THE TREATMENT AUGUST 4, 2009
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Republicans have a stable of bona fide health policy experts. These are recognizable, sometimes quite partisan conservatives. Yet they are handicapped as political operatives by their residence in the reality-based community. Hence the role of provocateurs such as Dick Morris and Betsy McCaughey, who are less constrained in delivering low blows in alley fights over health reform.
(Click here to read Ed Kilgore on The Plank today taking down Pat Buchanan on health care.)
Last year, Dick Morris and a co-author argued that under then-Candidate Obama's health plan, undocumented immigrants would
...be eligible for the entire range of medical services, all free of charge. That would trigger severe rationing... : bureaucrats deciding who gets to see an oncologist, who can have an MRI--and even who can have bypass surgery and who'd die for lack of it.
These decisions would be made not on the basis of legal status but on the brutal facts of triage: Treat the 37-year-old illegal with his whole life to live before you spend scarce resources on an overweight, diabetic, 80-year-old citizen with high blood pressure who smokes...
The piece omitted one pertinent fact, stated by Candidate Obama on national television: His health plan specifically excluded undocumented immigrants.
Republicans are still raising this theme. As Congressman Steve King's press office proudly phrased things,
Taxpaying families, already weighed down by bailouts and massive spending bills, cannot afford to pay for health insurance for millions of illegal aliens.
Like Morris, Representative King seems unfamiliar with the basic technology of Google search. A few keystrokes might have led him to Section 246 of the House bill, helpfully titled No federal payment for undocumented aliens.
Then in the New York Post, Betsy McCaughey writes:
One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration.
This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?
Republican leaders have picked this one up, too, releasing a public letter which claimed that this same section "may start us down a treacherous path toward government-encouraged euthanasia." They go on to say:
With three states having legalized physician-assisted suicide, this provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself.
Actually, the House bill expands (and thus necessarily describes) Medicare coverage for counseling about advance directives and palliative care. You are permitted to have one such a counseling session with your doctor every five years, more frequently if you have a life-threatening illness. To state the obvious: No patient is forced to undergo this counseling, to sign an advance care directive or living will. As far as I know, no one is forced to do anything at all.
The Republican letter claims, absent supporting evidence, that such counseling encourages mercy-killing and physician-assisted suicide. For the record, I suspect the opposite is true. Surveys indicate that fear of unmanaged pain and the fear of losing control provide powerful motives for suicide among patients with serious illnesses. Proper counseling and advance directives could reassure millions of patients and their families. AARP's John Rother gets this exactly right, when he notes:
This measure would not only help people make the best decisions for themselves, but also better ensure that their wishes are followed. To suggest otherwise is a gross, and even cruel, distortion-especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.
These attacks fit a pattern. As recently reported in the Washington Post, conservative politicians and talk radio hosts are trying with some success to frighten seniors.
This rhetoric is a bit strange. Aren't Democrats the ones regularly accused of pandering to seniors and ignoring the entitlement crisis? I guess that's yesterday's (and maybe tomorrow's) talking point. As the Republican base conspicuously grays, the party's rhetoric is changing. Today's talking point is that liberals want to divert resources from Medicare to address other social needs and constituencies.
The irony of yammering to seniors about the evils of government-financed care is always notable, as is the selfish appeal. In 1965, liberals enacted Medicare, perhaps the most radical social engineering project in American history. Some liberals believe that this was a strategic error, because it shrunk the constituency for truly universal coverage. I love my parents too much to go that far.
Unfortunately, Republican rhetoric hits a nerve with millions of vulnerable seniors who rely on large (and growing) public resources, and who understandably worry that young people will grow weary of paying the bill. They hear vague talk that health reform will cost $1 trillion-a number trumpeted without context or timeframe by most commentators. Seniors understandably fear that this will come from them. At a gut level, conversations about cost-effectiveness--even rhetoric trumpeting prevention-has frightening undertones to anyone beset with a costly chronic illness.
At a deeper level, these talking points go beyond the usual Medicare politics and pander. Seniors comprise right-wing talk-radio's core audience, but the anxiety extends beyond retired ditto-heads. A conspicuous number of scare stories pitched to seniors suggest that the main beneficiaries of health reform will be various frightening others. These listeners have endured dizzying social change, ranging from gay marriage to the rise of immigrants (legal and illegal) as a powerful political and demographic force. This predominantly white group watched an unprecedented youth vote fuel the unlikely ascendance of a black president with an Islamic middle name.
For millions of older people, America suddenly seems very different from the country they once knew. So when President Obama asks seniors to trust him as they trusted many Democrats before him, even his remarkable persuasive powers sometimes fall short.
Click here to read Ed Kilgore on The Plank today taking down Pat Buchanan on health care.
20 comments
Ed Kilgore is managing editor of The Democratic Strategist , a senior fellow at the Progressive Policy
- Anonymous
August 4, 2009 at 5:02pm
So seniors are disoriented and can't form their own rational opinions about health care reform. Usually the radical left does a better job of disguising their dismissive and paternalistic view of the peasantry. Rarely have I heard such an unadulterated expression of the conceited and arrogant attitude of the "liberal" policy elite. No wonder Americans have turned against health reform.
- dtohmatsu
August 5, 2009 at 3:41am
70% of both Beck's and Rush's audience are over 65. These fat corpusels (hat tip Jaunty I have to say) both know exactly how to keep those fat paychecks rolling in. Beck shows images of Nazis marching and mentions concentration camps regularly. Etc. I can't imagine some 30 year old watching that is going to get the same fear juice Beck's shooting for as a 75 year old.
That said, age is a broad demographic, I'd like to see some credible data on how this diverse demographic feels about health insurance reform. As I've said, anecdotal evidence is what it is, but I know dozens of seniors - and I'd bet you do too Mr. Pollack - in various states and every one of them supports change, knows it's coming and would laugh at any of the silly hysterics from the manufactured hate mobs. There are only informed people and uninformed people, people with a stake in keeing things the same and a people with a stake in change. Age, class, race - I wonder if there is any meaningful, documentented breakdown there. I doubt it.
People aren't as stupid and driven by fear anymore as the right is assuming they are. Americans of all ages are on to these clowns from bad experience at this point. More people than ever know when their intelligence is being insulted by hysterics and "killing granny" is so transparent as to be funny - throwing in undocumented immigrants as a bugaboo is always a sure fire way to juice up the hate too. WHo care about facts? I keep thinking about PJ O'Rourke's hilariously titled piece from the early 90's "Would You Kill Your Mother to Pave I-95?"
But I'm betting that most people can look right at their health care bills and see that costs controls are zilch and that the health insurance "industry" is a huge lie. The AMA and APA support (doctors and pediatricians) reform, corporate America supports reform, hospitals are begging for it. The people who actually know what they are talking about in concrete terms - rather than emotionally based fact free blubbering - support reform. I'm glad when flaws are pointed out in the bill, by the CBO for example, it will only make it better. It should be done correctly.
The foamers have zero credibility.
Saw two polls this morning - 52% pro reform. It should be stronger - saw that Chuck Schumer and the boys are readying a campaign to fight back, thank God. He really knows how to communicate clearly to upper and middle class people. Those numbers may stay the same and that's fine, but I'd bet we'll be up a point ot two by fall.
Just let Beck keeping blubbering and the KKK squads keeping filling up the nightly news every night.
- Wandreycer1
August 5, 2009 at 4:19pm
I am thoroughly confused by your post, dtohmatsu. If a sense of disorientation and insecurity aren't the reasons for some elderly citizens parroting ludicrously irrational and in some cases frankly paranoid "talking points' about euthanasia and abandoning older people, what do you suggest are the actual reasons?
- ironyroad
August 5, 2009 at 5:29pm
Irony,
I don't think there are all that many people out there thinking they are going to get euthanized, but I do think there are a few things that are of legitimate concern to seniors
1) They are concerned about the government getting involved in medical resource allocation decisions and the impact this could have on the availability, quality and timeliness of their care.
2) They don't see how change will provide any benefit to them.
3) They are concerned about the deficit and don't believe that insuring an additional 47 million people can be done without greatly exacerbating the deficit.
4) Like the CBO, they don't believe the proposed reform will do anything to restrain the growth in medical expenditures.
- dtohmatsu
August 5, 2009 at 11:21pm
1. it already is involved
2. the siren call of the self absorbed: what is in it for me, is hardly compelling as a basis for policy.
3. bullshit, the elderly won't be alive to feel the effects, they know it, you know it, and I know it. they sure as hell did not put up a squawk when they got the drug bill benefit, even though that put a hole in the budget
4. again, it will not affect them, they are simply prone to fear mongering.
honestly, is there a real rebuttal there anywhere?
- blackton
August 5, 2009 at 11:37pm
If illegals aren't going to be covered, then why call them out in the "47M uninsured Americans" that gets bandied about all the time?
Without the undocumented workers, that figure is 35M.
And of those 35M, 5M are eligible for medicare or schip, but they haven't applied.
And of those 30M, 18M make more than $50K/year, but opt not to buy insurance.
That leaves 12M that have access to insurance but might not be able to afford it and/or cannot find coverage due to a pre-existing condition. That's about 4% of the population.
If covering nearly everyone is what is wanted, then that's a 5 page law: Amend medicare eligibility, and a few paragraphs requiring you to report your health care policy for each SSN on an IRS form. The IRS then electronically checks each SSN with each provider. It takes milliseconds per citizen.
Instead we're at 1200 pages. Surely the authors are aware that there's a lot more stuff buried in there than just giving people that need insurance insurance.
Nobody is trying to frighten seniors. But seniors smartly understand that medicare expenses have been rising at 10% annually over the last 40 years (in excess of private care, BTW), and that either a lot more money needs to enter the system (not likely), or that a lot of people need to exit the system (babyboomers are getting ready to flood it even harder), or that doctors/nurses/insurers/pharma need to reduce their prices dramatically. Not likely, since none of them are making a dime on medicare today.
- SeattleEngineer
August 5, 2009 at 11:47pm
Wandreycer1: <The AMA and APA support (doctors and pediatricians) reform, corporate America supports reform, hospitals are begging for it.>
Everyone supports reform indeed. But everyone thinks its the other guy that will be reformed. They think they are doing fine. Will doctors take a 20% cut, followed by COLA? No way. Will nurses abide by patient:nurse ratios similar to EU? No way. Will pharma develop great drugs for 1/10 the cost? No way. Will patients promise to see their doctor 6 times per year as in the EU versus 9 times per year in the US? No way.
Everyone expects the other guy to carry the burden. Anytime the government is put between a rock and hard place, the status quo reigns supreme.
- SeattleEngineer
August 5, 2009 at 11:54pm
dtoh -- most Americans over 65 are covered by Medicare, which is a government-managed medical resource allocation program!!
Could we all agree to meet back on Earth, perhaps?
- ironyroad
August 6, 2009 at 12:44am
Blackton,
1. it already is involved. WHICH IS WHY THEY'RE WORRIED.
2. the siren call of the self absorbed: what is in it for me, is hardly compelling as a basis for policy. THAT'S THE WAY GOVERNANCE, POLITICS AND POLICY WORK AND WHY REFORM IS RUNNING INTO A WALL.
3. bullshit, the elderly won't be alive to feel the effects, they know it, you know it, and I know it. they sure as hell did not put up a squawk when they got the drug bill benefit, even though that put a hole in the budget. IF YOU'RE 65 OR 75 THERE IS CERTAINLY A GOOD CHANCE YOU WILL FEEL THE EFFECT. (OH I FORGOT THEY'RE GOING TO GET SPECIAL COUNSELING!)
4. again, it will not affect them, they are simply prone to fear mongering. OR MAYBE THEY THINK THEIR GOVERNMENT SHOULD ENACT GOOD POLICY.
- dtohmatsu
August 6, 2009 at 1:03am
Irony
Medicare is a medical care payor. It does very little resource allocation. Just says yes yes to whatever prices providers ask for.
- dtohmatsu
August 6, 2009 at 1:10am
seattle, nice figures you made up. I am surprised you did not whittle it down to one homeless drug addict in new york. and the notion that everyone is satisfied with their health care is ludicrous, do you work in the United States? I know many people who are unhappy with their policies. I really have no idea where you get this info.
dtoh, as to 1. that makes no sense, if government is already involved then if nothing is passed they can still be affected, hence should be worried no matter what.
2. yes, it is running into a wall because a few blue dog dems in the house and Senate don't have the courage to place the well being of the country above their own re-election. If they don't feel we need health care reform, then I really have no idea why these people are Democrats. If the Dems had balls they could ram this through Congress and no one could stop them. 3. that "counseling" bill was co sponsored by a Republican (and is a silly straw man, since the counseling is just ability to have consulations) and of course they won't feel the effect. The elderly have social security and medicare, they are the most pampered members of our society, it is absolute bullshit to claim they will be affected like working age Americans or poor children. 4. most old people have not got a clue as to what is good policy, in fact, most Americans don't. Just how many people do you find on health care blogs like this? Neither of my well educated retired parents have got a clue what this is really about beyond the bloviating they see on cable news. As to this bill, getting bills through congress is a messy process, of course it won't be what is best (nor do I think anyone knows what is best). Personally I would just prefer to see a public option created allowing the uninsured to buy into it (and whoever else) whether via subsidies or what have you, and nothing else. Make it about the poor being able to buy a government or private policy and let the asshole right wingers debate why that is bad. Maybe Obama overreached, or maybe Dems are so gutless nothing would get done.
- blackton
August 6, 2009 at 10:29am
"This mandate invites abuse, and seniors could easily be pushed to refuse care. Do we really want government involved in such deeply personal issues?"
Funny, I don't remember then expressing that concern when they were trying to ram abortion counseling down women's throats.
- thackerj
August 6, 2009 at 10:31am
blackton: <seattle, nice figures you made up. I am surprised you did not whittle it down to one homeless drug addict in new york.>
They're not made up at all. Go read them yourself from the left leaning Kaiser foundation:
www.kff.org/.../7451-04.pdf
Their figures:
45M uninsured in 2007. The number of chronically uninsured Americans (no insurance in 2-4 years) that make less than $50,000 per year is 8.2M. Out of a population of of 300M. That is 2.7% of the population. If you are wondering about those that have had no insurance in the last 6+ months, then that figure climbs to 14M. But still, less than 5% of the population.
That doesn't mean those 8.2M are getting no medical care. They get, on average, $1500 of free medical care per year according to the National Center for Policy Analysis. They get this by walking into a hospital and getting treated. Far from ideal. Let's help these ~10M or so folks that need it. But let's not rip up the entire system to do it.
- SeattleEngineer
August 6, 2009 at 3:28pm
"Medicare is a medical care payor. It does very little resource allocation. Just says yes yes to whatever prices providers ask for."
Let's say then, dtoh, that it's a public program that doesn't put a bureaucrat between doctors and their patients.
- ironyroad
August 6, 2009 at 8:58pm
ANDREA MITCHELL (MSNBC): What is the mood in the White House? Are they getting nervous about this, do
- Anonymous
August 6, 2009 at 9:26pm
ironyroad: <Let's say then, dtoh, that it's a public program that doesn't put a bureaucrat between doctors and their patients.>
Except, the public plan currently in place (Medicare) is growing at 10-12% annually over the last 40 years. It will grow 7% over the next few years. This is higher that private plans. And this is unsustainable. Obama has said so.
When the government lowers the booom on Medicare growth, how will they do it? Hint: It's spelled RATIONING.
Yes, public plans already do this. But Medicare has much less money (per capita) so the level of rationing will be much higher.
- SeattleEngineer
August 7, 2009 at 2:35am
Seattle:
How is the system being "ripped up"? The proposals on the table can be described at best as "tepid".
1. People are less likely to start new businesses because they will no longer have affordable insurance. Thus the system discourages innovation.
2. Our costs are higher, and our outcomes are poorer than any other industrialized nation. We are thus pricing ourselves out of the global economy to support our highly profitable health insurance sector.
3. Medical emergencies are still the #1 cause of bankruptancy. How is this a good system?
4. We currently receive health insurance tax free, and our employers get a tax break, which is highly redistributive (albeit upwards, which doesn't appear to bother non-poor people so much for some reason)
5. Your reference to the Kaiser numbers excludes the 6million people who we can assume lost their health insurance with their jobs during this recession, making them extremely vulnerable. If they're lucky they qualify for Cobra, but that again is an added tax on our productivity. If they don't, they've got a problem.
I'm going to assume you are either not one of them, or you don't think you're going to get sick or have an accident.
And it does not mention those who receive poor insurance or those the insurance companies deny coverage to, normally at a rather inconvenient time.
Or people who are employed but are still on the Medicare rolls because their employer (e.g. poor struggling small firms such as WalMart) don't give them enough hours to qualify for insurance.
etc. etc.
- Nari224
August 7, 2009 at 12:23pm
Oh, and no RATIONING occurs in the private system I assume? Oh, wait...
- Nari224
August 7, 2009 at 12:26pm
Seattle - might want to re-check your math.
1. "Without the undocumented workers, that figure is 35M."
Nope. According to the report, "79% are native or naturalized citizens" - so, 35.5 M are US citizens, and at least some of the remainder are documented (green card, H-2B, student visa, etc.) workers (say, 1 M of the remainder). So, about 36.5 M.
2. "And of those 35M, 5M are eligible for medicare or schip, but they haven't applied." Looks closer to 5.9M according to the report (8.9M children, "two-thirds" are eligible but haven't applied, 8.9*0.667 = approx 5.9).
3. "And of those 30M, 18M make more than $50K/year, but opt not to buy insurance." Nope. 10.8 M families make $40k (p. 32 - 150.8M nonelderly families @ $40k+, 7.2% are uninsured, 150.8M*0.072 = 10.8M). So - 10.8M.
4. "That leaves 12M that have access to insurance but might not be able to afford it and/or cannot find coverage due to a pre-existing condition." - nope: 36.5 M - 10.8 M = 25.7 M - 5.9 = 19.8 M -- AS OF 2007 (pre-crisis).
5. From the report (p. 19/42): "By 2007, many states had budget surpluses and began expanding their Medicaid and SCHIP programs to reach more of the uninsured." Note that these budget surpluses have completely disappeared, so the reverse should be expected.
This will almost exclusively affect US citizens and *documented* non-citizens, as undocumented workers are almost universally ineligible for the state programs.
6. Employers are looking at eliminating insurance and/or making it much more expensive - meaning we're likely already seeing a 2008-2009 uptick in employed uninsured. P. 20 of 42: "However, an economic downturn in early 2001, coupled with the return of double-digit inflation in health insurance premiums, decreased employer-sponsored coverage. In recent years, the growth rate of health insurance premiums has slowed, but the percentage of people with employer-sponsored coverage has not increased."
Again, this will affect US citizens and legal immigrants far, far more than illegals, as these are folks who are still employed but are losing insurance. People who are illegal immigrants overwhelmingly don't have insurance to start with (which is a public health disaster waiting to happen by itself, but that's another topic).
7. Large numbers of the recently-unemployed will be lacking insurance as well, as there's a lag time between losing it from work and gaining it through Medicaid/SCHIP - assuming people know to apply/know they can apply. Further, people who are becoming less-employed are saddled with bills appropriate to their former incomes, not their current incomes - and are more likely to have to forgo insurance because of that, even if their household income is >$40k. So - expand the number further.
The number is much, much larger than your figures indicate.
- twicker
August 9, 2009 at 3:32pm