Despite the passage of the Affordable Care Act, the U.S. medical system is near collapse. What will save it is a single-payer system and physicians in group practice.
Most people assume that insurance is an essential part of the health-care system. Some think it should be provided through public programs like Medicare, while others prefer to see it purchased from private insurance companies, but the majority believe that insurance is needed to help pay the unpredictable and often catastrophic expenses of medical care. That is why so much public policy focuses on extending coverage to as many people as possible and controlling its cost. I think this emphasis on insurance is mistaken.
HELENA - Gov. Brian Schweitzer said Wednesday he will ask the U.S. government to let Montana set up its own universal health care program, taking his rhetorical fight over health care to another level.
The latest Kaiser Family Foundation health reform tracking poll is out, and it's pretty seriously depressing. Essentially, as time passes, people understand less and less about the Affordable Care Act. This is the opposite of what the Obama administration and congressional Democrats want, of course, but it springs directly from the way the bill was designed and its implementation scheduled. Basically, we had this big contentious debate, Democrats won, then ... nothing.
Obama's pal, Senator Tom Coburn on, of all things, Medicare:
Responding to a man in Langley who asked if Obama “wants to destroy America,” Coburn said the president is “very bright” and loves his country but has a political philosophy that is “goofy and wrong.”
Obama’s “intent is not to destroy, his intent is to create dependency because it worked so well for him,” he said.
“As an African-American male,” Coburn said, Obama received “tremendous advantage from a lot of these programs.”
One thing is clear -- the prospects for a destructive "grand bargain" have gotten better, not worse.
Congressional leaders in both the House and Senate have now named the 12 appointees to the congressional Super Committee charged with finding $1.2 trillion in deficit savings from some combination of increased revenues and cuts to Social Security and Medicare and Medicaid. A deal that could be very damaging to the most vulnerable in society may be closer than anyone suspects.
Over the holiday weekend, Talking Points Memo's Brian Beutlerhighlighted this gem of a chart from the Senate Appropriations Committee:
As Hawaii Democratic Senator Daniel Inoyue explained in a statement, "Although non-defense discretionary spending in nominal dollars has increased, when taking inflation and population growth into account the amount contained in the FY 2011 Continuing Resolution represents no increase over what we spent in 2001, a year in which we generated a surplus of $128 billion."
Back when the Affordable Care Act passed, I was relatively unconcerned about its middling support in polls. Once the law went fully into effect, I argued, people would begin to reap the benefits and support would increase. After all, with the exception of the individual mandate, virtually all of the law's provisions were extremely popular.
These days I'm not so sure. Not because the popularity of the law hasn't increased yet -- the key provisions are still two and a half years away from taking effect. But because it's becoming clearer that the law was designed in such a way as to make its benefits almost invisible to people. For all that Republicans characterize it as a "government takeover," the ACA's problem is that people won't see it as government at all.
For the most part, David Brooks makes two points in today's column. First, a competition-based system (like Paul Ryan's plan) has a better chance of controlling Medicare costs than the alternative of greater centralization, and second, the current debate over Medicare illustrates the core philosophical difference between Republicans and Democrats. Republicans are skeptical about top-down decision making, Democrats are not:
In an effort to reverse their lagging popularity with the public after taking serious hits for their plan to privatize Medicare, Republicans have dusted off their 2010 playbook and returned to attacking Democrats on Medicare from the left, with the accusation that they voted to "end Medicare as we know it." Here's Paul Ryan leading the charge on the floor of House:
Efforts to defund Planned Parenthood on the state level took a big hit yesterday when the administration finally weighed in and deemed Indiana's effort to prohibit Planned Parenthood from receiving Medicaid funding illegal. A letter from Center for Medicare & Medicaid Services (CMS) head Donald Berwick made clear that "Medicaid programs may not exclude qualified health care providers from providing services that are funded under the program because of a provider's scope of practice. Such a restriction would have a particular effect on beneficiaries ' ability to access family planning providers."
Since Tuesday's election in New York, Paul Ryan has taken to complaining about Democratic "Mediscare" tactics, accusing Democratic leaders of demagoguing his Medicare plan and undermining "necessary" reforms to the program. At yesterday's Fiscal Summit, hosted by the Peterson Foundation, he repeated the charge:
Medicare has become the pivotal political issue in Washington, not just in the deficit debate but in the Republican 2012 election as well. GOP primary candidate Newt Gingrich has spent his week furiously backpedaling from his observation on Meet the Press last weekend that Paul Ryan’s Medicare plan amounts to “right-wing social engineering.” The incident shows that a willingness to gut Medicare has become the price of acceptance into the Republican Party.
