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Brad De Long's Semi Daily Journal
no more mister nice blog
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Benen and Hilzoy
my brother in law
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Saturday, April 21, 2007
April 21, 2007
The Medicare Privatization Scam
If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?
About a fifth of elderly Americans now belong to private Medicare Advantage plans, which — thanks to government subsidies — often charge less or offer more than traditional Medicare. As Congress struggles to find savings that could offset the costs of other important health programs, it should take a long and hard look at those subsidies.
The authoritative Medicare Payment Advisory Commission estimates that the government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries — by reducing premiums or adding benefits not covered by basic Medicare — and siphon off the rest to add to profits and help cover the plans' high administrative costs.
Although the insurance industry insists that the subsidies are much lower and are warranted by the benefits provided, Thomas Scully, who headed the Medicare program for the Bush administration until 2003, told reporters recently that the subsidies were too large and ought to be reduced by Congress.
The largest private enrollment is in health maintenance organizations, which typically deliver care a bit more cheaply than standard Medicare and should not need their 10 percent subsidies, on average, to compete. The biggest subsidies — averaging 19 percent above cost — go to private fee-for-service plans, which are the fastest-growing part of the Medicare Advantage program. Unlike the H.M.O.'s, which at least manage a patient's care and bargain hard with doctors and hospitals, these plans ride on the coattails of standard Medicare, typically providing access to the same doctors and paying them at the same rates. Thanks to the big subsidies they get, such plans are often a good deal for beneficiaries, charging less for the same benefits or adding benefits without raising prices.
The main losers are the beneficiaries in the standard Medicare program, whose monthly premiums are roughly $2 higher to help pay for the subsidies, and the taxpayers who pick up part of the tab. The subsidies also erode the long-term solvency of Medicare, which needs to rein in costs, not increase them with handouts to insurance companies.
When the Democrats first won control of Congress, it seemed possible that they might eliminate the subsidies — saving some $54 billion over five years — to finance a $50 billion expansion of a health insurance program for low-income children. But the insurance industry has mounted a furious lobbying campaign to head off any cuts....
Notice how dreadfully difficult health care reform will be in light of the astonishing danger to Medicare. Unless we leave Iraq completely and quickly, as we sould do in any case, budget constraints will put any health care reform program at risk.
April 20, 2007
Obama Makes Vow to End Iraq Conflict
By PHILIP ELLIOTT - Associated Press
NASHUA, N.H. - A woman's tearful plea to Democratic presidential candidate Barack Obama to end the Iraq war momentarily caught him off guard Friday at a New Hampshire town hall meeting.
The Illinois senator vowed to end the conflict if elected.
Obama fielded questions about health care, gun control and energy during a midday appearance before some 200 people at a Nashua, N.H., senior center. The residents politely applauded, and then Jean Serino of Hudson, N.H., told the candidate her nephew was heading to Iraq to serve.
``I can't breathe,'' she said, her voice breaking with sobs. ``I want to know, when am I going to able to breathe? Are you going to get us the hell out of there? Promise us you will get us out of there. That's the most important thing.''
The crowd's applause as she finished gave Obama time to compose an answer.
``I can only imagine how you feel, as a father and as a parent,'' he said. ``I don't go to a single town-hall meeting where I don't meet a mother or father who either is seeing a loved one go over there or has already lost someone, or has a loved one who has come back injured.
``So I make a solemn pledge to you, as president we will be out of Iraq,'' the Illinois senator said to loud applause....
Well, that makes John Edwards and Barrack Obama for leaving Iraq against the Warrior Princess. I am thankful to Obama and more encouraged. There will and should be ever more pressure on Hillary Clinton.
Somehow, as I feared it would from the moment Brad DeLong grew worried, John Edwards is being pounded over 2 expensive haircuts, also the idea that he has been a, shudder, trial lawyer has evidently been made a permanent liability by Republican campaigners past. I have no sense at all how to avoid being cast in a compromising set by a press that exists for just this, and by that I mean the New York Times to public radio. I do like John Edwards; a whole bunch. Darn.
There is absolutely nothing wrong with trial lawyers, who are a prime balancing factor for persons against institutions, but Republicans know how to vilify. Why was Franklin Roosevelt so well able to shake off the vilifying? Remember the Fala speeach?
The 'Fala' Address
These Republican leaders have not been content with attacks on me, or my wife, or on my sons. No, not content with that, they now include my little dog, Fala. Well, of course, I don't resent attacks, and my family doesn't resent attacks, but Fala does resent them. You know, Fala is Scotch, and being a Scottie, as soon as he learned that the Republican fiction writers in Congress and out had concocted a story that I had left him behind on the Aleutian Islands and had sent a destroyer back to find him--at a cost to the taxpayers of two or three, or eight or twenty million dollars--his Scotch soul was furious. He has not been the same dog since. I am accustomed to hearing malicious falsehoods about myself--such as that old, worm-eaten chestnut that I have represented myself as indispensable. But I think I have a right to resent, to object to libelous statements about my dog.
September 23, 1944
Roosevelt was the kind of tough Democratic we need, really need. Clinton was never have as tough, though Kennedy was tough enough. Then, too, there was Eleanor. Oh my.
In Turnabout, Infant Deaths Climb in South
By ERIK ECKHOLM
The reversal after years of progress in reducing infant death has raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors.
Yes; we are completely and utterly mad. Imagine coming on such a story in the New York Times. What to make now of the only prime candidate with a national health care plan? Hair cuts versus health care versus Iraq. I understand.
About funding, please bear with me while I point out that we can somehow manage to afford to spend $14 billion a month directly on Iraq, but Medicare and Medicaid are threatened, and, yes, Medicaid has been threatened these last few years especially in the "South." The choice has been guns or butter and we have chosen guns, while continually denying a choice is even necessary.
Now, imagine having to read such a story in the New York Times. Medicare is threatened, Medicaid is threatened, 47 million Americans, most adult and most working lack health care insurance, "welfare" (shudder) is everywhere disparaged. Infant deaths? Please.
Medicare is threatened over a mere $54 billion that will be needless spent over the coming 5 years, and could easily be saved. But, we will spend $56 billion in the coming 4 months on the tragic insanity of Iraq. And, we wonder where the funding is to come for health care.
Now, let's all go back to worrying about how much John Edwards pays for a haircut while Edwards is the only prime candidate with a national health care plan and a plgedge to take us from Iraq.
The health care columns by Paul Krugman over the months are critical and need to be set in context of this cursed war in and occupation of Iraq which is so crippling us in caring for ourselves let alone others. Ask me whether I will relent in my criticism of Iraq and I answer no, and no because of the direct morality as well as the crippling economic effects which we deny.
There was earlier a lunatic study from the University of Chicago showing how the war and occupation were cheap at twice the price, costless really, the dead and wounded nonetheless. Still there is the refrain of how cheap Iraq is as a portion of national income. Rubbish; complete rubbish. Iraq is cripplingly expensive here and abroad.
April 17, 2007
No-Fishing Zones in Tropics Yield Fast Payoffs for Reefs
By CHRISTOPHER PALA
NGIWAL, Palau — Sitting on a bench in a thatched hut in this village on Palau's main island of Babeldaob, Islias Yano, 57, looked over the bay he has fished professionally since he was 15 and recalled the fishing practices of his boyhood.
"We fished certain fish in certain seasons," he recalled. "Each reef could only be fished by people from a certain village." Village elders would rotate fishing on reefs, he recounted, to husband their slow-growing main source of food.
Starting in the 1980s, population growth, new seafood markets in Asia and modern ways of thinking washed away the elders' authority and rules....
April 21, 2007
The trouble with modernity is how efficiently it obliterates the troves of age-old knowledge otherwise known as wisdom. The good news from Palau, a Pacific island nation near the Philippines, is that some wise old ways have reasserted themselves to the great benefit of that tiny republic's fish and reefs, and the people who depend on them.
Under an ancient system of laws known throughout the South Pacific as tabu or kapu, rulers would forbid fishing in certain areas to let them recover from overuse. Their decisions relied on deep knowledge of seasons and of the habits of fish and plants, and were strictly obeyed by islanders, who understood that depletion of fisheries meant death.
Overfishing by local fishermen, commercial boats and poachers using dynamite has been as much a problem in Palau as elsewhere in the Pacific. Then elders in Ngiwal, a state of Palau, banned fishing on a small section of reef in 1994. It took only a few years for fish to return. Palau now protects 460 square miles of reefs and lagoons, and its reputation for recreational diving is unmatched.
In 2005, Palau's president, Tommy Remengesau Jr., issued the "Micronesian challenge," calling on the region to conserve 30 percent of coastal waters and 20 percent of land by 2020....
Medicaid, by the way, has been made increasingly restrictive in the South, as though there were no price to be paid, but beyond initial complaints the new patterns supplant the old and little is heard till the price comes.
anne asked Why was Franklin Roosevelt so well able to shake off the vilifying?Post a Comment
The man (well, his speechwriters) had a way with words. Remember "Martin, Barton and Fish," "The only thing we have to fear..." etc?