wouldn’t be paying a large and growing portion of their incomes for healthcare — which would alleviate pressure on Social Security. I’m still not convinced a “chained CPI” is necessary, though. A preferable alternative would be to raise the ceiling on the portion of income subject to Social Security taxes (now $113,600).

Besides, Social Security and Medicare are the most popular programs ever devised by the federal government, which is why Republicans hate them so much. If average Americans have trusted the Democratic Party to do one thing it has been to guard these programs from the depredations of the GOP.

Putting these two programs “on the table” is also tantamount to accepting the most insidious and dishonest of all Republican claims: That for too long most Americans have been living beyond their means; that we are rapidly approaching a day of reckoning when we can no longer afford these generous “entitlements;” and that prudence and responsibility dictate that we must now begin to live within our means and cut back these projected expenditures, particularly if we are to have any money left to invest in the young and the disadvantaged.

The truth is the opposite: That for three decades the means of most Americans have been stagnant even though the overall economy has more than doubled in size; that because almost all the gains from growth have gone to the top, most Americans haven’t been able to save enough for retirement or the rising costs of healthcare; and that because of this, Social Security and Medicare are barely adequate as is.

Paul Ryan’s House Republican budget takes on Medicare, but leaves Social Security alone. Why should Democrats lead the charge on either?

The Republicans are already slashing help for the young and the disadvantaged. Democrats shouldn’t succumb the lie that the elderly and young are in competition for a portion of a shrinking pie, when in fact the pie is larger than ever. It’s just that those who have the largest and fastest-growing portions refuse to share it.

We are the richest nation in the history of the world — richer now than we’ve ever been. But an increasing share of that wealth is held by a smaller and smaller share of the population, who have, in effect, bribed legislators to reduce their taxes and provide loopholes so they pay even less.

The budget deficit “crisis” has been manufactured by them to distract our attention from this overriding fact, and to pit the rest of us against each other for a smaller and smaller share of what remains. Democrats should not conspire.

Needy children should be getting far more help, better pre-school care, better nutrition. Seniors need better healthcare coverage and more Social Security. All Americans need better schools and improved infrastructure.

The richest nation in the history of the world should be able to respond to the legitimate needs of all its citizens.

Originally published at RobertReich.Org.

Shopping Cart Conservatism At CPAC

Derek Pugh — Mon, 18 Mar 2013 16:21:49 +0000

Just as Liberals have time honored pilgrimages, such as the annual march on Washington, so do conservatives. Last week, thousands of conservative activist and nearly a dozen possible 2016 Republican candidates gathered in Washington to attend the annual Conservative Political Action Conference (CPAC).

Speakers included top tea party darlings and leaders of anti-gay, anti-abortion, and anti-environmental organizations. The speakers spouted incorrect facts, and their credulous followers championed and praised every single word.

Friday’s first panel, entitled How I Learned to Stop Worrying & Love Plastic Water Bottles, Fracking, Genetically Modified Food, & Big Gulp Sodas, focused on Americas “apparent” obsession with alarmism. Angela Logomasini, at the Competitive Enterprise Institute, proudly stated that there is “no evidence of BPA” being a health hazard. Wrong. She also went on to advocate for the use of more plastic bags and bottled water. Following suit was Julie Gunlock from Independent Women’s Forum, who declared that “it is true we have gotten bigger” but that obesity is not a threat to the country’s health. Really?

The last “credible speaker” on the panel, Jillian Melchior at the Franklin Center for Government & Public Integrity, focused on the issue of fracking. She stated that fracking is a “positive environmental” practice and that it really does not contaminate ground water. The session ended with the moderator saying that alarmism is none other than an “effective weapon for proponents of big government,” and that conservatives need to “bring back freedom to our people.”

It’s odd that when it comes to topics like health, the environment, and consumer spending, Americans are too alarmist; yet when it comes to the military, conservatives believe that Americans can never be worried enough. This panel was a prime example of how the conservative and tea party movement is nothing more than a front for corporations, the wealthy, and those who wish to strangle the government.

The next words of wisdom came from none other than Rick Santorum. Santorum, like always, advocated for good old fashioned values, saying that “our culture and political leadership have robbed” conservatives and “transformed the American dream.” “Face it,” he continued, “the left can always promise more stuff,” but conservatives can’t “abandon their moral underpinnings.” Santorum ended by urging the crowd to “fight for the principles that made this country great and fight for those suffering.” Foster Friess, this year’s recipient of the ACU Award for Conservative Philanthropy, summed up those principles: “Chick Fil-A values are American values.”

What’s most bothersome is that Santorum ties fundamental Christian beliefs, morality, and American values to the conservative movement. First off, conservative policies do nothing for “those suffering” and only further drive inequity, which increases suffering. Wasn’t Jesus a man of the People, who believed in caring for the sick, elderly, and infirmed? Conservative fiscal policy does none of those, and only cuts health care, education, and Social Security for millions of hardworking Americans. The sequester, and the weakening of government, will literally cost lives due to cuts in vital programs.

Second, the conservative movement cares nothing for equality, and seeks to revert back to the heteronormativity of the 1950′s. If Santorum really believes his pious preaching, then he and every other conservative should re-read the Bible. Maybe they’ll begin to understand that they are not practicing what they preach.

Former presidential candidate Mitt Romney was a keynote speaker this year. But before Romney took the stage, Gov. Nikki Haley of South Carolina, proudly stated that SC was able to pass voter ID laws, and that as long as she is governor SC will not expand Medicaid: “And now they’re telling us we have to bust our budget and expand Medicaid. Not in South Carolina.” The crowd, of course, went wild. Again, shouldn’t a public servant be advocating for those with the least, instead of boasting about denying the neediest access to health care?

Romney, ironically, gave tips on how conservatives can win, advising them to “learn lessons from our success stories: the 30 Republican Governors.” Romney added: “Applaud the clear and convincing voice of my friend Paul Ryan.” The fact hat Romney actually believes that Ryan is clear or convincing to anyone except the far Right is a joke. Or it should have been. Romney ended, saying “I am sorry I won’t be your president.” We aren’t.

What would a conservative conference be without the anti-choicers? Probably smaller. The moderator introducing the panel on Roe vs. Wade began by saying “40 years ago the Supreme Court made one of the worst decisions ever.” This, to conservative minds, is an example of “raw, out of control federal power.” Marjorie Dannenfelser, President of the Susan B. Anthony List, even equated abortion to slavery.

The fact that conservatives at CPAC want the government to stay out of their shopping carts because it violates their personal freedom, yet champion government control of every uterus in the U.S. is mindboggling.

The combination of idiotology is astounding, and the hypocrisy of the conservative party is unparalleled. The whole event would actually be quite humorous, except for the fact that conservatives in Congress habitually hold our economy and democratic process hostage.

Paul Ryan’s Medicare Voucher Plan Is Back!

Thom Hartmann — Fri, 08 Mar 2013 18:16:44 +0000

House Republicans won’t give up on their efforts to voucher-ize Medicare. In fact, Representative Paul Ryan now wants to make it happen even sooner. As the House GOP is currently preparing their new budget, which will include Ryan’s Medicare voucher program, and they think it should now apply a year earlier than planned. In the past, Ryan and fellow Republicans have said any changes to Medicare wouldn’t effect people 55 and older, but now they want to make the cut off to age 56.

Republicans say they would give people the option of enrolling in traditional Medicare, or accepting a voucher towards the cost of a private plan, but that so-called choice is a sly attempt to destroy senior’s guaranteed health coverage. The only people who would opt for a voucher are seniors with few health concerns, and who don’t cost much to insure. Seniors who can’t afford to pay the difference in premiums, and those with greater health concerns, wouldn’t have the option of selecting a private insurance company.

This means Medicare would be responsible for seniors who need the most expensive care, and couldn’t off-set those costs with a pool of healthier individuals. With less money coming in, and the burden of covering those who require the most care, eventually the program would default. And that’s exactly what Paul Ryan and House Republicans want.

Last time Ryan proposed this voucher plan, poll-after-poll showed Americans didn’t approve, but that isn’t stopping him from pushing his privatization efforts again. We must make sure he doesn’t succeed. Call Congress now and tell them to stop Paul Ryan from destroying Medicare

Addiction, Recovery, and The Sequester

Terrance Heath — Fri, 08 Mar 2013 16:49:00 +0000

It was only a matter of time. As the debate over the sequester’s damaging, “just plain dumb,” across-the-board cuts ramped up, I just knew someone on the right would attempt to draw the analogy between government spending and addiction. “Addiction specialist” and “Fox News medical A-Team” member Dr. Keith Albow came through when he told host Jonathan hunt that “America is addicted to entitlement spending. We can’t afford it, and we’re drugging ourselves.”

Dr. Albow may think the sequester is just the “no frills” detox America needs. But the sequester does the most harm to the most vulnerable, and it will do a great deal of harm to the population Albow supposedly specializes in helping.

Addiction and recovery are issues near and dear to my heart. Last summer I celebrated 20 years of continuous sobriety, but that celebration was tempered by the sobering reality of how many Americans are struggling with addiction, and how few have access to treatment. In the 2011 National Survey on Drug Use and Health:

20.5 million Americans were classified with substance dependence or abuse
21.6 million Americans needed treatment for illicit drug or alcohol abuse
Of those needing treatment, just 2.3 million (0.9 percent) received treatment at special centers (hospital inpatient, drug or alcohol rehabilitation, or mental health centers)
19.3 million needed treatment for substance but did not receive it

Before the sequester was more than just a bad idea, less than 10 percent of Americans who needed treatment for addiction actually got treatment, despite efforts — their own and their families’ — to get treatment. If the sequester continues, and cuts trickle down to the state and local level, according to HHS about 200,000 Americans will lose access to addiction treatment, due to a 2% cut in Medicare.

In the 2011 NSDUH, most of the 0.9 percent who did get into treatment either used their own savings and earnings (46.4 percent), had health insurance that covered some part of the cost of treatment (38.5 percent), received funds from family members (26 percent), or used some combination of these. Some who qualified for programs like Medicare and Medicaid were able to find treatment programs that accepted one, the other or both. Most of those who did not get treatment either had no health insurance and could not afford the cost (37.3 percent) or had health insurance that did not cover the cost of treatment (10.1 percent).

With the cost of treatment running anywhere from $14,000 to $20,000 for an average 28-day stay, those without their own means or access to government assistance are already out of luck. The sequester will simply make it even harder for addicts to find help, or families of addicts to and pay for an open bed in rehab for a son, daughter, father, or mother.

The hardship of sequestration will fall large on low-income and middle class families. Low income families and addicts will simply find what meager public resources were available have become even more scarce. Middle class families who are either “too wealthy” to qualify for state or federal subsidies and “too poor” to pay out of pocket when insurance claims are denied, will be in much the same boat. (Despite laws like the Mental Health Parity and Addiction Treatment Act and the Affordable Care Act, intended to make treatment more widely available and stop insurers from discriminating in their coverage, insurance companies still frustrate families seeking addiction treatment.)

The most common response to all of the above is often “So, what?” After all, we’re talking about addicts here, and addiction is one of the few diseases for which we righteously blame the victim, and treat addicts as criminals rather than people with a chronic — and potentially deadly — illness. The addict “brought it on themselves,” should develop the willpower to “just say no.”

Our approach to addiction is both deadly and costly. Scientific research is providing more and more evidence to support the disease model of addiction; uncovering brain differences that suggest a predisposition to addiction in some people, and gene mutations that make us more or less sensitive to alcohol. As we often say in recovery, we’re as sick as our secrets, and our secrets are keeping us sick. Treating addiction as a crime rather than a disease is keeping millions of us sick, and killing too many of us. Drug overdose deaths have been increasing for years, and drug-related deaths have outpaced traffic fatalities.

And if none of that matters in when it comes to slashing budgets, how about this? Untreated addiction is expensive. Addiction treatment is a good investment.

Untreated addiction leads to higher costs in other areas. Emergency room visits and increased hospitalizations due to addiction lead to increased health care spending. About 1/3 of hospital admissions are the result of risky drug use and addiction. Untreated addiction causes more than 70 diseases — like liver disease, hepatitis, HIV/AIDS, Fetal Alcohol Syndrome, etc. — requiring medical care. All of that gets added to tab picked up by taxpayers. Since 1986, hospitals and emergency rooms have been required to treat all patients regardless of their ability to pay. Those costs get passed on to the rest of us, as addicts who land in emergency rooms and hospitals beds with addiction-related conditions are usually among the uninsured.

Untreated addition has costs far beyond health care. Because we treat addiction as a crime rather than an illness, we spend money on police, courts, and incarceration as we move addicts though the criminal justice system. In our prisons and jails, 86 percent of inmates are there for substance-related issues, and two thirds meet the criteria for addiction. We pay about $25,000 per year to keep each of them locked up, but often fail to treat the addictions that landed them there in the first place. Other consequences of untreated addiction — unemployment, homelessness, child abuse, domestic violence, mental illness, etc. — has expensive ramifications for our welfare system.

Altogether, federal state and local government spend about $467 billion per year on problems related to untreated addiction, accounting for 10% of the federal budget and 10 percent of most state budgets. Split the bill between all of us, and that comes to a yearly cost about $1,500 for every person in America. Just 2 cents of every dollar spend goes towards prevention and treatment. The other 96 cents goes to pay for the consequences of failing to prevent and treat substance abuse.

Providing treatment actually saves money. Every dollar spent on treatment saves $7 to $12 spent on the consequences of untreated addiction. According to a UCLA study, every $1,583 spend on addiction treatment is offset by $11,487 in savings — money that we would otherwise spend on the costs of medical care, mental health services, incarceration, unemployment, and public aid related to untreated addiction.

The sequester means that at least 200,000 more Americans will not get the substance abuse treatment they need. Any supposed “savings” will be obliterated by the cost of the consequences for denying treatment. The human cost to communities, families, and addicts themselves is incalculable — and unconscionable.

Paul Ryan Wants To Get Thin Without Counting His Love Handles

Stan Collender — Thu, 07 Mar 2013 17:05:17 +0000

This is not a post about House Budget Committee Chairman Paul Ryan’s (R-WI) exercise and diet program. It is, however, a post about how he’s planning to produce a budget that gets to balance in 10 years without actually balancing anything.

What Ryan is proposing is the fiscal equivalent of him saying that he wants to lose 20 pounds but isn’t going to counting the fat around his midsection to achieve it.

For weeks the budget and political worlds have been buzzing about how Ryan was going to be able to keep his pledge to bring a plan to the House floor that would balance the budget in 10 years without raising taxes. That’s a substantial task even after the already enacted revenue increases in the fiscal cliff deal and the $85 billion in sequester spending cuts, both of which Ryan has said he will include in his plan. It requires significant and politically very sensitive reductions in Medicare, Medicaid and probably Social Security.

We now know how Ryan’s planning to do it: by balancing the budget without counting interest on the national debt. In economic terms, that’s called bringing the budget into “primary balance.”

In other words, he’s not going to balance the budget at all.

How ridiculous is the Ryan balance-the-primary-deficit-only plan?

Try to imagine a Democrat proposing a balanced budget in 10 years by not counting military spending. That’s the equivalent of what Ryan is proposing to do.

This is not hyperbole. By fiscal 2017, total spending on the National Defense function of the federal budget currently is estimated to be close to what’s projected to be spent on “Net Interest” on the national debt — $590 billion vs $566 billion. As a percent of the budget in 2017 there is virtually no difference between the two.

Bringing the budget into balance without including interest means that the budget won’t be balanced at all. In fact, according to current projections it means that there will still be a $566 billion overall deficit.

My recommendation to Ryan: Don’t have your clothes altered anytime soon.

Originally posted at Capital Gains and Games.

The GOP and Obama’s Second Term: Rage of an Unprivileged Class, Pt. 3

Terrance Heath — Mon, 04 Feb 2013 18:32:00 +0000

Like I said in the first post in this series, Obama didn’t waste time talking to Republicans in his inaugural address because he didn’t need to talk to them. President Obama’s biggest accomplishments in his first term happened without their support and despite their opposition. And even though Republicans did everything within their power “make Barack Obama a one-term president,” Obama won re-election with a bigger margin of victory than either of our most recent two-term presidents.

Republicans complaining that Obama didn’t speak to them are missing or ignoring major cultural and demographic shifts in the electorate, and focusing instead on how best to turn back time.

What Do You Mean “We”?

Instead of talking conciliation to the very conservatives who tried and failed to stop him from taking the oath of office a second time, President Obama talked past them. Instead of appealing to the same right-wingers who obstructed his first term and promised to do the same during his second, President Obama went over their heads, and spoke directly to the people who helped him win a second term — the diverse coalition of voters who comprised a new majority in the 2012 election.

There’s a famous Nathan E. Birdwell/Joe Orlando comic from the 1960s that kind of sums up the difference between previous inaugural speeches, in which the newly-elected or re-elected chief executive “reaches out” to the opposition party with lofty-but-vague promises of “bipartisanship,” and the kind of speech Barack Obama delivered at his second inauguration. In the comic strip, which appeared in Mad magazine in 1958, as the Long Ranger and Tonto are fleeing a pursuing band of of “Indian Braves”, they have a brief exchange that became one of the most repeated and recycled jokes in decades (even by Pulitzer Prize winning economists).

The Lone Ranger and Tonto are watching a horde of Indian braves bear down on them in full battle fury. “Looks like we’re in trouble, Tonto,” says the Lone Ranger to his pal. “What you mean ‘we,’ white man?,” Tonto responds.

According to some numerical breakdowns of the inaugural address, and my own quick search after copying and pasting the text into Microsoft Word, Obama used the word “we” about 68 times in his speech. He used the word “together” about seven times, and repeated the phrase “we the people” about five times. By comparison, he said “I” about four times, and then only in the last two paragraphs of his speech.

What exactly did Obama mean by “we” in his speech? Who does he include in “we the people”?

As I wrote a couple of years ago, Washington is a town populate almost entirely by two kinds of people: “People Who Matter” and people who don’t.

After 15 years of living and working in Washington, D.C., the idea that there are “people who matter” and its corollary that there are then “people who don’t matter,” are at the heart of why so much in this town comes down to what I call “the least worst option.”

Whether it’s equality, energy, the economy, health care or any number of issues — the core question is the same: Who can we afford to leave out? Who can we afford to exclude? Who can we write-off? Who can we sacrifice? Who can we vote off the island? Who can we sacrifice for our own sake? Whose votes can we take for granted? Whose money can we count on after this vote?

Who are the “somebodies” and who are the “nobodies”? Who are the “people who matter” and who are the “people who don’t matter?”

Obama’s inaugural address was definitely not aimed at the usual “People Who Matter” in Washington.

Most of the 68 times Obama said “we” during his speech, he wasn’t talking to or about the members of Congress. Nor was he addressing the House GOP leadership, Senate Republicans, or any other conservative policymakers or pundits. He wasn’t addressing the people that he, as a Democratic president, might be expected to address with the obligatory words of conciliation and compromise on the occasion of his second inauguration; which they used every trick in the book (and invented a few new ones) to prevent. He didn’t even pretend to extend an olive branch to those who showed every sign of obstructing his second term agenda as much as they did his first.

That’s because the Obama’s second inaugural address was aimed at an entirely different group of “People Who Matter” — and who are likely to matter even more in the future than they did in 2012.

Thus, it was a rather startling speech for those long accustomed to everyone acknowledging them as the “People Who Matter.”

People Who Matter

In the Doonesbury comic strip for February 28, 2008, a college professor quotes Barack Obama’s first inaugural address to pose a question that’s even more relevant to his second inaugural address:

You see, the challenges we face will not be solved with one meeting in one night. It will not be resolved on even a Super Duper Tuesday. Change will not come if we wait for some other person or if we wait for some other time. We are the ones we’ve been waiting for. We are the change that we seek. We are the hope of those boys who have so little, who’ve been told that they cannot have what they dream, that they cannot be what they imagine. Yes, they can.

The line “We are the ones we’ve been waiting for,” had a long life in literary, feminist, and progressive circles long before then candidate Barack Obama used it to reach voters. It was first written by poet June Jordan, who died of cancer in June 2002, in “Poem for South African Women,” from her 1980 collection entitled Passion. Since then it has taken on a life of its own. It has been set to music by the vocal group Sweet Honey in the Rock, and borrowed by author Alice Walker as for the title of a collection of spiritual essays.

What made that sentence one of the biggest applause lines in Obama’s first inauguration, even for those who may not have heard it before, is the same thing that caused so many to take them to heart in the decades since Jordan penned her poem. The words are imbued with a sense of empowerment that speaks to people who have historically little very little power, sometimes even over their own fates. Obama referenced that theme again and again in the 2008 campaign.

Though he did not repeat that phrase in his second inaugural address, or repeat his 2008 campaign slogan, Obama touched on the same theme and spoke to the same constituency. He spoke to the diverse coalition of “people-who-have-never-mattered-before.”

But in 2012 that coalition forged a new majority that not only gave his a second term in office, but will almost certainly continue to change the face and focus of our politics, and the content of our discourse.

“We are the ones we’ve been waiting for. We are the change we seek,” candidate Barack Obama said in 2008. At the time, his comments came in for criticism: They were narcissistic; they were tautological; they didn’t make a whole lot of sense.

But in the aftermath of Obama’s 2012 reelection and his second inaugural address, his 2008 remarks seem less a statement of self-absorption than one of prophecy. There is an Obama majority in American politics, symbolized by Monday’s throng on the Mall, whose existence is both the consequence of profound changes to our nation’s composition and values and the cause of changes yet to come.

That majority, as the president made clear in his remarks, would not exist but for Americans’ struggles to expand our foundational belief in the equality of all men. The drive to expand equality, he said in his speech’s most historically resonant line, “is the star that guides us still, just as it guided our forebears through Seneca Falls and Selma and Stonewall.”

…The Obama Majority — its existence and mobilization — is what enabled the president to deliver so ideological an address. No such inaugural speech has been delivered since Ronald Reagan took office in 1981, demanding the curtailment of government programs and secure in the knowledge that much of the white working class had shifted its allegiance away from the Democrats and supported his attack on the public sector and minority rights. On Monday, Obama, secure in the knowledge that the nation’s minorities had joined with other liberal constituencies to form a new governing coalition, voiced their demands to ensure equality and to preserve and expand the government’s efforts to meet the nation’s challenges. As he left the stage, he stopped and turned to marvel at the crowd, at the new American majority they represented. They were the ones he, and we, were waiting for.

At his second inauguration, Barack Obama simply addressed “People Who Matter,” and who proved their power to confound pundits and chart the course of the nation in this election, and may prove more powerful in elections to come. For the GOP and its base, that’s a “startling” possibility.

The GOP and Obama’s Second Term: Rage of an Unprivileged Class, Pt. 2

Terrance Heath — Wed, 30 Jan 2013 18:19:06 +0000

In Part 1 of this series, I wrote that Republicans who were incensed that President Obama had nothing to say to them in his inaugural address should be far more worried the possibility that the president realizes he doesn’t need to spend time and energy reaching out to Republicans. After all, not only was Obama re-elected in spite Republicans’ “top priority” — literally adopted on day one of Obama’s first term — to make him a “one-term president;” he pulled off some major accomplishments, in the face of unprecedented GOP opposition.

The “Also Rans”

The irony of Republicans complaining that the president didn’t reach out to them in his inaugural address is that few Republicans bothered to be there to hear the speech. Other than the few in leadership, who were present if only for appearances’ stake, most Republicans got the hell of out Dodge. About 100 or so, including some Romney campaign staffers, left Washington for Las Vegas, where they comisserated in hotels owned by billionaire Romney backers Steve Wynn and Sheldon Adelson.

Romney himself remained in La Jolla, California, with his family. He told NBC News it was “doubtful” he’d even watch the ceremony. Romney also missed the one ceremony that was held in his honor on inauguration day, on the second floor of the First State Bank in Norton, Kasnas, where his portrait was hung in the “They Also Ran” Gallery.

After losing the 2012 presidential election, Inauguration Day likely provided little joy for former GOP presidential candidate Mitt Romney. While an aide to the former Massachusetts governor told NBC News that he was with family in La Jolla, Calif. — where it was “doubtful” that he would watch the ceremony — Romney is set to get his own celebration on Tuesday, just a day after President Barack Obama was publicly sworn into his second term.

On the second floor of the First State Bank in Norton, Kan., attendees are set to commemorate the enshrining of Romney into the “They Also Ran Gallery.” For 48 years, organizers have gathered there to raise the portrait and biography of the latest presidential election loser.

(Apparently, Romney made it to Washington a few days after the inauguration, to attend a reception in his honor and hosted by two of his top fundraisers, at Washington’s J.W. Marriot hotel.)

Four years after they decided that making Obama a one-term president would be their number one priority, Republicans are teetering on the verge of becoming an “also-ran” party — a point President Obama may have been signifying in his speech.

First, Obama racked up quite a list of accomplishments during his first term, in spite of the Republican obstructionism. Here’s just the top ten, from an April 2012 Washington Monthly article:

Passed Health Care Reform
Passed the Stimulus
Passed Wall Street Reform
Ended the War in Iraq
Began the Drawdown of War in Afghanistan
Eliminated Osama bin Laden
Turned Around U.S. Auto Industry
Recapitalized Banks
Repealed “Don’t Ask, Don’t Tell”
Toppled Moammar Gadaffi

The top five alone would be impressive for any president, but Obama accomplished that and more; not just without Republican support but in spite of Republican opposition. Now, some of these accomplishments weren’t as big as they could have been, and didn’t go as far as they should have gone. (Ask just about any progressive, and they can tell you.) That’s mostly due to Obama’s conciliatory approach to negotiating with an uncompromising GOP. The point is that Republican obstructionism only succeeded in weakening much of the above. The GOP utterly failed to stop any of the above.

Then, there is the obvious. After four years of total obstructionist opposition, Obama still handily won re-election with a majority of the popular vote, and 332 electoral votes thanks to winning all but one of the battleground states. (In a stroke of poetic justice, Romney’s share of the popular vote was 47 percent.)

Then there’s how Obama won his re-election bid. To add insult to injury, Obama won with a socially and economically progressive campaign. His stance on raising taxes on the wealthy, and investing in American resonated with more Americans than the Republicans’ insistence on keeping taxes low on the wealthiest Americans, and cutting safety-net programs instead.

On issues like marriage equality and abortion, Obama’s message appealed to more voters than the Republican message on those issues. In fact, 2012 may mark the first election in decades in which the social issues were an asset to Democrats and a liability to Democrats. Meanwhile, Republicans alienated women voters by positioning themselves against contraception, and running a slate of Senate candidates who couldn’t stop talking about rape and abortion in the worst possible way.

Obama won re-election with a diverse coalition of the same voters that Republicans spent the last four years degrading, denigrating, disenfranchising.

The thing is, Republicans, it looks like you haven’t learned anything from the 2012 election. You’re still asking yourselves the wrong question. You’re asking “Why don’t more Blacks/Latinos/gays/young people/women vote fur us?”(OK, maybe you’re not asking that so much about gays. But you should, and I’ll explain why in a bit.) Instead you should be asking “Why have we failed apply our values and principles to address their concerns?”

Let’s break this down, based on exit surveys.

Obama won the Latino vote by a 3 to1 margin, with 73% of the Latino vote. That’s up from 67% in 2008. On the other hand, you guys lost 17% of the Latino vote, compared to 2004.

Obama won 70% of the Asian American vote. Twenty years ago, Asian Americans voted Republican 2 to 1.

Obama won 93% of the African American vote, doing at least as well, if not better, with African American voters than he did in 2008. Despite attempts at voter suppression and long lines at polling places, African American voters turned out in big numbers, and played a big part in Obama’s reelection.

Forty percent of white voters backed Obama, while Romney only gained 3% of the white vote over what McCain got in 2004. Even though 88% of Romney voters were white, a lot of white voters didn’t want him in the White House.

Obama won 67% of the women’s vote, compared to 55% in 2008. It wasn’t just single women either. Women who are”married, with children” backed Obama 56% to 43%.

Obama won 77% of the gay vote. While they only make up about 5% of the electorate, gay voters were crucial to Obama’s victory — and a growing number of voters identify themselves as gay.

Obama won 60 percent of the youth vote, which was crucial to his victories in a number of swing states.

Republicans’ problem with the inauguration was that Obama wasn’t talking to them. Republicans are either failing or refusing to face of to an even bigger problem: a new political reality in which the president doesn’t need them or their support to get things done.

What’s The Cure For Shorter Lives And Poorer Health In America? Can You Say “Public Option”?

Terrance Heath — Thu, 17 Jan 2013 20:26:30 +0000

Harold Myerson, over at the Washington Post, points out a new report by the National Research Council and the Institute of Medicine contains some bad news about about the America’s health. The title pretty much says it all: “U.S. Health in International Perspective: Shorter Lives, Poorer Health.” The summary of the report goes into more detail.

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although life expectancy and survival rates in the United States have improved dramatically over the past century, Americans live shorter lives and experience more injuries and illnesses than people in other high-income countries. A growing body of research is call- ing attention to this problem, with a 2011 report by the National Research Council confirming a large and rising international “mortality gap” among adults age 50 and older. The U.S. health disadvantage cannot be attributed solely to the adverse health status of racial or ethnic minorities or poor people, since recent studies suggest that even highly advantaged Americans may be in worse health than their counterparts in other countries.

Either Billy Joel was onto something when he sang “Only the good die young,” or America’s health care system still has some serious problems.

Compared to 16 other high-income “peer” countries America is almost always dead last (no pun intended). Every single one of these countries — Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom — get more bang for their health care bucks than we do. We’re only tops in how much we spend on health care. (Well, that and violent deaths. We’re number one in that category too.)

What gives? Meyerson hones in on a likely factor.

But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.

What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians?

Part of the answer is Darwinian: Those Americans who have been less able to access reliable medical care, maintain good diets and live in neighborhoods that are not prey to gun violence have disproportionately died off before age 80. That isn’t natural selection but social selection — the survival of the economically fittest in a nation that rations longevity by wealth.

But the larger part of the answer is that at age 65, Americans enter a health-care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.

That, as Meyerson points out, puts the defenders of private health insurance in a bit of a bind. That bind may get even tighter. Thanks to a bill introduced by Reps. Jan Schakowsky (D-Ill.) and Henry Waxman (D-Calif.), the “public option” is back in the mix.

A group of House Democrats are surfacing the health care public option as a way of reducing the deficit, revisiting an approach suggested by President Obama’s debt commission in 2010.

According to a Tuesday statement from Rep. Jan Schakowsky’s (D-Ill.) office, Schakowsky, Rep. Henry Waxman (D-Calif.), and 43 other House members have introduced the Public Option Deficit Reduction Act, which would “would offer the choice of a publicly-run health insurance plan, an option that would save more than $100 billion over 10 years.”

“As Congress looks to reduce the deficit, it is important to remember the one policy that could save billions of dollars is the public option. I hope that my colleagues will take a fresh look at this in the months ahead,” Waxman said in the statement.

The public option, hotly debated during negotiations over Obama’s health care reform law, was left out of the legislation after it repeatedly failed to gain enough traction in Congress.

The statement from Shakowsky’s office points out that a public option would cut the country’s health care spending by more than $100 million, and lower health care costs for families by putting pressure on private insurers to lower their rates in order to compete. Not only would it save money, but according to this report, it would also save lives.

Let’s face it, we weren’t really done with health care after the Affordable Care Act, and this report tells us that we’ve still got a long way to go.

"Death Panel" of GOP Governors Refuse Medicaid Expansion

Terrance Heath — Tue, 08 Jan 2013 21:47:41 +0000

A growing number Republican Governors are refusing to expand their state Medicaid programs. The Supreme Court weakened the Medicaid expansion written into the Affordable Care Act, when it ruled that the federal government can’t penalize states that refused the expansion by withholding their existing Medicaid funding. That made it easier for conservative governors to withhold lifesaving access medical to the poor and uninsured in their states.

Since the last time I wrote about this subject, four more Republican governors have joined what amounts to GOP’s own death panel.

Republican governors are standing up for a conservative health care reform principle articulated by conservative economist Tyler Cowen.

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

First, there were six.

Meet the newest “Death Panel” on the block.

They are the six Republican governors who have vowed refuse the Medicaid expansion that will happen most other states, under the Affordable Care Act — Rick Scott (FL), Rick Perry (TX), Phil Bryant (MS), Nikki Haley (SC), Terry Branstad (IA), and Bobby Jindal (LA). These Republican governors are opening the “trap door” that the Supreme Court installed in the Affordable Care Act, even at it upheld most of the law. But it’s the poorest residents in these states, many of whom are African American and Latino, and who would have gained health coverage and access to care, that will fall through that trap door.

Now there are ten. Meet the newest members of the GOP Governors’ Death Panel (indicated below).

They are: C.L. “Butch” Otter (ID), Rick Perry (TX), Phil Bryant (MS), Mary Fallin (OK), Robert Bentley (AL), Nikki Haley (SC), Terry Branstad (IA), Bobby Jindal (LA), Dennis Daugaard (SD), and Paul LePage (ME).

As of Monday, Idaho’s C.L. “Butch” Otter became the newest member of the GOP Governor’s Death Panel.

Idaho won’t expand Medicaid to cover more poor people under President Barack Obama’s health care reform law, Gov. C.L. “Butch” Otter (R) told legislators during his State of the State address on Monday.

Otter is the 10th Republican governor to reject extending Medicaid health coverage to more poor residents. The governor’s decision contradicted a unanimous recommendation from a commission appointed by Otter that the state take advantage of the available federal funding to broaden Medicaid.

… Idaho could add 88,000 poor people to Medicaid under the Obamacare expansion, and 19,000 people already eligible under today’s rules, but not enrolled, also may sign up for coverage, the report says. The state would spend an additional $261 million from 2013 to 2022 to cover these individuals and the federal government would send $3.7 billion to Idaho.

Otter’s rejection of the Medicaid expansion follows his decision to adopt another major element of Obamacare. Last month, Otter was one of just three Republican governors who said he intends to establish a health insurance exchange in his state under the law.

According to StateHealthFact.Org, there are about 280,700 uninsured Idahoans (18% of the state’s population). Iowa could cover about 107,000 of its uninsured, with the federal government picking up something like 99% of the cost.

But Gov. Otter said “No.”

Florida governor Rick Scott has since moved into the “undecided camp,” according to the this handy resource from the Advisory Board Company on where the states stand on the Medicaid expansion. (It’s the most up-to-date I’ve found so far.)

Via: The Advisory Board Company

Scott declared back in June that Florida would not expand its Medicaid program. Perhaps Scott had a change of heart, once the election outcome made it clear that neither the president or health care reform were going away. Maybe Scott no longer believes his own overblown estimates about how much the expansion would cost Florida. In any case, this week, Scott sat down with HHS Sec. Kathleen Sebelius to talk about whether Florida will expand its Medicaid program and set up its own health insurance exchanges.

Iowa’s Terry Branstad is still a member of the club. The Advisory Council Company put Branstad on the “Leaning Toward Not Participating List.” I’m leaving him GOP Governor’s Death Panel member in good standing, because it seems unlikely that Branstad will change his mind. In November, Branstad was one of 11 Republican governors who asked the Obama administration for leeway to implement partial Medicaid expansion in their states, while getting 100% of the federal funding for full expansion. In December, the Obama administration said “No” to partial expansions. States must fully implement Medicaid expansion in order to get full funding.

Many of these states have the the highest percentages of uninsured in the country. Texas, South Carolina, Louisiana, Georgia, Florida, and Mississippi are among top ten states with the highest percentages of uninsured.

All of members of the GOP Governors’ Death Panel offer the same excuse for refusing to expand Medicaid in their states, or wanting to get full federal funding for a partial expansion. (What they would then do with the rest of that funding, I’ve no idea.) They say “We can’t afford it,” but they lie.

In most cases, these the Medicaid expansion would mean a significant reduction in the number of uninsured, at a modest cost to the states. They might even save money.

Expanding Medicaid health benefits to everyone eligible under President Barack Obama’s health care reform law would increase state spending on the program by just 3 percent while extending health coverage to more than 20 million people, according to a study released Monday by the Henry J. Kaiser Family Foundation and the Urban Institute.

The health care law seeks to enroll into the Medicaid program anyone who earns up to 133 percent of the federal poverty level, which is $14,856 this year. But when the Supreme Court upheld the law in June, its decision allowed states to opt out of the Medicaid expansion. So far, Republican governors in eight states have declared they won’t participate, denying health care coverage to millions of their poorest residents.

… The total cost of the Medicaid expansion would be $1.03 trillion between 2013 and 2022, according to the study. States would pay $76 billion of that, which amounts to a 2.9 percent increase compared to what states would have spent on Medicaid if the health care reform law hadn’t been enacted. Under the health care reform law, the federal government will pay the full cost of covering newly eligible people on Medicaid from 2014 to 2016, then will scale back funding to 90 percent in 2022 and later years.

In addition to receiving a large federal subsidy to enroll these uninsured residents, states that expand Medicaid would be able to reduce spending on taxpayer-funded programs to help hospitals and other health care providers cover the cost of so-called uncompensated care, or unpaid medical bills. If Medicaid expanded across the country, states would save $18 billion between 2013 to 2022 , according to the study.

Republican governors’ refusals to expand Medicaid will cost lives. It’s been shown that expanding Medicaid saves lives.

A new study from Harvard School of Public Health (HSPH) finds that expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, and—most importantly—improved health and reduced mortality. It is the first published study to look specifically at the effect of recent state Medicaid expansions on mortality among low-income adults, and the findings suggest that expanding coverage to the uninsured may save lives.

…The results showed that Medicaid expansions in three states were associated with a significant reduction in mortality of 6.1% compared with neighboring states that did not expand Medicaid, which corresponds to 2,840 deaths prevented per year for each 500,000 adults gaining Medicaid coverage. Mortality reductions were greatest among older adults, non-whites, and residents of poorer counties. Expansions also were associated with increased Medicaid coverage, decreased uninsurance, decreased rates of deferring care due to costs, and increased rates of “excellent” or “very good” self-reported health.

The groups that benefitted from Medicaid expansion in this study—older adults, racial and ethnic minorities, and those living in poor areas—are groups that have traditionally had higher mortality rates and faced greater barriers to care. The study results provide valuable evidence for state policymakers deciding whether or not to expand Medicaid, say the authors.

“Sometimes the political rhetoric is at odds with the evidence, such as claims that Medicaid is a ‘broken program’ or worse than no insurance at all; our findings suggest precisely the opposite,” said Epstein.

But 10 Republican governors are opting to deny the poor in their states health care they might otherwise get. (Care they would get if they lived in any of the other states that are expanding their Medicaid programs.) That means denying people like Laura Johnson in Louisiana.

With no health insurance and not enough money for a doctor, Laura Johnson is long accustomed to treating her ailments with a self-written prescription: home remedies, prayer and denial.

Over decades, she made her living assisting elderly people in nursing homes in jobs that paid just above minimum wage and included no health benefits. So even as her feet swelled to such an extent that she could no longer stuff them into her shoes, and even as nausea, headaches and dizziness plagued her, she reached for the aspirin bottle or made do with a teaspoon of vinegar. She propped her feet up on pillows and hoped for relief.

…After she collapsed last year and landed in in a local emergency room, doctors diagnosed her with congestive heart failure, high blood pressure and hypothyroid. They ordered her not to work. She arranged a Social Security disability benefit, and she enrolled in Medicaid, the government-furnished insurance program for the poor. She used her Medicaid card to secure needed prescription medications. Her ailments stabilized.

But this year, the state determined that the $819 a month she draws in disability payments exceed the allowable limit. By the federal government’s reckoning, her $9,800 annual income made her officially poor. But under the standards set by Louisiana, she was too well off to receive Medicaid.

This is how Johnson, 57, finds herself back amid the roughly 49 million Americans who lack health insurance. This is why she must again reach into her pocket to secure her prescription drugs, a supply that runs about $200 a month. That sum is beyond her, so she has gone more than four months without taking her pills on a regular basis. Once again, her feet are swelling and her chest is filling with fluid. Once again, she is confronted with the realization that a lifetime of labor does not entitle her to see a doctor any more than it enables her to gain crucial medications.

“It just doesn’t seem right to me,” she said. “It just doesn’t seem fair.”

Johnson is precisely the sort of person who is supposed to benefit from the national health care reform now known as Obamacare. The law championed by President Obama and enacted by Congress nearly three years ago includes a dramatic expansion of Medicaid. In place of the patchwork of eligibility levels now set by each state, one standard is to prevail everywhere: Individuals with annual incomes up to 133 percent of the federal poverty line — currently, $14,856 or less — are supposed to be able to enroll.

Multiply Laura Johnson by the more than 6 million people who will be left without access to coverage in states that reject the Medicare expansion. Maybe half of them will get access to care from health insurance exchanges starting in 2014, but according to the CBO the other 3 million will face a “bleak outlook.”

The net result is that 6 million fewer people will have access to Medicaid coverage in 2022 than projected in March, before the Supreme Court ruling.

The latest CBO estimate “confirms the bleak outlook” for those who don’t have access to affordable health care now, said Bruce Siegel, MD, president and chief executive officer of the National Assn. of Public Hospitals and Health Systems, in a statement. “They might not be able to count on the promise of health care reform to help them, and the safety net on which they rely will struggle to meet their needs.”

Not all of the 6 million people shut out of the Medicaid expansion are expected to remain without coverage. An estimated 3 million of them will have access to subsidized coverage through the health insurance exchanges that also will launch in 2014. The other 3 million people in this equation would remain uninsured.

Yet, Republican Governor’s like Bobby Jindal are choosing to deny people like Laura Johnson health care. Bobby Jindal says Louisiana can’t afford to expand Medicaid so that people like Laura Johnson can get the medical care they need (outside of an emergency room, anyway). Again, that’s a lie.

In Louisiana, Governor Bobby Jindal has said the state can’t “afford another entitlement program.” But his state also allows residents to deduct 100 percent of their federal income tax payments from their state taxes. If it didn’t, it would raise $642 million a year—or $3.9 billion over six years. By getting rid of this tax break for the rich, Louisiana could newly insure 366,000 people by 2019, at a cost of just $337 million to the state, more than eleven times over.

Jindal won’t even accept federal money to make sure that people like Laura Johnson have access to health care.

There’s no fiscal justification for this, and no moral justification either.

When a policy change is being debated, it’s not unreasonable to say that you oppose this particular change because the change you’d like to see is a different one, even if your preferred change isn’t going to happen any time soon. But that’s not the choice. The choice these governors face is between people having no health insurance, and people getting covered through Medicaid. And what they’re saying to their own citizens is: I’d rather you have no health coverage than get covered through a government program. And if you get sick or get in an accident, well, maybe you should have thought of that before you went getting all poor.

There are people who believe that eventually even the likes of Rick Perry will be unable to resist all the money the federal government is offering, so these governors will bluster for a while but take it in the end. But I’m not so sure. That would require them to give a crap about the welfare of the people of their states. And there isn’t a whole lot of evidence for that.

The only justification is ideological. From their perspective, these Republican governors are standing on principle. Unfortunately for many in their states, The principle they stand on is the one I quoted earlier, from Tyler Cowen,

We need to accept the principle that sometimes poor people will die just because they are poor.

Or, to put it simply, “Let them die.”

Click here to view the video on YouTube.

And that’s why the real “Death Panel” are the Republican Governors who are “standing in the hospital/clinic door” by refusing to expand Medicaid and thus extend health care to the poor an uninsured in their states.