cab drollery

(Cartoon by Drew Sheneman/Tribune News Services and featured at US News.com.  Click on image to enlarge.)

What's old has become new again.  The force behind this miracle?  Why, it's Paul Ryan, who has decided it's time to re-introduce his already rejected budget.  No surprise here.

From the L.A. Times:

House Republicans will revive Rep. Paul Ryan's lightning-rod proposals to slash the federal safety net, beef up military spending and reduce taxes for the wealthy in a budget unveiled Tuesday -- an election-year calling card that Democrats are poised to use against the GOP.


Drafting the budget for the 2015 fiscal year, which begins in October, was a challenge this time because the nonpartisan Congressional Budget Office projected sluggish economic growth. That made it more difficult to achieve Ryan's goal of eliminating federal red ink within 10 years.
To get to balance -- especially while protecting Pentagon accounts -- Ryan shifts the burden of reductions onto domestic programs.

He suggests money can be saved by cutting food stamps, capping college Pell grants, imposing more welfare work requirements, eliminating federal arts funds, even selling off public lands. He leaves the details to the House committees to sort out.  [Emphasis added]

And guess what?  The old-but-new-again budget was introduced just in time ... for the 2014 elections, that is..

What a surprise, eh?

And that old-but-new-again budget just might garner Mr. Ryan an award or two.

Stay tuned.

Labels: Budget, Food Stamps, Medicaid, Medicare, Republican Welfare

The Granny Bird Award is given from time to time to those who violate or in any way harm the rights of the elders, or who use the elders to rip folks off.  Today's award goes to the Medicare Advantage insurers who rip off our precious Medicare system.

Michael Hiltzig of the Los Angeles Times put these plans in his spotlight and explains just why they are a way for insurers to take advantage of government largesse in order to turn a buck.

Here's what he had to say in his March 26, 2014 column:

A big part of the argument made by enemies of the Affordable Care Act that the Act is hurting Medicare applies to a category of health plan known as Medicare Advantage. New evidence has just come in showing that Medicare Advantage is a ripoff that fattens the health insurance industry while scarcely helping its enrollees, all at public expense. ...

Labels: Granny Bird Award, Insurance Companies, Medicare

(Editorial cartoon by Mike Luckovich and published 8/25/13 by the Atlanta Journal Constitution.)

Over the span of about a week, I watched as my right ankle began swelling and stiffening, and then my calf began swelling, and then my upper leg, and finally, the whole right side of my body (breast and face included) swelled up to the point that I looked like the Michelin Man's Wife.  This is not good, I thought to myself, so I showed my leg to my neighbor.

She freaked and told me to grab my Medicare card, she was taking me to the ER of Methodist Hospital of Southern California ("Arcadia Methodist").  And when I showed the admissions clerk my leg, she freaked, ordered a wheelchair and put me at the front of the line.

The ER doctor, a very funny young man, did not freak, but he did tell me I might have thrown one or more blood clots so he would be ordering a whole slew of tests.  And, boy!, did he.  I had a series of ultra sounds to my lungs and legs, blood tests (from a vein and from an artery), a chest x-ray, and then he hooked me up to a whole series of machines until just about every inch of my body was covered with little plastic discs which would hold the lead wires from those machines.

There were no blood clots.  There was, however, a massive bacterial infection which for some reason only affected my right side. The jury is still out as to why just one side of my body was affected, but one part of that right side was my lung, so by mid-day I was having some trouble breathing.

Dr. Hong (the funny ER doc who calmed me down by using a hilarious Irish accent) started me on an IV of hydrating fluids and another with Cipro, an anti-bacterial antibiotic.  And then he told me he'd be admitting me one day at least.

That Cipro did the trick, so I got to come home on Tuesday evening,  On the way home. we picked up the prescriptions and discovered that my Medicare Part D coverage was in full force.  That relieved a lot of my anxiety.  I hoped that was a harbinger that my Medicare Part B was going to cover what must be at least $45,000 worth of tests.  That still remains to be seen.

At any rate, I'm home, with my old cat, wondering whether this was a signal the universe was giving me that my days of independent living are about over.  That also remains to be seen.  I'll be waiting to see the Social Security and Medicare raises at the end of the year before I make any decisions.

All I can say is thanks to whatever stands behind this universe for Medicare and for LBJ's push for it.

Labels: Medicare

(Editorial cartoon by Mike Luckovich and published 9/4/13 in the Atlanta Journal Constituion.)

More on how I spent Labor Day after I get some rest and have some cuddle time with my cat.

Labels: Medicare

This edition of the Granny Bird Award, given from time to time by those who adversely affect the rights and benefits of elders, goes to those doctors identified in a recent report as issuing prescriptions for questionable drugs or over-prescribing medications as identified in a recent report noted in the Washington Post.

More than 700 doctors nationwide wrote prescriptions for elderly and disabled patients in highly questionable and potentially harmful ways, according to a report of Medicare’s drug program released Thursday.

The review by the inspector general of the Department of Health and Human Services flags those doctors as “very extreme” in their prescribing and says Medicare should do more to investigate or stop them. ...

The inspector general’s report focused on the prescribing by nearly 87,000 general-care physicians, such as family practitioners and internists, in urban and suburban areas in 2009. These doctors accounted for about half of all the prescribing in the program that year.

The review found more than 2,200 doctors whose records stood out in one of several areas: prescriptions per patient, brand-name drugs, painkillers and other addictive drugs, or the number of pharmacies that dispensed their orders.

Of those, 736 were flagged as “extreme outliers.” Their patterns, the report says, raised questions about whether the prescriptions were “legitimate or necessary.” ...

The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone — that is 151 times more than the cost of an average doctor’s tally, the report says.

Most of this physician’s drugs were supplied by two pharmacies, both of which the inspector general had identified previously as having questionable billing practices.   [Emphasis added]

Whether for fraudulent purposes or because of just plain sloppy medical management, these doctors cost Medicare/Medicaid a ton of money.  At a time when this very important program for elders and the disabled is under attack by all parts of the federal government, such behavior is extremely angry-making and needs to be stopped in its tracks now.  Hopefully CMS and the DOJ will come down hard on the miscreants.

Labels: Justice Department, Medicaid, Medicare, Medicare Fraud, Medicare Part D

This edition of the Granny Bird Award, given from time to time to those who adversely affect the rights and benefits of the elders, goes to those hospitals who overcharge for surgical procedures frequently required by the elders.

The Center for Medicare/Medicaid Services (CMS) has released a report showing the unbelievable variance in charges for procedures covered by Medicare.  The Los Angeles Times has checked California hospitals on that list and has found some pretty dramatic differences in charges for such procedures as hip replacements and gall bladder surgery.  Here's what the Times found on hip replacement:

Medicare released pricing information Wednesday for more than 3,300 U.S. hospitals on the top 100 procedures and treatments in 2011. The federal health program for seniors and private insurers only pays a fraction of these billed charges.

Nonetheless, this information shows the wide variation in prices among hospitals for common medical procedures at a time when policymakers are wrestling with how to hold down rising healthcare costs.

Officials said they released this data in hopes that increased transparency will help squeeze some excess cost out of the system and enable consumers to become savvier shoppers for healthcare.

One of the most common surgeries is for an artificial joint replacement. Medicare data show that Cedars-Sinai Medical Center in Los Angeles charged, on average, $110,123 for those cases. Keck Hospital of USC billed an average of $123,885 and Prime Healthcare's Centinela Hospital Medical Center in Inglewood averaged $220,881.

In contrast, Hoag Orthopedic Institute in Irvine billed Medicare $52,066, on average, for joint replacements and Kaiser's Los Angeles Medical Center charged $35,524.   [Emphasis added]

The spread on laprascopic gall bladder surgery is just as variable.  And, as the article points out, the "cash" price is often dramatically lower than any quoted price for the insured.

The problem is that elders don't have the ability to shop around for a good price.  Whether they have a Medicare Advantage plan or a straight Plan B and Plan D, they are pretty much stuck with the facility their doctor is on staff at.  And then what?  What about the balance?

And, just as importantly, who pays that balance?  Who ultimately gets stuck with the bill and what does that do to the cost of healthcare for everyone?

No, the system is messed up and needs to be cleaned up.  It's long past time to take medical treatment out of the hands of private enterprise.

Labels: Granny Bird, Medicare, Universal Health Care Access

(Photo by Patrice Carlton and published at National Geographic.)

This edition of Elder Belle's Blessing, an award given from time to time to those who work to enhance the rights and benefits of the elders, goes to Dr. Art Kellermann, a physician and a senior policy researcher at the Rand Corp, for his wonderful op-ed piece in this weekend's Los Angeles Times.

The bipartisan deal that kept the federal government from hurtling over the "fiscal cliff" on Jan. 2 actually increased Medicare spending. At the last minute, a powerful bipartisan group of senators inserted a provision into the bill that blocked Medicare, for two years, from getting a better price on an expensive drug used by kidney dialysis patients. This was in addition to a previous two-year extension obtained by Amgen, the drug's manufacturer. The move saddled Medicare with roughly $500 million in added costs over the next two years and generated a windfall for Amgen.

This is but one example of how Congress publicly criticizes growth of Medicare costs while privately restraining the Centers for Medicare and Medicaid Services, or CMS, from getting a better deal for Medicare patients and U.S. taxpayers. ...

Unfortunately, Medicare can't require proof that an expensive new product is any better than the one it's replacing; it's explicitly prevented from doing so by law. Medicare can't even encourage patients and doctors to select a less-expensive option that works just as well. With few exceptions, neither CMS nor the Food and Drug Administration can take a new product's price or its performance into consideration when making coverage decisions. And once Medicare starts writing checks, private health plans generally fall into line.

The practical result of this policy is that the U.S. healthcare marketplace lacks the strength to distinguish valuable innovations from those that simply drive up costs. It's a bad deal for patients and taxpayers. ...

If budget hawks are serious about lowering entitlement spending, they'll remove Medicare's straitjacket. The CMS should not be forced to pay more — sometimes lots more — for treatments, tests and equipment that work no better (and sometimes worse) than less costly alternatives. Permitting the purchase of lower-cost drugs or care would be far more humane to seniors than cutting their benefits.

If the CMS were empowered to negotiate for the patients it serves, it would not only reduce Medicare spending but also slow the growth of healthcare costs. If it could hold the line and pay only for drugs, devices and treatments that conform to professional guidelines, it would also improve the care that Medicare patients receive. Equally important, scrapping the "anything goes" approach of today would encourage America's drug and device manufacturers to focus their efforts on producing innovative products that cost less but do more.  

The core problem is this: While many worried that Medicare would lead to a government takeover of healthcare, the healthcare industry has been quietly increasing its influence over government.   [Emphasis added]

We don't need to raise the age for Medicare eligibility, cut benefits, or issue vouchers to cut the cost of Medicare now or in the future.  All we need to do is to untie the hands of CMS.  Not only will Medicare costs be lowered, so will healthcare costs in general.

It's time, even past time.

Labels: Elder Belle's Blessing, Medicare

(Editorial cartoon by Joel Pett / Lexington Herald-Leader (March 22, 2013) and featured at McClatchy DC.  Click on image to enlarge -- which you really have to do to appreciate it -- and then please come back.)

Michael Hiltzig has a great post on the lack of integrity (and compassion, and intelligence) of the critters in Washington DC.  His subject is the slipping of the chained cpi method for calculating cost of living raises for those on Social Security.

It's a benefit cut. It's not merely a "technical" change. It's not a "more accurate" measure of inflation.

The "chained CPI" has become one of the linchpins of the debate in Washington over what to do about the cost of Social Security. The idea is to ratchet back the annual cost-of-living adjustment provided to recipients by basing them no longer on the standard consumer price index, but this new creature. Its virtue, supposedly, is that it points to a slower inflation rate than the unchained index, by about .3% a year.

But as I wrote in 2011, it's a stealth benefit cut for seniors. After 10 years, the average Social Security retiree will be getting 3% a year less than under current law; after 20 years it's 6%. The change is presumed to be almost painless--who would notice a lower cost-of-living adjustment that amounts to three-tenths of one percent. So the proposal has garnered the favor of Democrats in Congress and President Obama, who seem to think they can offer it as a concession to Republicans and get something good in exchange, like a tax increase. ...

It's a benefit cut. It's not merely a "technical" change. It's not a "more accurate" measure of inflation.

Let's face it. The "chained CPI" is a benefit cut, dressed up in the faux-finery of economic rigor. Can't Washington be even a teensy bit honest about what it's up to?  [Emphasis added]

Why, no, Michael, Washington can't be "even a teensy bit honest about what it's up to."  If it were, and if the Village bobbleheaded press would actually print the truth about the benefit cut, all hell might break loose.

And as for hope that the GOP as currently constituted will give in on the issue of raising taxes, especially on the wealthy, oh, please!  Paul Ryan and his Tea Party Express is still rolling, Mitch McConnell is still not cooperating.  Why shouldn't they continue to say no.  They've snookered the White House, Harry Reid, and Nancy Pelosi.

Joel Pett's cartoon nailed it quite nicely, don't you think?

The question is, what are we prepared to do about it?

Labels: 113th Congress, Medicare, Our Owners, Republican Lying

(Editorial cartoon by Jim Morin / Miami Herald (March 18, 2013) and featured at McClatchy DC.)

Well, we've seen how the RNC report I posted on yesterday has been received by the Tea Party/CPAC faction of the Republican Party.  The basest base is clearly not going to roll over and die. Instead, it will indeed hold the knives against the throats of moderate Republicans. 

From the Los Angeles Times:

The austere House budget drafted by Rep. Paul D. Ryan (R-Wis.) that has come to define the Republican Party was approved Thursday on a strict party-line vote, as the GOP argues that a balanced budget should now be Washington’s top goal.

The blueprint is merely a proposal, without the force of law, but its overhaul of the Medicare program and steep reductions to other social safety net spending serves as the GOP’s opening salvo in renewed budget negotiations with President Obama. It was approved, 221 to 207, with no Democrats and 10 GOP defectors, largely conservatives or congressman in swing districts.

Republicans are anxious to reopen the debate over government spending with the White House even though some attribute the party’s setbacks in the November election to the plan from Ryan, the party’s former vice presidential nominee. ...

The centerpiece of the GOP plan would turn Medicare into a voucher-like program for the next generation of seniors, those younger than 55. When they become eligible, at age 65, those seniors will be offered a voucher that can be applied either to the purchase of private health insurance or toward the cost of Medicare, though the voucher may not cover all the costs of the policy chosen.

The Ryan budget also cuts Medicaid, the health program for the poor and seniors in nursing homes, as well as food stamps, welfare programs and student loans, while largely preserving money for defense accounts.   [Emphasis added]

Thankfully, the Ryan plan (version 2.2) is merely a proposal, but it does signal what the GOP in this Congress considers fair game for negotiation: the elders, the poor, the vulnerable.

People like me.

It's time for some "kingbirding."

Labels: 113th Congress, Budget, Economic Justice, Kingbirding, Medicaid, Medicare

(Editorial cartoon by Kevin Siers and published in the Charlotte Observer 3/14/13.  Click on image to enlarge and then please return.)

Open Secrets reminded me that appealing to the Tea Party faction was only one impetus for Congressman Ryan's budget plan.  In fact, a more substantial reason exists:

Over the course of Ryan's career in Congress, insurance has been the top industry (after retired people) contributing to his campaigns, with $895,928 in contributions since he first campaigned for his House seat, according to OpenSecrets.org data.The Health Professionals and Pharmaceutical industries follow close behind as his fourth and seventh most supportive industries, contributing $626,249 and $350,282, respectively, since 2000.   [Emphasis added]

If you noodle around the site a little bit, you'll see that Ryan isn't the only active politician on the payroll of these groups.  Lots of folks on both sides of the aisle have been recipients of the largesse of these groups.  Is it any wonder that Medicare is still on the chopping block and that members of Congress and the White House are willing to negotiate it away for the next generation?

Bought and paid for.

Labels: 113th Congress, Medicare, Our Owners

(Political cartoon by David Horsey and published 3/7/13 in the Los Angeles Times.  Click on image to enlarge and then return.)

Yesterday, I posted on Horsey's second cartoon on the morass which is the 113th Congress, so I thought it would be appropriate to give you the first, especially given the news since he posted both.  If he does post the Last Supper cartoon, you can count on seeing it on Sunday.

Since then, Congressman Paul Ryan has returned to the fray, suggesting that what the country needs is the repeal of Obamacare.  Yes, I know he's not a senator and therefore wasn't invited to dinner with the president, but the effect will be the same.  From the Los Angeles Times:

Rep. Paul D. Ryan of Wisconsin, last year's Republican vice presidential nominee, said Sunday his forthcoming budget proposal will include repeal of "Obamacare," as his party calls it. That position puts tea-party conservatives at odds with others in the GOP who want to find common ground with Obama on the nation's fiscal woes after the U.S. Supreme Court upheld the health law.

In the Senate, conservatives will press for a vote this week to delay funding for the health law as part of a bill that must pass to keep the government running beyond March 27.

"We say we get rid of 'Obamacare,' " Ryan said on "Fox News Sunday." ...

Key to Ryan's blueprint, to be unveiled Tuesday, is a return to a proposed Medicare overhaul that would create a voucher-like system for the next generation of seniors – when those who are now 55 or 56 become eligible for the program at 65. Under Ryan's plan, seniors would be given a set amount to apply toward the purchase of private health insurance or toward the cost of Medicare.   [Emphasis added]

Ryan claims his stance is not an attempt to wrest Boehner's speakership away, and that may very well be true.  It's more likely that he is stirring the pot in anticipation of running for his party's nomination in 2016 and he wants to keep his credibility with his Tea Party backers. 

But the effect in the here-and-now is to put both House and Senate in the position of having to deal with the issue, which means both Obamacare funding and Medicare will be on the agenda.  It will, once again, push the discussion to the right, and that means our President (not the world's finest negotiator) will probably find a way to cave.

I grow old, I grow old.  I shall wear my trousers rolled.

Labels: 113th Congress, Austerity, Budget, Medicare, Tea Party

(Photograph by Patrice Carlton and published at National Geographic.)

This edition of Elder Belle's Blessing, an award given from time to time to those who enhance elders' rights and benefits, goes to Michael Hiltzig whose latest column delineates the sham of those who want to cut Social Security and Medicare because both are unfair to the children of the country.

Here's a phrase you can expect to be hearing a lot in the national debate over fiscal policy, as we move past the "sequester," which is the crisis du jour, and toward the budget cliff/government shutdown deadline looming at the end of March:

"Generational theft."

The core idea the term expresses is that we're spending so much more on our seniors than our children that future generations are being cheated. An important corollary is that the government debt we incur today will come slamming down upon the shoulders of our children and grandchildren. ...

So here's the truth about the "generational theft" theme: It's wrong on the numbers and wrong on the implications.

Let's start with that 7-to-1 spending ratio on seniors versus children. Among the flaws in the calculation is that the vast majority of government dollars spent on children comes from state and local governments, which pay most of the cost of education. On a per capita basis, state and local spending on kids swamps the federal government's spending 8 to 1.

Moreover, there are twice as many children 18 and under as seniors 65 and over (this 2008 figure also comes from the Urban Institute report). Put the numbers together and you discover that spending by governments at all levels in 2008 came to about $1 trillion on seniors and $936 billion on children. In other words, very close to 1 to 1. ...

In other ways, treating Social Security and Medicare spending on the one hand and spending on kids on the other as though they're opposite sides of a zero-sum game is just an act of ideological legerdemain aimed at undermining those programs.
If America wants to spend more on children, it's plenty rich enough to do so without eating away at the income of their grandparents. The money can come from the defense budget, farm supports or dozens of other places, even higher income taxes.

Let's not forget, too, that the people who will really suffer from gutting Social Security won't be today's seniors, who will escape the worst of the cutbacks — they'll be today's young people, for whom Social Security would become much less supportive when they retire.   [Emphasis added]

Oh, it's theft alright, but the thievery is being perpetrated against today's and tomorrow's elders, not by them.  The whole point is to destroy both programs for the benefit of the Wall Street Banksters and mega-insurance companies, and the children and elders be damned.

Go read all of Michael's column.  You'll see why he earned yet another Elder Belle's Blessing.

Labels: Child Welfare, Corporatocracy, Elder Belle's Blessing, Elders, Medicare, Our Owners, Social Security

(Photograph by Patrice Carlton and published at National Geographic.)

This edition of Elder Belle's Blessing, an award given from time to time to those who enhance elders' rights and benefits, goes to Atrios, the proprietor of Eschaton, a lefty-blog.  Atrios (whose real name is Duncan Black) is an economist of the Keynesian School and he thinks that the very worst thing to do in this economy is to institute austerity measures.  Among his many suggestions for kick-starting things is lowering the age for Medicare and Social Security and increasing the benefits.  Here's his latest.

The pain caucus, austerity freaks, fix the debt assholes, the Washington Post editorial board, etc... basically exist to scare politicians away from actually promising (and maybe even delivering) nice things to voters. One would think it'd be a nobrainer for politicians, especially in certain parts of the country, to campaign on an immediate across the board 20% increase in Social Security benefits. Some people completely screwed by the great recession could really use it.   [Emphasis added]

 The post was written in response to this New York Times article

In the current listless economy, every generation has a claim to having been most injured. But the Labor Department’s latest jobs snapshot and other recent data reports present a strong case for crowning baby boomers as the greatest victims of the recession and its grim aftermath.

These Americans in their 50s and early 60s — those near retirement age who do not yet have access to Medicare and Social Security — have lost the most earnings power of any age group, with their household incomes 10 percent below what they made when the recovery began three years ago, according to Sentier Research, a data analysis company. ...

The share of older people applying for Social Security early spiked during the recession as people sought whatever income they could find. The penalty they will pay is permanent, as retirees who take benefits at age 62 — as Ms. Zimmerman did, to help make her mortgage payments — will receive 30 percent less in each month’s check for the rest of their lives than they would if they had waited until full retirement age (66 for those born after 1942).  [Emphasis added]

That's a pretty sizable loss. That's one good reason for raising the benefits just by itself.

Lowering the eligibility age for both Medicare and Social Security would also take the pressure of the elders, something which Atrios has also advocated.  The upside of both of his proposals would have a dual effect:  elders could remove themselves from the labor market (whether working three part-time jobs at much lower pay just to pay the mortgage or holding onto a job only because of the need for health insurance) and be able to exist more comfortably; their retiring also would free up some jobs for the rest of the labor market.

We don't need to cut Social Security and Medicare, we need to expand it.

Labels: Austerity, Elder Belle's Blessing, Medicare, Social Security

Doyle McManus had an interesting op-ed column this weekend, one that made sense to me and gave me a little hope that maybe this Congress will actually get something done.  He used the metaphor of "an orderly retreat," and I think it works beautifully.

Astonishingly, for perhaps the first time since they won the majority in 2010, Boehner's House Republicans were seized by a sudden fit of pragmatism. That debt ceiling that couldn't be lifted as a matter of sacred principle? It was "suspended" until May with only perfunctory debate.

Boehner's sometimes fractious lieutenants, Eric Cantor of Virginia and Paul D. Ryan of Wisconsin, fell into line. Tea party firebrands including Michele Bachmann of Minnesota voted no, but they remained uncharacteristically quiet.

Score one for Boehner.

It may seem painfully obvious that a political party needs to seek favorable ground on which to wage its battles — to choose "smart fights" and avoid dumb ones.
But until last week, Democrats could pretty much count on House Republicans to ignore that rule. Only three weeks ago, the same Republicans had dared President Obama to take the country over a fiscal cliff of brutal tax increases and spending cuts — only to retreat in disarray when they noticed that the country wasn't behind them.

The logic of Boehner's gambit last week was straightforward: A debt ceiling showdown looked like another dumb fight. The speaker wants to change the subject to federal spending, an issue on which conservatives think they have more public support. On March 1, deep automatic cuts in both domestic and military spending are scheduled to take effect. And on March 27, the federal government will have to shut down unless Congress passes a new spending bill. Both of those events, Republicans say, will let them push for new spending cuts without the hair-raising dangers of a debt-ceiling crisis.   [Emphasis added]

First, apparently Speaker Boehner is getting better at herding cats.  Maybe he got some coaching from Nancy Pelosi, or maybe House Republicans finally figured out that they actually took quite a hit in November and might want to change their mode of operating.  Their obstructionism in the last Congress led to their actually losing ground in both houses.

Secondly, and more importantly, the manufacturing of crises to get their way just didn't work the way they thought it would.  The President isn't playing nice any more, and he's making them look bad.

I'm not suggesting that congressional Republicans will turn into nice guys who will voluntarily cut the entitlements to oil companies, banks, large farm corporations, and wealthy investors.  Not hardly.  They've still got their knives out for Social Security and Medicare/Medicaid.  At least, however, they are now meeting with Democrats to start on the broad outlines for an immigration reform bill, something that has been totally off the table with them.  That's a start.

With a little more pressure from the public, they might even consider cutting the Pentagon budget, lopping off a few of the more ridiculous programs and cheating contractors.

I sure hope so, even though I know hope is not a plan.

Popcorn futures are up.

Labels: 113th Congress, Budget, Corporate Welfare, Medicaid, Medicare, Social Security

(Editorial cartoon by Jim Morin / Miami Herald (January 10, 2013) and featured at McClatchy DC.  Click on image to enlarge and then hustle back.)

I used this cartoon a while back to head a post on Medicaid fraud.  I think it's even more useful when talking about getting Medicare and Medicaid costs under control.  I would direct your attention to the buttons labeled "Bureaucracy" an "Lax Oversight."

A think tank has issued a report suggesting a better way to cut costs in these programs than raising the eligibility age or lowering reimbursement rates to medical providers.  The report puts forward the rather interesting suggestion that if we change the paradigm, the programs will be stronger, more effective, and less expensive.

From the Minneapolis Star Tribune:

Most people in the Medicare reform fight argue about how much patient benefits and doctor and hospital reimbursement rates must be cut to deal with the burgeoning federal budget deficit.

UnitedHealth Group's Simon Stevens talks about saving more than half a trillion bucks over the next decade by doing neither.

"It is very important that the debate does not become a stylized arm wrestle between those two alternatives," Stevens, chairman of the UnitedHealth Center for Health Reform & Modernization, said in an interview last week.

The UnitedHealth Center has entered the Medicare deficit discussion in a surprising place. As think tanks and business groups line up on the side of raising eligibility ages or other austerity measures, the country's biggest private health insurer suggests ways to save the country's biggest public health insurance program without cutting services.

A new report from the UnitedHealth Center outlines ways to change Medicare from a fee-for-service program that pays doctors and hospitals per procedure to a results-driven, managed-care model that coordinates payments, offers greater rewards to medical professionals who give quality care and reduces the costs to senior citizens who make the healthiest choices.   [Emphasis added]

UnitedHealth is one of the largest private insurers in the country and has a huge chunk of the Parts B, C, and D Medicare supplement programs.  It is refreshing to see that kind of outside-the-box thinking from that part of the equation.  Yes, the program would be a "managed care" program, but frankly, all insurance depends on "managed care," as anyone who has health insurance well knows.

The news article contains specific details and I would urge you to read it all.  You can also read the UnitedHealth Center's summary of its report (which contains a link to the report itself in pdf format).  If you agree that this is a welcome alternative to what is currently under discussion by the Very Serious People in Washington, let your congress critters and the White House know.  I suggest you do that now.  The GOP is pushing hard to get Medicare cuts with the end goal of ultimately dismantling this valuable program, and I'm afraid the White House and the Democrats will give in on this.

Labels: 113th Congress, Budget, Medicaid, Medicare

(Editorial cartoon by Jim Morin / Miami Herald (December 31, 2012) and featured at McClatchy DC.  Click on image to enlarge and then please return.)

This is being written at 4:35 PM PST on Monday.  I'm not going to waste New Year's Eve tracking the yahoos in DC and any deals they might make before Midnight to avoid the fiscal cliff.  At this point, the tentative agreement between the White House and Senate Minority Leader McConnell has not yet been voted on.  Even if it were voted on and passed, the House leadership has already announced that it will not hold a vote on the bill before Midnight.  That means we go over the cliff. 

BFD.

Now, it's possible that all of this is simply posturing and that a bill will sail through both houses tonight.  If that is the case, I will update the post and apologize for being a slacker tomorrow.  Tonight I intend to spend curled up with my cat, my kindle, and the vaporizer which is finally dispelling the chest congestion which has bedeviled me all week.  At midnight, when all the fireworks go off in the neighborhood, and there will be plenty, I will toast the new year with hot apple cider.  And then I will go back to sleep.

Assuming, however, that the House has no intention of passing any kind of bill, I do have a few suggestions for the White House and the Democrats in Congress.  Come January 1, 2013, it's a new ball game.  It's time to tell the Republicans that all previous negotiations are null and void.  Time to start from scratch.  Those Bush tax cuts are over.  That Pentagon budget is sliced.  You want a deal, start talking.

And, no, we're not cutting Social Security and Medicare/Medicaid.  And, yes, we are extending Unemployment Insurance for another year.  So, what should we be talking about?

Of course, that's not the way the White House and the DLC Dems negotiate, and that's a rotten shame.

Other than that, Happy New Year everyone!

Labels: 113th Congress, Budget, Medicaid, Medicare, Pentagon, Social Security, Tea Party

(Editorial cartoon by Mike Luckovich and published 12/19/12 in the Atlanta Journal-Constitution.  Click on image to enlarge.)

Kind of says it all, don't you think?

Back to the phones:

Senate

House

White House

Sic'em!

Labels: Budget, Interactive Government, Medicaid, Medicare, Social Security

This edition of the Granny Bird Award, given from time to time to those who harm the rights and lives of elders, goes to Charles Agbu, who has copped a plea in a Medicare fraud case.

A Carson pastor pleaded guilty Monday to submitting more than $11 million in Medicare reimbursement through fraudulent clinics and by promising patients expensive equipment, according to the Department of Justice.

Charles Agbu, 58, of Carson, pleaded guilty to one count of conspiracy to commit healthcare fraud and one count of money laundering in U.S. District Court.

Agbu, a pastor at Pilgrim Congregational Church, faces up to 20 years in prison and a $500,000 fine when he is sentenced in May.

Agbu admitted to owning Bonfee Inc., a fraudulent medical equipment supply company, and acknowledged that he paid patient recruiters to approach Medicare beneficiaries and convinced them to give him their Medicare information in exchange for specialized power wheelchairs, officials say.

Agbu would then bill Medicare officials for the wheelchairs without delivering them to his clients. He also admitted to paying for fake prescriptions and other fraudulent documents in order to be able to continue  billing Medicare for medical equipment, authorities say.  ...

The case was brought by the Medicare Fraud Strike Force, a special unit of investigators launched in May 2009 by the Justice and Health and Human Services departments.   [Emphasis added]

Apparently "Pastor" Agbu wasn't too familiar with the Ten Commandments, especially that one about lying.  Some attribute for a man of God.

While the article isn't clear as to how much money the good "pastor" reaped by his scam, the fine does seem a little low, even by plea-deal standards.  That 20 years in prison, however, does seem appropriate and I hope the judge gives him all 20 years.  That will at least send a message.

Finally, at a time when the vile idiots in Washington are considering cuts to Medicare/Medicaid, perhaps that could be accomplished by tightening up the language of the original legislation which left loopholes for this kind of fraud to be accomplished.  The Center for Medicare/Medicaid Services, the agency charged to oversee such billings needs to be ramped up so that it can spot these scams before they hit the $11 million mark.  And more money to the agencies investigating such fraud (DOJ and HHS) would also be helpful in rooting out the wrongdoers, recovering their ill-gotten gains, and slamming their backsides in prison for long terms.

Let your congress critters know that these are the only kind of "cuts" to Medicare/Medicaid which are acceptable and do it today.   

Labels: 112th Congress, Granny Bird, Medicaid, Medicare, Medicare Fraud

So, has Grover Norquist reached his use-by date, like Karl Rove?

I don't think so, but David Horsey does, and so do many others.  This is one of those times I'd love to be wrong.

Norquist has never been elected to anything. Nobody ever said he should be in charge of the GOP’s true religion (although he claims President Ronald Reagan urged him to found his lobbying group, Americans for Tax Reform). But he certainly has been the Republicans’ key political theologian, making opposition to tax increases the party’s central tenet for more than 25 years.

He got 95% of Republican candidates for Congress, the presidency and state offices to sign a pledge never to raise taxes and he enforced it by getting retribution at reelection time on anyone who failed to keep the promise. Now, though, he is facing a dramatic rebellion in the ranks. The country is teetering on the so-called fiscal cliff thanks to Republican-backed legislation from 2011 that will automatically begin slashing the federal budget and raise taxes on Jan. 1 if an alternative plan is not adopted by Congress. This has everyone a bit freaked out, including quite a few GOP senators and representatives who have expressed a willingness to consider revenue increases for the sake of making a budget deal with the Democrats.   [Emphasis added]

I do understand the logic.  Republicans are suddenly faced with a problem of their own making, a big one.  In fact, it's a very big one.  They've just lost an election and, while they still hold the House, they've lost ground in both houses of  Congress and the electorate appears to be in a very pissy mood when it comes to tax breaks for the 1%.

And President Obama, who has that second term Mitch McConnell was determined to deny him, has suddenly gotten a little surly.  He seems to think that he has a little political capital to spend so he's whipping that out against the GOP on the fiscal cliff issues.

House Republicans said on Thursday that Treasury Secretary Timothy F. Geithner presented the House speaker, John A. Boehner, a detailed proposal to avert the year-end fiscal crisis with $1.6 trillion in tax increases over 10 years, an immediate new round of stimulus spending, home mortgage refinancing and a permanent end to Congressional control over statutory borrowing limits.

The proposal, loaded with Democratic priorities and short on detailed spending cuts, was likely to meet strong Republican resistance. In exchange for locking in the $1.6 trillion in added revenues, President Obama embraced $400 billion in savings from Medicare and other entitlements, to be worked out next year, with no guarantees.

He did propose some upfront cuts in programs like farm price supports, but did not specify an amount or any details. And senior Republican aides familiar with the offer said those initial spending cuts might well be outnumbered by upfront spending increases, including at least $50 billion in infrastructure spending, mortgage relief, an extension of unemployment insurance and a deferral of automatic cuts to physician reimbursements under Medicare.

This is a great opening gambit, one that should have been used four years ago when the Democrats had control of both houses as well as the presidency.  It would have made a difference then.  But, no, Mr. Hopey-Changey was all into bipartisanship, and the Democrats for all sorts of reasons played along.  That's why a single payer system or even a public option system for health care were never on the table. 

Gitmo is still open.  We are still operating under Bush rules for reading our emails and checking our library habits.  Oil companies are still drilling in sensitive areas, even after a catastrophic spill in the Gulf Coast.  Our use of drones has been expanded.  Wall Street is still calling the tunes.  No change, and for most of us, no hope.

 So, is the opening gambit a sign that times have changed?

I tend to think not.  Sometime before Christmas, a deal will be reached.  Our current crop of Democrats in the 112th Congress will have their collars tweaked by our owners, as will the President. Social Security will suddenly be on the table, as will Medicare/Medicaid, all before Christmas.  And we know what that means.  In 2014 both Karl Rove and Grover Norquist will be back in action.  With a vengeance.

Like I said at the start, I'd love to be wrong, so I called the DC offices of Senators Boxer and Feinstein and Congressman David Dreier and made my wishes clear.  I figure one for three is the best I'll do, but maybe that will be enough to get us to the 113th Congress.  Maybe we'll have better luck there.

Labels: 112th Congress, 113th Congress, Change, Election 2012, Medicaid, Medicare, Our Owners

(Click on image to enlarge and then be kind enough to return.)

I have to admit, I am not too terribly worked up about the looming, dooming "fiscal cliff" so many people are concerned about.  Yes, yes, I know:  if Congress doesn't act by the end of the year, there will be drastic cuts to some of the programs I would just love to see cut, but also to programs I don't want to see cut any further.  And I appreciate that some of those cuts will add to the economic problems we currently face.  It just seems to me that it's about time Congress and the President face the music for their joint refusal to take care of business, and the rest of us face the music for letting them get away with it.

David Horsey's cartoon and column makes the same point, although he is far more concerned than I am.

The reason we are where we are is because our elected leaders put us here. The fiscal cliff -- a set of automatic draconian budget cuts and tax increases that will start taking effect on Jan. 1 -- was purposely created as a way to force the squabbling Congress and president into a budget deal. It is part of the Budget Control Act of 2011 that grew out of the near-disastrous debt ceiling showdown between President Obama and House Republicans.

The idea was that Republicans and Democrats would finally put differences aside and reach a budget compromise because both sides would be motivated by dread of automatic across-the-board cuts and tax hikes that would almost certainly hit the U.S. economy like a wrecking ball. ...

Many folks who claim to be political experts say this is mere posturing and that both sides will give up something to get a deal done -- with Republicans giving up more because the president is in a commanding negotiating position having just won reelection. Perhaps they are right, but the kind of hardheaded political calculation that used to get deals done in the days of Lyndon Johnson or Tip O’Neill has given way to ideological purity.

Congress is now filled with people like tea party cheerleader Michele Bachmann who has said that maybe it would not be such a bad idea to let the country go over the fiscal cliff. Boehner will have a tough enough time cajoling Ryan into any kind of compromise; he is unlikely to ever get crusaders like Bachmann and her hyper-conservative compatriots to give him an inch or a vote.

Hard-line liberals will also be difficult to move, especially if a proposed deal threatens the status quo in Social Security or Medicare. What is needed in the House and Senate is a bipartisan effort of folks in the center. That's where all the work used to get done in the old days, but it has been a long time since anyone has pulled together a coalition of rational compromisers.

While I agree that it is lamentable that our elected officials cannot seem to get any kind of deal done, I disagree with Horsey that it's because both far ends of the spectrum are to blame.  I mean, c'mon, David:  the "hard-line liberals" haven't had any kind of voice for over 20 years at least.  Our two parties keep moving further and further to the right thanks to the DLC, Blue Dog, and Third-Way Democrats who are perfectly happy keeping our owners perfectly happy.  The rest of us, all 99%, have been hung out to dry for a long time because we can't write the big checks come election time.

And it's not like THE DEFICIT is such a big deal.  Really.  It wasn't a big deal in 2000 when the GOP took power with the SURPLUS Bill Clinton handed it.  It didn't take long for the Bushies to run through that surplus in various ways, including fighting two wars off budget.  Deficits surely didn't matter then, and, truth be told, it really doesn't matter now.  Adjust a few things and we can offset a lot of the damage.

First of all, we should damned well take Social Security and Medicare off the table.  Social Security has absolutely NOTHING, zero, zip, nada, to do with the deficit.  It is a user-funded program which for too long has been used as an ATM by Congress.  If folks are so concerned that 35 years from now Social Security will go into red-ink, then raise the payroll tax from its current level.  Cap it at $130,00 or remove the cap entirely.  Medicare has the potential for being a drag on government spending, but there are ways to short-circuit that, including adding funds to the DOJ for slamming the fraudsters who are ripping the program off.

Next, end the Bush-era tax cuts for the wealthy.  It finally looks like President Obama and the Dems got the message from the election that the rest of us are tired of that 1% getting more breaks than they are entitled to.  Michele Bachmann and Paul Ryan may throw a snit-fit, but both had a harder time than expected in returning to Congress.  And the rest of the GOP, smarting from the last election, is hardly in any position to object too vigorously if it wants to continue as a viable party.

I'd also end the "middle class" payroll tax break.  All that did was undercut Social Security and Medicare funding.  Instead, provide real tax breaks for those of us with incomes below, say $250,00.  Avedon Carol has an excellent idea, one that hadn't occurred to me: raise the standard deduction from the laughable $3,800.  Go read what she has to say about that.  And then put real money into people's pockets by lowering rates.

Then tax all income, regardless of the source and regardless of the recipient.  Make corporations actually pay taxes.  To those who say that would affect job creation I would reply "Bovine Excrement!"  I didn't see any jobs being created by those tax breaks.  All I saw was outsourcing and offshoring.  The only "trickle down" we've seen has been of the decidedly urine-based  fluids raining down on all of us.  Those corporations who object and threaten to move out of the country can pay for their own damned security.  I'm sure Eric Prince and whatever his mercenaries are called these days will be happy to oblige.  We, then, can apply tariffs to the imports.

And that's just for openers.  I don't have any hard and fast rules for cutting "the fat" out of government programs, but, then, neither does the GOP beyond killing Big Bird and FEMA.  I do think cutting the junk contracts of the Pentagon is long over-due, as are outsourced programs in Homeland Security and the State Department.  Let government do the job the Constitution gave to it.

But I'm not sure we have enough stiff-necks and strong spines to accomplish this.  If not, there's always 2014.

Labels: Budget, Bush Legacy, Corporate Welfare, Election 2012, Election 2014, Medicare, Our Owners, Outsourcing, Social Security