Tag Archive: cuts

Mar 24 2015

The Squeaky Wheel Gets the Grease

Leaders in Congress, particularly John Boehner and Nancy Pelosi are preparing another bipartisan fiasco in order to reward a particularly powerful constituency and stop them from engaging in their annual screamfest.

Every year, due to the structure of Medicare created by previous legislation, doctors and healthcare providers face an adjustment of their pay from the government for services to Medicare recipients. There is a provision in the current Medicare law that creates a “Sustainable Growth Rate” (SGR) for Medicare payments based upon economic growth. Since medical costs have far outpaced economic growth for years, this means that doctors, hospitals and other healthcare providers face a cut in their pay for services to Medicare patients every year.

Because doctors and the healthcare industry have incredibly powerful lobbies working for them, Congress hears their screams loud and clear.

This has resulted in congressional action:

On 17 occasions in the last 12 years, Congress has passed legislation to block such cuts without fundamentally changing the payment formula.

The screaming for Congress to fix this has got Congress’ attention:

Removing the threat of future cuts has been a top goal of lobbyists for the American Medical Association and other doctor groups.

David Dayen has a really good article up on Fiscal Times explaining what Bipartisans Pelosi and Boehner have come up with:

There would reportedly be more means-testing for Medicare beneficiaries, increasing premiums for seniors showing income over $133,000 and couples over $266,000. These seniors would have to pay 65 percent of their total costs under the new plan. This would go up at higher incomes. Means-testing historically dips lower and lower as budgeters try to get more out of beneficiaries, so this continues that ratcheting process for Medicare. It’s not necessarily where this line is set now but where it might go in the future that should cause concern.

Under the deal, new Medigap policies – privately sold but publicly managed plans which fill in spaces in Medicare coverage – would need a $250 deductible starting in 2020. Virtually every senior I’ve ever spoken with says that they need supplementary coverage because Medicare doesn’t stretch far enough. But this would raise out-of-pocket expenses on all 9 million seniors with a Medigap plan, including the 86 percent of these beneficiaries who have incomes under $40,000, and almost half with incomes below $20,000. So this cut hits those who can’t really afford it. (This idea, along with the means-testing, was in President Obama’s budget, incidentally.)

See who gets to pay the bill for this?

The proper term for this is cost-shifting, pushing funding for a public program onto those who get the benefits. Medigap was created to deal with cost-shifting in Medicare, and now Congress may look to shift costs within it as well. And like means-testing, cost-shifting is prime terrain for double-dipping over time.

And look at who doesn’t have to take a haircut:

All of this is being done to protect doctor salaries, which are among the highest in the industrialized world.

Dayen links to this article in the New England Journal of Medicine that shows the majority of healthcare spending goes to salaries:

Of the $2.6 trillion spent in 2010 on health care in the United States, 56% consisted of wages for health care workers. Labor is by far the largest category of expense: health care, as it is designed and delivered today, is very labor-intensive. The 16.4 million U.S. health care employees represented 11.8% of the total employed labor force in 2010. Yet unlike virtually all other sectors of the U.S. economy, health care has experienced no gains over the past 20 years in labor productivity, defined as output per worker (in health care, the “output” is the volume of activity – including all encounters, tests, treatments, and surgeries – per unit of cost). Although it is possible that some gains in quality have been achieved that are not reflected in productivity gains, it’s striking that health care is not experiencing anything near the gains achieved in other sectors. At the same time, health care labor is becoming more expensive more quickly than other types of labor. Even through the recession, when wages fell in other sectors, health care wages grew at a compounded annual rate of 3.4% from 2005 to 2010.

Those doctors must have a really effective union representing them!

Dayen also points out one other less obvious way that the bipartisans will be robbing patients to reward the screaming healthcare industry:

Doctor payment rates are tied to Medicare premiums, as the Congressional Budget Office has explained: “Beneficiaries enrolled in Part B of Medicare pay premiums that offset about 25 percent of the costs of those benefits.” This means that any permanent change to a new doctor payment formula will likely result in a hike to Part B premiums.

Those folks that aren’t represented by powerful lobbies apparently have a couple of days to scream at their “representatives” to stop this monstrosity that will likely cause people with lesser incomes to forego needed medical care. The bipartisans are feeling good about their prospects for getting the doctors off their backs and sticking us with the bill:

House of Representatives Speaker John Boehner said on Tuesday that prospects were good for passage of a permanent fix to Medicare’s flawed doctor-pay formula that would spare physicians from impending steep pay cuts. …

Earlier on Tuesday, Boehner and House Democratic Leader Nancy Pelosi announced that bipartisan legislation had been introduced to change the way doctors are reimbursed for Medicare costs. A vote is expected on Thursday.

Thursday. Hey, that’s not too far away!

Better call your congressperson and share the Secret Word with them. The secret word is “Medicare.”

You know what to do when somebody (even you) says the secret word – scream real loud!

Apr 08 2013

Are “Progressives” Destroying the New Deal?

Does the term Progressive mean anything anymore?

Surely it has an historical meaning and there are some roundabout descriptions of modern progressivism online like this one from Wikipedia:

Today, members of the Green Party of the United States are most likely to self-identify as liberal progressives. In the U.S. Congress, the Congressional Progressive Caucus is the most liberal wing of the Democratic Party, and it is often in opposition to the more centrist or conservative Democrats who form the Blue Dogs caucus. It is also in near-continuous opposition to the Republican Party.

But what does it mean when say, the leader of the Democratic Party, President Obama proclaims himself a Progressive:

“I am someone who is no doubt progressive.”

… and then later proceeds to describe himself as a, “moderate Republican?”

“The truth of the matter is that my policies are so mainstream that if I had set the same policies that I had back in the 1980s, I would be considered a moderate Republican.”

Further, what does it mean when three quarters of the Congressional Progressive Caucus won’t stand up for the indispensable legacy of the progressive New Deal and Great Society advances, Social Security, Medicare and Medicaid?

Three-Quarters of Progressive Caucus Not Taking a Stand Against Cuts in Social Security, Medicare and Medicaid

For the social compact of the United States, most of the Congressional Progressive Caucus has gone missing.

While still on the caucus roster, three-quarters of the 70-member caucus seem lost in political smog. Those 54 members of the Progressive Caucus haven’t signed the current letter that makes a vital commitment: “we will vote against any and every cut to Medicare, Medicaid, or Social Security benefits — including raising the retirement age or cutting the cost of living adjustments that our constituents earned and need.”

… Addressed to President Obama, the letter has enabled members of Congress to take a historic stand: joining together in a public pledge not to vote for any cuts in Social Security, Medicare or Medicaid. …

The Progressive Caucus co-chairs, Raul Grijalva and Keith Ellison, signed the letter. So did Barbara Lee, the caucus whip. But no signer can be found among the five vice chairs of the Progressive Caucus: Judy Chu, David Cicilline, Michael Honda, Sheila Jackson-Lee and Jan Schakowsky. The letter’s current list of signers includes just 16 members of the Progressive Caucus (along with five other House signers who aren’t part of the caucus).

What about the other 54 members of the Progressive Caucus? Their absence from the letter is a clear message to the Obama White House, which has repeatedly declared its desire to cut the Social Security cost of living adjustment as well as Medicare. In effect, those 54 non-signers are signaling: Mr. President, we call ourselves “progressive” but we are unwilling to stick our necks out by challenging you in defense of Social Security, Medicare and Medicaid; we want some wiggle room that you can exploit.

Yes, that’s right the President, who has, “no doubt” that he’s a progressive wants to cut the social safety net, despite the fact that he made rather a big deal that he would not do just that thing:

Now, however, the, “no doubt progressive” President is about to release his budget, which will reportedly contain cuts to programs that have always been the core of progressive policy:

President Obama’s budget proposal to be unveiled next week will include cuts to Social Security and Medicare, according to media reports Friday morning.

Politico reports:

The most controversial element of Obama’s proposal is the inclusion of “chained CPI,” the adjustment that would over time reduce cost-of-living increases to Social Security and other federal benefit programs – effectively, a cut to Social Security benefits by tying them to inflation.

Progressives in the Media and the Blogosphere

So while many congressional “progressives” have chosen between their divided loyalties and come up as cowering yes men for the misguided juggernaut of the Obama administration, parts of the progressive media are spouting propaganda:

John Nichols tells only part of the truth in this piece and the failure to represent the whole truth makes it a specious bit of propaganda, that distracts and diverts attention away from those that are carrying out the agenda of the big money forces he decries.  

[Perhaps this is a problem created by editing as Nichols is generally a reasonable guy, who has written a number of articles calling for opposition to President Obama’s Chained CPI plan.  This was a publication of The Nation magazine, so perhaps they edited it and it represents their editorial position more than Nichols’ opinions and position.  Since Nichols is the face, name and voice of this piece, however, the criticism will be directed at him and presumably if he gives a damn about what some blogger says, he can assert that the blame lays elsewhere.]

Nichols explains that in, as he puts it a, “Dollarocracy,” the ideas that get put forward are the ideas that have big money behind them, like cutting Social Security.  He goes on to highlight the fact that austerity-loving-corporate-greedheads were able to get, “one of their own,” Paul Ryan on a ballot to run for Veep to push their plans.  What Nichols fails to mention is that those austerity-loving-corporate-greedheads were going to win no matter what this election.  They already have a Democratic president who is promoting their agenda on the other ticket.  Guess what, they won! And there was no chance that they wouldn’t!

How is it that Nichols could have failed to notice and call out the Obama administration and the many Democrats that are performing the bidding of the, “Dollarocracy” with such alacrity these days?  Nichols is an experienced pundit, he certainly has been around and allegedly paying attention long enough to know who has been pushing the 1%’s, “Dollarocracy” agenda.  

Let’s take a trip through some of the evidence that one would have to ignore to create that Dollarocracy video with such a glaring omission in it…

Mar 09 2013

The Sequester: Lies, Damned Lies, and Libel Against Critics on the Left

Lately there have been some rumors about me that I feel need to addressed. Because I have more class than some people spreading nonsense about me and others, I am not going to name names or link to them, but some of you will know what I am talking about. First off, in the comments of my last diary it was rightly brought up that the President did issue a veto threats against anyone who wants to get rid of any part of the sequester.

This veto threat applied to anyone in both parties which also included the plan from Republicans that wanted to give federal agencies more leeway in how the sequester was implemented so as to spare the defense cuts instead of equal foreign and domestic cuts across the board. It’s not surprising that no one else put anything forward with that veto threat.

Obama Threatens Veto on Bid to Avoid Automatic Cuts as Supercommittee Fails

President Obama said today he will veto any efforts to get rid of the automatic spending cuts that will be triggered by the supercommittee’s failure to reach a bipartisan solution to deficit reduction.

“There will be no easy off-ramps on this one. We need to keep the pressure up to compromise, not turn off the pressure,” the president said this evening. “The only way these spending cuts will not take place is if Congress gets back to work and agrees on a balanced plan to reduce the deficit by at least $1.2 trillion.”

Only those that enable the real life terror federal employees and their families will soon feel deny that this is a debacle created by the Executive and the Legislative working together for austerity. The direct quotes up above can only be ignored by those with an agenda and not one for working people. Get real.