As We Approach the Fiscal Cliff: What is the GOP’s Primary Goal?

In theory, the GOP’s main concern is the deficit. We must reduce it they say—and we must do it now–or face a financial Armageddon. But somehow or other, “cutting the deficit” always turns out to mean “reducing entitlement programs.”

Let me suggest that cutting those entitlements programs is the GOP’s primary goal.

Why would I say this?

Earlier this week , wh en Republican House speaker John Boehner presented his party’s counter-proposal for solving the budget deadlock, he once again put lifting the eligibility age for Medicare from 65 to 67 near the top of his list. Yet, it you take a hard look at the numbers, it becomes clear that this proposal would not save money–or strengthen the economy. Moreover, entitlement programs did not create the current deficit.

Begin with forcing seniors to wait until they are 67 before they can apply for Medicare. As I explain in the post above, this proposal simply shifts costs to employers, the states, everyone buying insurance in the Exchanges, other Medicare beneficiaries, and 65 and 66-year-olds themselves. It does not lower the nation’s total healthcare bill. Indeed, the GOP’s remedy would wind up costing us twice as much as we now spend providing Medicare benefits for people who are 65 and 66. (See graph in the post above).

I am not  the first person to make this argument. The Kaiser Family Foundation and the Center for Budget Policy and Priorities  offer  eye-opening numbers that prove the point.  One would think that, if the GOP’s main goal were to save the economy, Republicans would be interested in these numbers.

One would be wrong.  They ignore them (and seem to have persuaded the mainstream media to follow suit.) Why would conservatives close their eyes to the financial facts? The GOP has an agenda, and it’s not about the deficit. The party’s main fear is “creeping socialism.”

Conservatives use the deficit as an excuse for slicing benefits that they acknowledge will inflict pain on the people who most depend on Medicare, Medicaid and Social Security—the elderly and the poor.


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Can U.S. Businesses Afford Obamacare?

No doubt you have heard that the Olive Garden, Denny’s and Papa John’s Pizza all are slapping an “Obamacare surcharge” on the price of their products.  They claim they have no choice.

But the news that Americans might pay 50 cents more for a mediocre $10 meal at the Olive Garden is not what bothers me most. Since President Obama was re-elected each of these restaurant chains have announced that they also plan to cut many full-time workers’ hours back to less than 30 hours a week in order to duck the cost of providing health care benefits.. This means that employees who are now working 40 hours a week will have to look for a second job—or find a way to support themselves on less than three-quarters of their current salary.

Michael Tanner, a fellow at the conservative Cato Institute, argues that companies outside the restaurant business also will be forced to down-size. Just a few days ago, Tanner wrote: “While restaurants are especially vulnerable to the cost of Obamcare other business are being hit too. For example, Boston Scientific has announced that it will now lay off up to 1,400 workers and shift some jobs to China. And Dana Holdings, an auto-parts manufacturer with more than 25,000 employees, says it too is exploring ObamaCare-related layoffs.”

Obamacare will  “keep unemployment high,” Tanner claims, because under reform legislation, businesses that have at least 50 employees working over 30 hours a week are expected to offer their workers affordable health insurance. If they choose not to, and more than 30 of their employees qualify for government subsidies to help them purchase their own coverage, the employer must pay a penalty of $3,000 for each worker who receives a subsidy— up to a maximum of $2,000 times the number of the company’s full-time employee minus 30. (The Kaiser Family Foundation offers an excellent graphic explaining the rule.) 

By paying the fine, the employer is, in effect, paying a share of a tax credit that would cost the government anywhere from roughly $1,700 for a single young worker  to over $12,000 to help the average 35-year-old worker who has a spouse, two children, and reports $35,000 in total household income.

Conservatives like Tanner argue that that is unfair, and that small businesses– “the engine of job growth”– will be hit hardest.  

What they  don’t do is look at the math:

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Conditional Cash Transfers: An Interim Model for Health Care Reform?

This past September, New York City’s Mayor Bloomberg welcomed 5,000 families into the pilot program of Opportunity NYC– the nation’s first conditional cash transfer (CCT) program. Based on a Mexican program called Oportunidades, CCT programs like Opportunity NYC (ONYC) provide financial incentives for poor households to “meet specific targets” in three areas: education, employment/training, and health.

I recently spoke with Héctor Salazar-Salame, Advisor to the Center for Economic Opportunity, which operates ONYC, about the health components of the program. I wanted to get an idea of the aims and strategy behind ONYC—and also to learn more about CCT as a potential model for thinking strategically about health care reform. 

According to the city’s press release, ONYC’s health incentives will be offered “to maintain adequate health coverage for all children and adults in participant households as well as age-appropriate medical and dental visits for each family member.” In terms of coverage, families can earn “$20 or $50 per adult per month for maintaining health insurance and $20 or $50 for maintaining health insurance for all the children in the family.”

The point is to encourage low-income families to enroll in health insurance plans. “Many families work for employers that offer insurance,” Salazar-Salame explains, but “many times the necessary employee contribution is quite high for low-income families. We’re providing an incentive for families to opt into their work-based, private health plan—and hoping that the incentives will help them offset the cost of the employee contribution.”

If parents are unemployed—or work for employers that don’t offer coverage—the family can still be eligible for health incentive rewards that keep them enrolled in Medicaid. “We know that to recertify for Medicaid can be a challenging yearly process that takes a lot of time,” says Salazar-Salame. (It’s worth keeping in mind that roughly 30 percent of parents who don’t manage to enroll or re-enroll their children in Medicaid have less than a high school education).  “We’re hoping the incentive will help them maintain the insurance that they’re eligible for,” Salazar-Salame explains.

Maintaining insurance is harder than it sounds. In October, Maggie wrote about  just how difficult it can be to stay enrolled in Medicaid and SCHIP, pointing to a Health Affairs article titled "Why Millions of Children Eligible for Medicaid and S-Chip Are Uninsured."

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Replying to Comment on “Should 21-year olds pay less,”


Thanks for your comment on “Should 21-Year Olds Pay Less . . .” While we’re in agreement on many points, I have to disagree with your first sentence—that “in theory the Massachusetts approach of charging older people up to twice as much as younger people for health insurance is more reasonable, in my opinion, than pure community rating because younger people, as a group, incur far lower healthcare costs.”

I believe that insurance, by definition, is supposed to get everyone into one pool so that those who need less care can help those who need more care.  You are, of course, right that younger people incur far lower costs—until they get older. At that point, another generation of young people will help pay for their care. That’s how insurance is supposed to work.

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Should People Who Don’t Take Good Care of Themselves Pay More for Health Insurance?

When healthcare reformers talk about making health insurance fair, some suggest that people who don’t take care of themselves really shouldn’t expect the rest of us to pay for their folly. They point to a study published in 2002 showing that, each year, the average smoker needs an extra $230 worth of inpatient and ambulatory care. “Problem drinkers” require an additional $150; obesity adds $395 to the annual bill, while simply being overweight costs an average of $125 a year. (According to researchers about one in three Americans are overweight while in one in five is obese).

Asking those who puruse less-than-healthy lifestyles to pay higher healthcare premiums seems, on the face of it, a simple matter of equity. But one needs to ask: what will be the effect? And where do we draw the  line?


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Jacob Hacker on “Sicko” –and Employer-Based Insurance

You know that Michael Moore’s “Sicko” is being taken seriously by the medical community when you see it reviewed in The New England Journal of Medicine. The issue that came online last week contains Jacob Hacker’s take on the film—as well as his prescription for national health care reform.

Hacker calls the first half of the film “ruthlessly efficient,” declaring that, “along with Al Gore’s global-warming warning, An Inconvenient Truth, Sicko may well be remembered as our generation’s Silent Spring or The Jungle — propaganda, in the best sense of the word, that pricks our collective conscience about problems that are hidden in plain sight.”

But as a political scientist (Yale) and New America Foundation fellow, Hacker is dissatisfied that, in the second half, Moore doesn’t offer a better solution to the crisis. This may be asking a bit much of Moore. My theory is that a film-maker, like any other artist, need only raise the right questions, (however abstractly), spurring his audience to think—and to imagine.

That said, Hacker’s point that Moore ignores the best model for reform by never mentioning Medicare is a good one: “He talks about the post office, the fire department, public education — but not the one public program that most resembles the ‘free universal health care’ he extols.

“That’s too bad,” says Hacker, “because the Medicare model is the not-so-secret weapon in the campaign for affordable health care for all. Today, many advocates of national health insurance have wisely started calling for Medicare for All’ rather than their old rallying cry, ‘Single Payer.’”

Hacker’s right. To many Americans, “single payer” evokes images of long lines—not to mention the Specter of Socialism. Medicare, on the other hand, represents the Promised Land –that point in time when you no longer have to worry about whether or not you have health insurance, or whether it will cover what you need. Medicare is hardly perfect, but not a few seniors breathe a huge sigh of relief when they finally find themselves in the warm embrace of the second-most-popular federal program in the U.S. (Social Security comes first.)

But Hacker doesn’t think we’re ready for “Medicare for All.” Instead, he suggests that “For now, the best step may be to require employers either to provide their workers with good private coverage or to enroll them, at a modest cost, in a new public program modeled after Medicare. Workers enrolled in this new public framework could be asked to pay a modest premium on top of employers’ contributions, based on their income, and they could be allowed to enroll in qualified private plans — as people with Medicare coverage can today. No doubt many employers would seize the opportunity to obtain inexpensive coverage for their workers, which would give the new public insurance plan a large, diverse enrollment and a great deal of leverage to contain costs and improve care.”

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