The budget debate should be a health care debate, because that’s where all the money goes. We didn’t have a health care debate the last time around, because conservatives spent enormous amounts of time, money and media making sure our health care debate had nothing to do with the health care system we actually have.
Liberty, broccoli, death panels, abortion, state’s rights, the commerce clause, tort reform, anything but the health care system we have. I’m an optimist, so I see an opening. Maybe this time we’ll get around to talking about health care.
I found an article about a governor who is not Chris Christie, although this governor talks about America’s Governor, Chris Christie, which is probably how he snuck into the newspaper.
Dannel P. Malloy, the governor of Connecticut, said this:
But Mr. Malloy does not apologize for proposing tax increases. “It’s what’s right for my state,” he said. “Connecticut would not be Connecticut if we cut $3.5 billion out of the budget. We are a strong, generous, hopeful people. We’d be taking $800 million out of education. You can’t do that in this state. You’d have to gouge the Medicaid system. You’d have to close 25 percent of the nursing homes. What do you do with people?”
A fact has entered our budget debate!
He’s talking about nursing homes and Medicaid because he’s telling the truth. He’s talking about dual eligibles (pdf):
Nearly 8.9 million older Americans and younger persons with disabilities participated in both the Medicare and Medicaid programs in Federal Fiscal Year (FFY) 2007. Although
these dual eligibles accounted for only 15 percent of Medicaid enrollment in 2007, 39 percent of all Medicaid expenditures for medical services were made on their behalf. These same individuals also account for more than 25 percent of Medicare spending.
Dual eligibles as a share of total Medicaid enrollees ranged from a low of 10 percent in Arizona and Utah to a high of 25 percent in Maine, due to demographic differences and policy preferences across the states. Similarly, spending on dual eligibles as a percentage of total Medicaid spending ranged from a low of 26 percent in Utah and New Mexico to a high of 59 percent in North Dakota.
70% of Medicaid spending was for long-term care services which are mostly not covered by Medicare or private insurance. Nearly two-thirds of Medicaid spending on dual eligibles was for enrollees age 65 and older. Although only 15 percent of dual eligibles were in an institutional long-term care setting in 2007, these enrollees accounted for more than half of all spending on duals.
Medicaid is going to be in the conservative cross-hairs so I think it’s probably important to talk about where Medicaid money actually goes.
Two more points:
Nearly one quarter (24%) of Medicaid spending for dual eligibles went toward Medicare premiums and cost-sharing and other Medicare services in 2007.
In other words, Medicaid money goes to Medicare.
Forty states have higher Medicaid income levels for nursing home residents than for ordinary Medicaid recipients.
That’s because people who are lower middle class cannot afford a nursing home, as everyone who has ever had to find one knows.
I don’t bring this up this to start some pointless, vicious battle over resources, where we’re all fighting over our allotment of health care. I think that’s the wrong away to talk about health care, because it’s fear-driven and divisive, and leads to months wasted on slippery-slope bullshit like death panels and state-mandated broccoli consumption. We are, after all, “a strong, generous, hopeful people” like Governor Malloy says, and we spend so much on health care now there should be plenty to go around. I raise it because we can’t talk honestly about Medicaid without looking at where nearly 40% of the spending goes, now, in the real world.
If you hear a governor talking about Medicaid and they forget to mention dual eligibles, that’s a solid indication they’re lying to you.
polyorchnid octopunch
That’s not really the real debate (though I will allow as it is at the state level). The real budget debate is about defence.
You guys want to fix your budget problems? Wrap up your wars, and cut your defence budget by a quarter, and your fiscal woes will disappear. This will mean you’re only spending as much as 2/3 of the rest of the world, instead of the whole ball of wax.
cleek
evidence suggests otherwise.
Kay
@cleek:
Well, I know, but wouldn’t it be great if we were?
Maude
I read the NYT article.
Christie is a thug act.
He is as incompetent as George Bush and as ignorant.
I want to see if the Republican Party Darling becomes less popular.
It is good that someone called Christie out on his mean spirited approach to money matters.
Jeff Darcy
If you hear a governor talking, whether they even mention Medicaid or not, they’re probably lying to you. Haven’t seen any exceptions that I can remember.
kay
@Maude:
I think it’s good that someone pointed out there’s another possible approach.
c u n d gulag
I read in an article yesterday that part of the tax increase will be on sales of things that weren’t taxable before, like non-presciption drugs.
This is, again, a tax on the poor and the middle.
How about adjusting the state income tax a bit so that the uber-wealthy, which CT has a ton of, pay more?
Now, I’m not saying don’t tax those things. But really take a look at the impact of those taxes on the poor and middle vs. the rich.
I’m sick of sin taxes, when real sinners don’t get taxed. Tax them, too! (Not that all rich people are sinners, despite the old line about ‘behind every wealty family there is a great crime’).
Mudge
Looking at the numbers, it would seem the Republicans will in effect try to establish death panels for these duals who earn less than $10,000 a year (57% of them).
Looks like we need a national nursing home program.
mistermix
Great post – Medicaid is constantly demonized because the perception is that it only goes to the poor and brown.
rikryah
about Medicaid, I’ll say it again….percentage wise of dollars, the largest chunk for such a small group is MIDDLE-CLASS FOLKS (usually WHITE), who have shielded Mama and Papa’s assets to get the Guvmint to pay for their NURSING HOME.
Bulworth
Seriously. It’s amazing for our “liberal” media to not be showcasing the latest fearless budget-cutting, union busting neoconfederate Republican governor, along with the fearless budget-cutting, program eliminating, union busting governor Cuomo.
Good luck, Malloy.
mds
@c u n d gulag:
Well, Malloy’s plan does that, too. The state income tax would become much more progressive. Since the Democratic legislature has tried to impose a “millionaires’ tax” for years, only to be blocked by Republican governors, I expect that something close to this plan will make it through.
I agree about the sales tax fiddling, though. Go ahead and raise the rate if you must, but leave the exemptions alone. Same with the property tax rebate that’s supposedly in the crosshairs. Connecticut municipalities (at least some of them) collect property tax on automobiles. Currently, the state allows you a credit on your state income tax form of up to 500 dollars. This policy thus offsets a regressive tax on all car owners, while still not subsidizing brand-new BMWs. Removing this turns into another tax primarily hitting the low end. So I hope there’s pushback from the legislature about some of these things.
Bill White
Illinois increased its income tax last month and the arguments appear to parallel those in Connecticut.
kay
@Bulworth:
He seems to have plenty of that:
Because of his dyslexia and other perceptual and motor-function problems, Mr. Malloy said, his teachers thought he was retarded until he was in the fourth grade.
“I was spastic,” he said. “I had little hand-eye coordination. My eyes moved the wrong way.”
He developed compensatory skills like a capacious memory, he said, but he still does not write or type and almost never speaks from a prepared text.
burnspbesq
The battle over resources may indeed be vicious, but to suggest that it is pointless is completely wrong and deeply irresponsible.
News Flash: Resources Are Finite! We as a people need to make hard choices about what we really want government to provide, and what we are willing to do without or pay for through other channels. To pretend otherwise is … I know you know better than that.
burnspbesq
@rikryah:
I don’t suppose you could be bothered to supply any empirical data to support that canard.
Maude
@mistermix:
And poor people are bad.
Brown people are bad.
@rikryah:
I think it’s harder to do that now.
kay
@burnspbesq:
Did you read the article, burns? He manages to talk about allocating resources in a sane way, that assumes we won’t be convening death panels. He’s asking people in his state what they value (education, etc.) instead of demonizing a sector of the workforce.
This whole debate has been panic-driven and fear-based, thanks to conservatives and their media allies, and people who are afraid make poor decisions. People who don’t know where money actually goes make poor decisions, too.
liberal
@burnspbesq:
Completely agree. Especially given we pay, what, 16% of our GDP on health care? Some other countries get away with spending around 8% and have roughly the same outcomes.
Of course, these thoughts are heretical, given the theological doctrine that all resource allocation decisions should be up to the patient and doctor, and any attempts at (rational) rationing, etc, is EVIL EVIL EVIL.
liberal
@kay:
Well, we should start demonizing sectors of the workforce. Starting with doctors that perform tens of billions of dollars on unnecessary spinal fusion surgeries every year in the US.
There are all sorts of patient groups expecting the taxpayer to spend a gazillion dollars on a single life-month saved by some newfangled treatment. They’re not afraid at all, unfortunately. (Happens in Britain, too.)
kay
@burnspbesq:
We’re not even at the point where we know where they resources go, let alone how we might value or allocate them.
I listened to GOP House members last week promoting this ridiculous argument that people without health insurance are better off than people on Medicaid.
Do they now know where Medicaid goes? Why are they promoting these lies?
kay
@liberal:
Yeah, cause that works so well when conservatives do it.
No sale. I talk about the cost of health care all the time, and I’ll happily talk about it some more, but I’m not having this insane blame-shifting conversation.
I don’t think it works. Further, I think you’re going to end up where I am, with looking at the whole mess, so let’s just skip to that.
ThatLeftTurnInABQ
@burnspbesq:
These choices are hard not because rational and effective options cannot be found and do not exist, but rather because the US is a deeply fractured nation and fighting over these priorities is an easy way for different groups of Americans to express their hatred for one another. We are a house divided.
kay
@liberal:
70% of the nursing homes in this country are for-profit. Nursing homes are low-wage work factories. Literally. When the factory closes here, all the displaced workers go to health care.
It’s just much bigger than physician’s salaries, or special interest groups that lobby for particular groups of patients, is my point, and it’s all inter-connected. Shit, Medicare and Medicaid aren’t even separable.
c u n d gulag
mds,
Thanks.
I live in neighboring NY, so I only know what I read about CT, and the article I read didn’t go into a great deal of detail.
Tom Mathers
A little easier to raise taxes when you don’t have the highest property taxes in the US (like NJ) and your top end income tax rate can be increased by 35% and still be lower than NJ. But please keep pushing the compassionate CT theme, such a better narrative.
burnspbesq
@kay:
They lie because they can.
And The Debate is driven by more than just fear. Former Sen. Simpson was on NPR this morning and talked quite matter-of-factly about how racism plays a part in the Republican base’s thought process on fiscal policy questions.
If you had told me 15 years ago that Alan Simpson would end up as the face of the rational wing of the Republican Party, I would have sought to have you committed.
burnspbesq
@ThatLeftTurnInABQ:
That.
Look, I get this. My roots are in Donegal. It took my uncles and cousins and their Protestant neighbors over 300 years to figure out who the real enemy was. The problem is that the Republican base has been lied to for so long that they are no longer capable of distinguishing truth from fantasy. That’s not going to change overnight.
someofparts
Surviving law school and becoming a practicing attorney when you can’t write is stunning. I’ll bet the story of how Malloy managed that would be worth hearing.
Stefan
But Mr. Malloy does not apologize for proposing tax increases. “It’s what’s right for my state,” he said. “Connecticut would not be Connecticut if we cut $3.5 billion out of the budget. We are a strong, generous, hopeful people. We’d be taking $800 million out of education. You can’t do that in this state. You’d have to gouge the Medicaid system. You’d have to close 25 percent of the nursing homes. What do you do with people?”
Aiyeee! Aiyeee! Communist! Fascist! Communofascist! How dare — HOW DARE! — he appeal to our better natures by calling the people of his state a “strong, generous and hopeful people” and talking about how he’s not willing to hurt the poorest and most vulnerable?!?! Just what does this clown his job is???
Stefan
News Flash: Resources Are Finite! We as a people need to make hard choices about what we really want government to provide,
A safety net, including medical care, unemployment insurance, and a dignified retirement.
and what we are willing to do without or pay for through other channels.
Massive military spending and tax breaks for the wealthy.
burnspbesq
@Stefan:
Cool. Now figure out how to get majorities in Congress to vote for what you want.