Obama to Boehner: “John, I’m Getting Tired of Hearing You Say That”

Posted on February 26, 2013 by Maggie Mahar

This was President Obama’s reply, during fiscal cliff negotiations, when House Speaker John Boehner declared, for the umpteenth time, that “ The U.S. has a spending problem.”

I can understand the president’s irritation. How could anyone believe that we have a “spending problem?’

Look around. Consider the state of our bridges, our roads and our crumbling inner city public schools. Are we spending too much on the nation’s infrastructure?

Next, think about unemployment. During this recovery we have lost 750,000 public sector jobs. Republicans are intent on “starving the beast” (of government) and as a result Washington has not given states the financial support they need continue delivering public services. Across the nation, public school teachers have been laid off in droves, while class sizes increase at unprecedented rates. Does this sound like government spending run amuck?

One in five American children now lives in poverty. Seventeen million children find themselves in homes where they can’t be sure of getting enough to eat. (a.k.a. “food-insecure households.”) At the end of the month, many kids go to bed hungry because the government Food Stamps program (now known as Supplemental Nutrition Assistance Program, or SNAP) gives families less than $1.50 per person per meal. Are we being overly generous?

During the past two wars, we sent millions of American men and women to Iraq and Afghanistan –many went back for repeated tours. In some cases, their bodies were not broken–but their minds were. Now 1.3 million Vets seeking mental health services are told they must wait of 50 days before getting treatment. A recent government report suggests that 22 Vets die by suicide every day – about 20 percent of all Americans who kill themselves. Are we spending too much on healthcare for Veterans?

Let me suggest that we don’t have a spending problem. We have a revenue problem. Current federal revenue levels are at their lowest levels since the 1950s.

How Anti-Tax Pledges Have Weakened the Nation

In a recent post, Jared Bernstein, a senior fellow at the Center on Budget and Policy Priorities, nailed it: “The tax system doesn’t raise enough revenue. And that’s not just the recession; it’s also tax policy and anti-tax pledges . . . The system has become less progressive, with the largest declines in effective tax rates at the top of the income scale.

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Health Wonk Review-The Holiday Edition

Posted on December 29, 2012 by Maggie Mahar

On this last holiday week-end, I hope many of you will have the time to read the newest edition of Health Wonk Review, a round-up of some of the best health care posts of the past two weeks.

This time Lynch Ryan hosts HWR on Worker’s Comp Insider. . The posts raise provocative questions:

Did the LA Times Sensationalize Blue Cross of California’s rate increases?

Why doesn’t President Obama require that CMS negotiate for drug discounts –a move that would take us $200 billion closer to a cliff-avoiding deal?

[My guess is that this will happen sometime this year. Back in April of 2011 Naomi published a HealthBeat post suggesting that Obama had put the idea of letting Medicare negotiate prices back on the table].

How do commercial insurers evaluate physician quality?

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Pelosi Says “There’s Still a Chance”

Posted on December 21, 2012 by Maggie Mahar

Last night House Majority Leader John Boehner withdrew his “Plan B” proposal for the budget. He had no choice: conservative Republicans in the House made it clear that would not vote for a plan that raises taxes for ANYONE—even millionaires.

Many in Washington believe this makes a bungee-jump over the “fiscal cliff” inevitable. As I have explained, that is not as scary as it sounds. The precipice is an imaginary line drawn in the sand and dated “January 1.” Any damage done if we miss the deadline can easily be reversed. Early in January Congress would, no doubt, extend tax cuts for 98% of all Americans while voting down Draconian across- the- board spending cuts scheduled to kick in the first of the year.

But today, House Minority Leader Nancy Pelosi said “there is still a chance for a deal” before year-end. In fact, Pelosi probably knows that House Democrats and Republicans have more than enough votes to extend tax cuts for the 98% now. The Senate has already passed a bill that would do just that. And in the House few Republicans are eager to stand up and vote to hike taxes for the vast majority of Americans. Conservatives just want to give the same break to the wealthiest 2%. But by now, most Republicans recognize that some tax increases are inevitable.

Pelosi’s optimism makes me hopeful. She’s a superb vote-counter, and she knows what’s happening on the other side of the aisle.

CEOs Urge Republicans to Compromise

As Bloomberg reported yesterday, corporate chieftains have begun to lobby Republicans to give way on tax increases: CEOs such as Lloyd Blankfein of Goldman Sachs Group Inc., Robert Iger of Walt Disney Co. and Randall Stephenson of AT&T Inc. have been meeting with White House officials and their “support for Obama’s tax stance has split the Republican business alliance, driving a wedge between CEOs urging compromise and the nation’s most prominent small-business group.

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“Fiscal Cliff” Talks: An Update

Posted on December 10, 2012 by Maggie Mahar

Today, for the first time since the election, President Obama and House Speaker John Boehner met alone, face-to-face, at the White House to discuss ongoing negotions over the budget. (I can’t help but see the photo, which shows Obama with a hand on Boehnr’s shoulder, as a reference to the “Saturday Night Live” skit that appeared last night.

I’m more and more hopeful about the budget negotiations. Recentlly, I wrote that Obama had “won round one,” explaining that I believed CNN’s report that the Republicans and Democrats have reached a deal on taxes. “Both sides agree the wealthy will pay more, so now fiscal cliff talks come down to how much Republicans can wring out of the White House in return for giving in on taxes.” Based on everything I know about the economics and the politics of the situation, this makes sense. /

Since then Boehner has said: “No progress has been made.”

This does not change the story: If, as CNN’s sources say, (and I believe) Republicans have conceded that taxes cuts for the top 2% must expire Janauary 1, while cuts for the remaining 98% will continue, that doesn’t mean they are ready to make the agreement public.

Understandably, Republicans are not willing to acknowledge that they lost round one of negotiations until they can also announce that they won something in round two. Nor does President Obama want to blind-side Boehner by letting it leak that a tax deal is in place. That would be counter-productive.

The Inside Story and the Outside Story

Recentlly, the Washington Post’s Ezra Klein reported: “Right now, the fiscal cliff negotiations are proceeding on two tracks.

“One track includes the press releases, public statements and legislative tactics the two parties are deploying to prove the purity of their faith and their commitment to beating the other side to a bloody pulp. Watch these closely and it’s easy to get depressed. . . ‘There isn’t a progress report;’ Republican House Speaker John Boehner sighed Friday, ‘because there’s no progress to report.’

“The other track includes the offers, counteroffers and red lines proposed by Boehner and President Obama. If you look at these closely, a deal is taking shape.”

I agree with Ezra about the “two tracks”. But I don’t agree regarding the “shape” of the deal that is emerging.

First, I agree that the majority of Republicans in Congress have accepted the fact that the Bush-era tax breaks for folks earning over $200,000 (and couples earning over $250,000) will have to expire. I won’t try to guess when politicians will complete the two stages of bargaining and be ready to announce a deal. We may go right up to the January 1 deadline.

Moreover, it is possible that when it comes to cutting government spending, too many Republicans will remain stubbornly, and foolishly, intransigent — insisting on concessions that would inflict pain on the middle-class.

If that happens, I predict that President Obama will let us sail over the so-called “fiscal cliff.” He knows this wouldn’t do any permanent damage to the economy. As Rutgers reported today, even Wall Street does not seem panicked by the prospect: “Investors have peered over the cliff and realized they are looking at a gentle slope . . . . some investors say lawmakers still have time in early 2013 to strike a deficit-reduction deal without imperiling the economy. A survey of 62 Wall Street money managers released on December 5 showed market losses would be manageable if the U.S. goes over the fiscal cliff, even though worries still run deep.

Many on Wall Street understand that, early in the spring, the administration could undo Draconian spending cuts, while lowering tax rates for the 98%. Public pressure will ensure that happens. (In the meantime, the Treasury Secretary could lower withholding rates so that middle-class Americans didn’t suddenly see their paychecks trimmed.)

But taking a ride down that slope would do lasting damage to the GOP. Polls show that voters would blame Republicans. This is why I think that, in the end, Republican leadership in Congress will do whatever it must to make a deal before January. As I indicate in the post below. Tea Party extremists in the Republican party are being side-lined.

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

Posted on December 4, 2012 by Maggie Mahar

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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The Post-Election Edition of Health Wonk Review

Posted on November 20, 2012 by Maggie Mahar

This most recent edition of HWR, a compendium of some of the best health care posts of the past two weeks, came out ten days ago. I apologize that I’ve been tardy in commenting— but, not to worry, it’s an “evergreen.” The problems Health-Wonkers raise haven’t been solved in the past week, and the issues discussed remain just as “hot”– as they were.

“Managed Care Matters” Joe Paduda does an outstanding job of hosting the round-up in a post titled: “Elections Have Consequences.”

He begins with “Health Policy and MarketPlace Review’s” Bob Laszewski, who notes in the wake of the election, we can be certain of one thing: Obamacare will be implemented. To be sure, there will be lawsuits challenging reform legislation, but Laszewski says, “I wouldn’t waste a lot of time worrying about those. Anyone in the market will do better spending their time getting ready for all of the change coming.” He’s far more worried about whether the government will be able to set up the Exchanges in time to meet the deadline—and how legislators are going to solve the “fiscal cliff” problem.

Writing on “Health Affairs” Timothy Jost agrees that “there is a great deal of work needs to be done before reform becomes a reality.” He focuses on the many rules that the administration will need to issue to provide guidance to the states, to employers and to insurers: “The exchanges must begin open enrollment on October 1, 2013,” he observes. “By that date, the exchanges must have certified qualified health plans. But before health plans can be certified, they must have their rates and forms approved by the states. And before that can happen, insurers must determine what plans they will offer and what premiums they will charge. Yet insurers cannot establish their plans and set their rates until they know a lot more than they do now about the rules they are going to have to play by.” In other words, the administration had better “roll up its sleeves and get to work.”

Meanwhile, President Obama still must contend with ornery governors, and rebellious states. “In an ominous sign,” Jost notes, “Missouri passed a ballot initiative prohibiting state officials from cooperating with the federal exchange in its state, and authorizing private lawsuits against any official who cooperates.” (Thanks, Missouri–just what we need, lawsuits against officials trying to do their jobs..) “Whether this is constitutional remains to be seen,” says Jost, who is a constitutional expert.

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Health Care Reform: Stage Two

Posted on November 20, 2012 by Maggie Mahar

Last week, my editorsat the Health Insurance Resource Center (Healthinsurance.org) challenged me to write a letter to President Obama and suggest what he should do next to advance reform. They were looking for a “new, big idea.”

After thinking about it, I concluded that we don’t need another big idea. The Affordable Care Act (ACA) contains a great many ideas. Now we need to implement them.

Critics of Obamacare have suggested that as we approach 2014, Washington needs to turn its attention to containing healthcare costs. In particular, they suggest that Medicare is too expensive.

But the fact is that if you read the legislation (and I have, more than once) , you’ll find that it already cuts Medicare spending by some $716 billion. And it does this without cutting medical benefits and without slashing Medicare’s reimbursements to doctors.

In addition, the ACA includes many carrots and sticks designed to encourage hospitals and doctors to provide more efficient, less costly, safer care. In the future they won’t be paid for doing More; they’ll be paid for doing it Better–for Less. Only health care providers have the power to truly reform our wasteful health care system. Already we’ve seen some evidence that they are responding to the incentives: Medicare spending has slowed.

Finally, and most importantly, President Obama should reject any attempts to re-negotiate the ACA during budget talks. The ACA is not on the table. It is now the law of the land. The American people do not want to listen to politicians continue to debate healthcare. (They want their elected leaders to focus their attention on just one Big Idea: Jobs)

The election gave the president the green light to go ahead with reform.. Now, the administration needs to implement the legislation to so that we can see what works and what doesn’t. This will take time–but only then will we be in a position to revise, refine and improve on reform legislation. .

I hope you’ll read the entire post--and come back here to comment.

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The Nation is Divided, Not between Whites and Minorities, But between the Past and the Future

Posted on November 7, 2012 by Maggie Mahar

Women, minorities, and young people re-elected President Obama.

Pundits have pointed out that the president won only 39 percent of the vote among whites—down from 43 percent four years ago. But exit polls reveal that among women, Obama enjoyed an 11 percent advantage. “Fifty-five percent of women chose Obama,” Blooomberg observes —and clearly, this group included many white women. Sixty percent of voters ages 18 to 24 favored Obama—again, many were white voters. Among Latinos, the fastest growing demographic in the U.S., Obama won with a 44-point advantage. Romney secured just 27 percent of the Hispanic vote, down from the 31 percent who voted for the Republican candidate four years ago. Ninety-three percent of African-Americans voted for the president, along with 73% of Asians (who now make up 3% of the electorate.) And in the rust belt, Obama appealed to enough of the Democratic Party’s old blue-collar base (which is largely white) to carry that section of the country.

Romney captured just two groups: Americans over 65 and white men. Romney’s cohort is made up of the people who ran this country in the 1980s. In a word, his supporters represent the past. Obama won among the young people, Latinos and women who will shape this nation’s future. They will be our leaders. We have reached an inflection point in our history.

Women in the Senate

When Massachusetts elected Elizabeth Warren this was the first time that the Commonwealth sent a woman to the Senate. Thanks to last night’s election a record number of women will be serving in the U.S. Senate. There are currently 17. While two are retiring, at least four more have won — Democrats Tammy Baldwin in Wisconsin, Warren in Massachusetts, Mazie Hirono in Hawaii, and Republican Deb Fischer in Nebraska. Claire McCaskill of Missouri, once considered the party’s most vulnerable Senator, held off a challenge by her Republican challenger, U.S. Representative Todd Akin (one of two Republicans who learned that during an election it is never a good idea to talk about rape)

This is not to say that, going forward white men will not also be in positions of power. But in the future, a more mosaic leadership will reflect a new majority. As Ross Douthat observed in today’s New York Times: “conservatives must face reality: The age of Reagan is officially over, and the Obama majority is the only majority we have. (It is worth noting that Douthat describes himself as a conservative, though less “starry-eyed” than George Will.)

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The Future of Health Reform May Turn on Senate Races

Posted on November 4, 2012 by Maggie Mahar

Below, the introduction to a post that I published earlier today on Healthinsurance.org

While all eyes focus on the presidential race, the ultimate fate of the Affordable Care Act (ACA) could depend on the Senate contests in the states.

Even if Mitt Romney were elected, he alone could not overturn major provisions of healthcare reform. Only Congress can pass the legislation needed to change the ACA.

Republicans are expected to maintain control of the House, but if Democrats hold the Senate, they will be able to block House bills aimed at eviscerating “Obamacare.”

What is At Stake

If Republicans take the Senate, the two chambers could pass legislation that would:

eliminate the premium subsidies designed to make health insurance affordable for middle-income and low-income families
bring an end to Medicaid expansion, and
rescind the individual mandate that everyone buy insurance or pay a tax.

Under “budget reconciliation,” Republicans would need only a simple majority to pass such legislation. In the Senate, 51 votes would do it. Today, Republicans hold 47 seats.

Razor-sharp margins in many states make it impossible to predict outcomes. Polls only give us a blurry snapshot of one moment in time – and in states like Arizona, candidates have been trading leads from week to week.

Much will depend on the demographics of who turns out to vote.

What Could Happen: Three Scenarios . . .

To read the rest of this post please go to HealthInsurance.org

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A Centrist Perspective: Makers and Takers, Obamacare, and the Path Forward

Posted on November 4, 2012 by Maggie Mahar

Below, a guest post from Stephen Reid, Managing Partner at Pharmspective, a market research firm that provides advisory services to healthcare and pharmaceutical companies on strategic issues including the Affordable Care Act. (ACA)

I don’t agree with Reid on every point. (For example, if Republicans take both the White House and the Senate, I believe that they could and would eliminate both the premium subsidies that will make insurance affordable for middle-class Americans and the mandate.) Nevertheless, when he sent his Op-ed to me I was impressed by how well he understands the legislation. A great many moderates have been confused by the arguments coming at them both from the left and from the right. A combination of misinformation, half-truths and fear-mongering has created so much “noise” that it has become extremely difficult to separate fact from fiction.

By contrast, Reid does a very good job of explaining the reasoning behind the Affordable Care Act, and how its “checks and balances” work. I agree with him that the legislation is far from perfect, but it represents a good beginning.

There is just one major aspect of reform that I think Reid doesn’t understand: the rationale for expanding Medicaid. See my note at the end of his post.

A Centrist Perspective: Makers, Takers and Obamacare

by Stephen Reid

With a few days left before we elect a president, the prevailing belief is that an Obama win would propel the Affordable Care Act (ACA) forward with little delay and a Romney win would kill it. Both parties have gone to great lengths to characterize healthcare reform; the Democrats tout the legislation as essential to addressing a broken healthcare system that results in the U.S. spending twice as much as most developed countries on healthcare while leaving 50 million people without coverage; the Republicans cite the ACA as an example of hopeless dependency on government and contrary to free-market principles and individual rights.

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