[lbo-talk] The Bush Re-Election Juggernaut

Westrich, James james.westrich at umassmed.edu
Wed Nov 26 12:02:22 PST 2003


I agree that it can be easier to increase benefits for an existing program rather than create a new entitlement. I also agree that the potential damage of adding another layer of private contracting for the administration of prescription benefits is at this time largely theoretical. There have been several Republican measures to "privatize" aspects of Medicare but they have failed to generate any profits for those private interests (mainly because of the benefit austerity for Medicare led mainly by Republicans--a clear case of the inter-Republican clash of neo-Con mercantilism and old-Con government stinginess).

HOWEVER, the bill creates $12 billion in subsidies to private companies to enable them to do Medicare business. SO we get all the inefficiencies of private profit seeking AND we get to pay public money. This is what most Democrats/commentators were refering to in their attacks on "privatization" presumably.

Nathan got the cost control mechanisms built into the legislation wrong as well (in fact, understanding the mechanisms may strengthen his point). Future prescription prices get built into the premiums and deductibles born by recipients. This is one of the really horrible things about it. Now, this will undoubtedly help create political pressure to reform the package but sadly does not necessitate Congress or anyone else "to do things about drug costs."

The lack of doing anything about any aspect of health costs is one of the clear political problems in this country. Afterall, this is not really about drugs but the health and care of seniors/disabled. Any long-term interest in helping the healthcare needs of people has to address the ridiculous costs and above-CPI inflation.

I also need to correct a few other policy matters: --The bill does other things to Medicare benefits that are not so good: like creating higher premiums for Medicare Part B (while this is a "sliding scale" I generally think it is wrong to means test programs) --Medicare does not cover "every other kind of health care" as Nathan suggests, in fact it leaves out any long term care coverage which is pretty damn important if you consider it covers 65+ and disabled. --MEDICAID already covers senior prescription drugs for the poor and large private employers cover it for their retirees. Dually-eligible Seniors in the less generous states may benefit by the fed Medicare benefit but most will lose benefits or get nothing new. The ones who will likely get screwed are those losing their much more generous private benefits (like unionized workers in large firms) "because the government now covers that". --Bush's juggernaut is engaged in a clever plan to undermine Medicaid through (ironically) bureaucratic measures in CMS (imposed on state Medicaid programs--in other words have the government fight itself). The number of audits, second guessing, and plan change oversight has increased dramatically not in any clear direction (even conservative). What is going on is that this is an attempt to soften resistance to block granting Medicaid, which is what Bush wants because limiting benefits (particularly in tough times) will be much easier with block grants. --The new co-pays that even the poorest have to pay have seriously bad implications for the most economically vulnerable. I would not gloss over this either.

I do think it is sad that so much of the political leadership in both parties, the media, and Nathan are more concerned with the myriad political implications of this bill's passage than the actual implications to the well-being of Medicare recipients. Very telling but still "sick".

Peace,

Jim

-----Original Message-----

From: Nathan Newman [mailto:nathanne at nathannewman.org]

On policy, we now have the principle that drugs should be covered just like

every other kind of health care under Medicare. Now, the question is how

generous the benefit should be, which is a winning terrain for progressives.

It's a lot easier to expand coverage in an existing program than create a

whole new entitlement-- a fact that conservatives generally recognize and

which is making most of the rightwing apoplectic as they see Bush and the

GOP push through this plan for short-term political gain. As for the

"privatization" aspects, I just don't think a few pilot projects and such

are as threatening as most critics make out. And the very cost of the drugs

will put pressure on Congress to actually pass drug cost controls as a

deficit fighting measure.

Emphasize the last point-- without the drug bill, cost controls on drug

manufacturers was just "anti-business regulation." With $400 billion in

government spending at stake, suddenly drug price controls is a way to cut

government spending, another good terrain for progressives to advocate

against drug company profits.

As for the politics, passing a shitty bill is worse for the GOP than if the

Dems had defeated it. If the Dems had defeated it, Bush could have said,

"Well, I tried to fulfill my promise to give seniors a drug benefit, but the

obstructions Dems stopped me." Now, Bush has full responsibility for the

details of the bill and seniors won't be happy. They'll recognize that the

trillions of dollars in tax cuts meant they only had this pathetic benefit

available.

So much for the juggernaut.

Nathan Newman

----- Original Message -----

From: "Michael Pollak" <mpollak at panix.com>

On Tue, 25 Nov 2003 mike larkin wrote:

>

http://www.nytimes.com/2003/11/25/politics/25CND-MEDI.html?hp=&pagewanted=print&position

[An article about passage of the medicare bill]

The LA Times cites a new, non-partisan poll which says respondents 65 and

older oppose the bill by 49 percent to 33 percent. And that's before they

figure out that nothing's covered in 2004.

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