The following words are from House Bill 1181, passed by the North Carolina House and endorsed by Governor McCrory. “It is the intent of the General Assembly to transform the State’s Medicaid program from a traditional fee-for-service system into a system that provides budget predictability for the taxpayers of this State while ensuring quality care to those in need.” Translation: Instead of paying for whatever health care is used, they want to budget a fixed amount and make doctors and hospitals absorb any additional costs. They want doctors to save money by keeping patients healthy more so than treating them after they are sick. If their plan works everyone wins. If it fails, our poorest citizens will bear the burden. Continue reading REPUBLICAN SOCIALIZED HEALTHCARE?
Category Archives: medicaid
MEDICAID AND MANAGEMENT INCOMPETENCE
“What are the most important decisions that you have made in your work?” Ask that question of executives who have been successful in leading complex organizations and a clear majority will give an answer that has to do with choosing the rest of the leadership team. That is a lesson which Governor Pat McCrory is learning in the school of hard knocks while North Carolina taxpayers fund his tuition bills.
Shortly after Dr. Aldona Wos was named Secretary of Health and Human Services for the state, I pointed out that her principal qualification appeared to be the success that she and her husband had in raising money for Governor McCrory’s and President George W. Bush’s election campaigns. In a column at the time, I described her as “…a physician who has not been involved full-time in health policy or medical practice for many years…President Bush rewarded Dr. Wos by appointing her as Ambassador to Estonia. Likewise, the Governor made her DHHS Secretary and she hired a young McCrory campaign staffer, Matthew McKillip, as the Chief Policy Officer of DHHS. At age 24, he has no previous health service education or experience but he has worked for a right wing think tank and now he is leading health policy development for the state.” She proceeded to select others for the DHHS team including Ricky Diaz, a McCrory campaign staffer hired as the top public information officer. He was forced to resign after lying to the press about violations of medical record confidentiality laws.
Wos picked Carol Steckel, another conservative ideologue but one with substantial experience in Louisiana, to re-organize the Medicaid program. Steckel resigned after only eight months. Dr. Laura Gerald resigned as the State Health Director as did Dr. Rebecca King, the state’s top dentist, citing differences with Wos and the administration. Wos and the Governor publicly misinterpreted the findings of the North Carolina Auditor to create the appearance of extraordinarily high administrative costs in the Medicaid program. They used that interpretation to support their goal of privatizing Medicaid. Protests by the auditor and health professionals later demonstrated that the state’s administrative costs are actually quite moderate.
Wos changed the application and enrollment procedures for Food Stamp assistance and her new process takes months for many low income families. It is so bad that the federal government has warned the state that funding for administrative costs will be withheld if improvement is not made promptly. She implemented a new computer system for making Medicaid payments to physicians and other health care providers despite credible warnings that it was not workable, resulting in payment slowdowns that have jeopardized the financial survival of health care providers (doctors, hospitals, therapists and others) who depend heavily on Medicaid.
She is promoting an idea for addressing our troubled state mental health system by merging several quasi-governmental regional agencies into a smaller number without addressing the underlying issues about how and by whom services are delivered to living, breathing patients. Thinking that this administrative re-shuffling will improve mental health services is a bit like preventing the sinking of the Titanic by rearranging its deck chairs. It may appear that something is being done but the ship is still headed for the bottom of the ocean.
The biggest problem in this case is not with Dr. Wos. The major problem is with a Governor who has “rewarded” (punished might be a more apt description) political allies by putting them in highly responsible leadership positions for which they are unprepared. In this case the Governor chose someone who ideologically agrees with him but lacks necessary experience then he offered encouragement as she put other unqualified people in key roles. More recently he has failed to take action as a series of high level staff resigned. The debilitation of DHHS began with the appointment of unqualified personnel and that has demoralized more capable members of the department’s team.
DHHS is by far the largest and most expensive department of state government – comparable in fact to the Titanic. A ship so large cannot turn on a dime and ours is clearly in peril. Unless the Governor acts soon, DHHS will take many thousands of mentally ill and low income North Carolinians down along with some of our health care providers. It remains unclear whether Governor McCrory and Secretary Wos will go down with the ship.
ESSE QUAM VIDERI
The Latin phrase that heads this column is the North Carolina state motto, adopted from the Roman philosopher and political theorist Cicero. It means “To be rather than to seem”. It is a fine motto; inspiring integrity and openness in government. In The Prince, Niccolo Machiavelli taught the reverse saying, “It is not essential, then, that a Prince should have all the good qualities which I have enumerated above, but it is most essential that he should seem to have them.” Machiavelli was coaching a prince who would soon become a ruler and he wanted his pupil to understand that it is not necessary or even advisable to always behave with integrity. All that is necessary is to SEEM trustworthy.
Proponents of North Carolina’s voter ID law understood Machiavelli’s lesson well. They would have us believe that the purpose of the law is to protect the value of every citizen’s vote by eliminating voter fraud; but they never produced evidence that fraud has affected the outcome of a North Carolina election (or that fraud exits). If they had proof, they would publish it. The leaders of the Voter ID movement only need for fraud to SEEM real so they can SEEM to be protecting the rights of voters while they selectively reduce the rights of targeted groups.
Their decisions regarding which IDs are acceptable for voting discriminate against minorities, the poor and the young. A state issued driver’s license was accepted but a state issued college ID was not. A federal military ID is ok but a Food Stamp ID is not – selectively targeting the poor and the young. The photo ID requirement, which sounds nondiscriminatory, will be discriminatory in practice. The proportion of black voters in the last election who lacked a driver’s license is more than double the proportion for white voters. Those problems demonstrate that the bill is not what it seems to be. Supporters of the new law argue that the state will provide a free ID to anyone who doesn’t have one, conveniently failing to notice that poor folks generally don’t have the certified original birth certificate, passport, or alternatives needed to get the free ID. Nor do they have time and transportation for trips to license offices to complete the application process. As Machiavelli pointed out, the sponsors don’t need to BE non-discriminatory as long as they can SEEM non-discriminatory.
During the legislative session, the Supreme Court terminated one of the protections of the 1965 voting rights act. Afterward Republicans moved quickly to supplement the Voter ID Bill with schemes that target the poor, the young, minorities, and college students. Believing that the Federal Government could no longer interfere with discriminatory laws and practices, they cut the early voting period in half, making it harder for those who depend on their churches or civic groups to provide transportation to the polls. They made it illegal for those who will soon turn 18 to pre-register as voters. They banned registering and voting on the same day, making it harder for unregistered citizens to vote. The targeted populations, of course, are ones that traditionally tend to vote for other parties.
Republican majorities on some local Boards of Election are adding their own means of disenfranchising their targets. In Elizabeth City, the Republican dominated elections board has denied students at historically black Elizabeth City State University the opportunity to run for elected office. The new Republican chairman of the Forsyth County Elections Board has proposed closing the early voting location at historically black Winston Salem State University. At Appalachian State University in Boone, not only will the on-campus polling place be eliminated, there will be over 9300 voters assigned to the new polling place which has only 35 parking spaces. There are no sidewalks between the campus and the polling place, just a dirt path along a highway.
Over recent decades, North Carolina has made huge strides in voter participation, moving from 47th in the nation in 1990 to 11th in 2012. During that period, we made it easier to vote through measures like same day registration and early voting. Now the same Republicans who cut taxes for the wealthy then failed to support public education, Medicaid expansion and unemployment benefits have implemented a voter ID law which will make it harder for those they have harmed to vote them out of office. Their new law is much more than an ID law. It will have the effect of discouraging voting, especially among minorities, the poor and the young.
On the Seal of the United States is the slogan “E Pluribus Unum” – out of many, one. It is a principle which has helped our nation become great. By disenfranchising many voters the new North Carolina law makes a mockery of both “E Pluribus Unum” and the state motto. A reversed motto, “Videri quam esse” – to SEEM rather than to BE better fits the law’s supporters but it does not fit the proud and free traditions of our state and our nation.
http://www.npr.org/2013/08/16/212664895/in-rural-n-c-new-voter-id-law-awakens-some-old-fears lack of voter fraud evidence
Bush administration 5 year study turns up no evidence of fraud: http://www.nytimes.com/2007/04/12/washington/12fraud.html?_r=2&
Annual nc voter turnout http://www.ncsbe.gov/content.aspx?ID=70
Early voting and campus voting: http://www.newsobserver.com/2013/08/19/3120626/county-elections-boards-in-nc.html
http://www.thenation.com/blog/175837/north-carolina-republicans-escalate-attack-student-voting#
http://www.journalnow.com/news/state_region/article_1bedcab6-0acc-11e3-9d20-001a4bcf6878.html
NORTH CAROLINA REPUBLICAN CHECKBOOK
If you want to know what is important to people just read their checkbooks and credit card bills. They are far more enlightening than press releases or diaries. The same is true of political parties. After about seven months of total Republican control, the values of that party’s leaders have become apparent in their tax reform law and their budget.
They eliminated the tax on estates of over $5 million so that the wealthiest North Carolinians will no longer pay it when tens of millions of dollars are passed from one generation to the next; and they reformed the income and corporate taxes so that those with the highest incomes will pay less than in the past. They are sure that they reduced the State’s revenue but they are not sure by how much. Good government requires matching tax revenue with necessary spending.
After reducing the state’s income they announced that they did not have enough money to budget a salary increase for teachers. Our teacher salaries were already extremely low and may well be the lowest in the nation after another year with no adjustment. Most state employees were treated little better. Republican leaders did not consider the state’s financial obligations and the needs of our schools before they cut taxes. That is not good government.
Probably the most troubled department in State Government is the Department of Health and Human Services which is responsible for Medicaid, all of our mental health services, and many other programs. To lead this critical area, the Governor picked Dr. Aldona Wos, a physician who has not been involved full-time in health policy or medical practice for many years. She is very wealthy and has been among the largest fund raisers for former President George W. Bush and for Governor McCrory in both of his campaigns for governor. President Bush rewarded Dr. Wos by appointing her as Ambassador to Estonia. Likewise, the Governor made her DHHS Secretary and she hired a young McCrory campaign staffer, Matthew McKillip, as the Chief Policy Officer of DHHS. At age 24, he has no previous health service education or experience but he has worked for a right wing think tank and now he is leading health policy development for the state.
After only a few months on the job, he has received a 35% salary increase. That is just one example of large raises for campaign supporters while there is nothing left over for teachers or other public employees. How might those other employees feel about this?
Republican leaders said that the state does not have enough money to maintain the unemployment compensation program so they cut the maximum monthly benefit by 35% and cut the maximum length of benefits from 26 weeks to 20. As a result of the change, we lost eligibility for over $700 million in federal funds intended for North Carolina’s unemployed workers while our unemployment rate remains one of the highest in the nation.
Then they turned down the Medicaid expansion which would have been totally paid by the federal government for the first 3 years and would have been over 90% federally funded thereafter. That expansion would have covered most of our low-income working people at federal expense. Through 2019 it would have brought $15 billion federal dollars to the state and created 25,000 new jobs (mostly in the private sector). That would have helped mightily with our unemployment problem. Our middle class and poor will have to pay the federal taxes to fund the expansion but we won’t get the health care or the jobs.
The inescapable conclusion is that the Governor and legislative leaders think it is more important to cut taxes for the wealthy than it is to provide health care for low income workers and fair salaries to teachers. You can read their values in the state’s checkbook. This is particularly sad, because these are not the values of most North Carolinians; and many Republicans also disapprove. Some must be wondering how their party got away from them. In retrospect, the answer seems to be that a few very wealthy people not only bought the election with incredible amounts of spending; they also bought the soul of a once proud political party. It’s quite a set of values: Take care of your wealthy donors and reduce their taxes then pay for it by denying fair wages to teachers and other public employees and by cutting back on the public education and health services which would help the poor improve their earning power. They may preach family values but support for families is not written in their checkbook.
After doing such things, the only sure way to stay in office is to prevent those who disagree and those you have harmed from voting. That is a subject for another day.
N.C. LEGISLATURE’S HASTE MAKES WASTE
Current events bring to mind two lessons from childhood: “Stop, look and listen.” and “Haste makes waste.” Although they are using different words, those are the messages that I hear Governor McCrory and DHHS Secretary Aldona Wos sending to the North Carolina Legislature.
A hastily proposed bill now in the Legislature would require every facility performing abortions to meet ambulatory surgical center licensing standards. The purported goal is to assure that the procedure is safe for women but the apparent effect is to severely limit the availability of abortion because only one facility in the state could meet the standards. Both the Governor and Secretary Wos have urged the legislature to slow down and to look at the bill and the situation carefully before acting. The governor has even threatened to veto it.
If the bill is about patient safety, the sponsors should be able to present data indicating a problem. What percentage of women have complications after the procedure? What is the evidence that the complications would be reduced in an Ambulatory Surgical Center? The absence of facts is stunning. Many surgical procedures are permitted in physician offices. Without evidence that safety would be better in a surgical center, the law will be extremely vulnerable to court challenges and we will waste lots of tax money defending it. It seems obvious, that the bill is not about the safety of patients. Instead, it is a dishonest attempt to nearly eliminate abortion services in the state under the guise of patient safety, clearly infringing on women’s rights to make decisions about their own bodies. In their haste to act, the legislators could run us into the street and get all of us hit by an oncoming car – the lawsuits which will inevitably follow passage of the law.
In a similar matter, Governor McCrory is urging caution in the tax reform debate where radical legislators would reduce the state’s revenue so much that major new spending reductions would be required – and they would do that without a plan for which budget items would be cut. They would do it in a state which already ranks 44th among the 50 states in the percent of our economic output that is collected in taxes. The legislators will run into the street without looking and get us hit by a large truck – inability to fund public education, health services, infrastructure, and public safety needs.
It is to the Governor’s credit that he is warning the legislature that haste makes waste but he is far too late in confronting the legislature’s radicals. They have already rejected the return of $15 billion of federal taxes which North Carolina residents will pay for Medicaid expansion through 2019. They also gave back federal money for unemployment benefits at a time when we rank fifth in the nation in unemployment. And they have cut spending on public education in our state which already ranks 44th among the 50 states in per student spending. Yet excellence in public education may be the single most important key to economic vitality.
In November 2012, before the takeover by extremists, Site Selection Magazine ranked North Carolina as the best state in the nation for locating a new business. The magazine cited our “combination of work-force availability and skill sets of interest to employers, proactive business-development agencies, logistics assets and higher education infrastructure” as reasons for the top ranking. The legislature is taking us backwards. To see how the rest of the nation is viewing us now, you can Google “the decline of North Carolina” and read the opinion of the New York Times Editorial Board. In part, the observation from what may be the most influential newspaper in the country is, “In January, after the election of Pat McCrory as governor, Republicans took control of both the executive and legislative branches for the first time since Reconstruction. Since then, state government has become a demolition derby, tearing down years of progress in public education, tax policy, racial equality in the courtroom and access to the ballot…North Carolina was once considered a beacon of farsightedness in the South, an exception in a region of poor education, intolerance and tightfistedness. In a few short months, Republicans have begun to dismantle a reputation that took years to build.” The growing crowds at demonstrations opposing the legislature’s actions are ample evidence that something is seriously wrong and that many North Carolina Citizens recognize the problem. We ignore these problems at our peril.
When I listen to Republican friends, the ideas that I hear are not the ones that are emerging from the legislature. Instead, I hear thoughtful fiscal conservatives who want to improve efficiency, reduce waste, and limit the scope of government’s role in our lives. While we may disagree on some issues, we share goals of economic growth, excellence in education and efficient use of tax money. We can hope that the Governor is having a change of heart and that public opposition will slow down the march of radical lemmings which is headed for a cliff over which few of us want to fall. On the other hand, maybe the lemmings who walk over the cliff will not be returning to the next session of the legislature. Maybe by letting them go ahead we can improve the legislative gene pool…just a thought…
NORTH CAROLINA TAX REFORM
We create some of our own big problems when we act on our beliefs without checking to see if the beliefs are true. Governor McCrory and the North Carolina Legislature are about to do that as they reform our taxes. They have been cutting spending and now they plan to cut taxes with religious zeal based on two erroneous beliefs. One belief is that cutting taxes will stimulate creation of good jobs and economic growth. The other belief is that North Carolina taxes are too high.
First, let’s look at how much we are actually spending compared to other states. Counting all forms of state taxes including corporate and personal, we collected $2320 per person in 2011. That ranked us 34th highest among the 50 states. Gross State Product measures the total economic output within the state. Our combined state and local government spending as a percent of our Gross State Product ranked 44th among the 50 states. That means that the tax burden on our state economy was lower than all but six states.
Our spending on public K-12 education has been a hot topic. Our per pupil spending in 2011 ranked 44th among the 50 states and the legislature has already cut it below that level. As a percent of GSP, our per pupil spending ranked 46th. The K-12 tax burden on our GSP was 4.8%. Some states with low GSPs are trying to catch up with the rest of the nation. While we go backwards, low wealth states like West Virginia, Mississippi, Alabama, South Carolina and Arkansas are placing a tax burden of 7% to 8.4% on their GSP to support K-12 education.
What about the other reason for cutting taxes – to bring more jobs and economic development? High wage employers will be looking for a highly educated and skilled workforce. That is the reason, for example, that tech industries have concentrated around Seattle, San Francisco and Boston. It is because strong public education K-PhD produces a strong workforce and because those regions provide the quality of life (some of which is tax supported) which attracts and retains highly skilled people. Here in North Carolina, the Research Triangle Park has been a viable competitor for those companies. A few other communities have made some headway, mostly in proximity to universities which help attract the workforce. A tech company might put a call center or data center in other parts of our state (and that would be a good thing) but the corporate headquarters and the R&D functions which provide the best jobs will be elsewhere.
If our taxes and wages are reduced enough, we may indeed attract some jobs because there are some businesses which consider small differences in tax rates as an important criterion when choosing a location. They are also typically looking for the lowest labor costs. They don’t need a highly educated and skilled workforce and they keep benefit costs low by using as many temporary workers as they can. Those are also the jobs which are most vulnerable to outsourcing and automation. Having a mix of jobs available is a good thing but if we can’t attract our share of the high wage jobs then why will our brightest and most ambitious children return home for their careers? Or will they migrate to other parts of the country (or the world) for better wages and the environment that they want?
My conclusion is that the legislature and the Governor have entered us in a race to the economic bottom and if they continue cutting taxes and spending we are likely to win that race. I hate waste and don’t enjoy paying taxes but I’m very willing to pay for excellence in public education from birth through college. And I’m willing to pay fair wages to public servants who make our lives safer and better, and for parks, arts, and other government programs which promote the general welfare. Business leaders already know, but may require an occasional reminder, that it is a lot easier to earn a profit when your customers have money to spend. For that to happen, we need high wage jobs and a high skill workforce and public education to support both.
Tax reforms to close loopholes, to begin taxing services, and to reduce corporate taxes may indeed be good things but the design of the changes should increase rather than decrease state revenue and the tax burden must not be shifted to the middle class and poor who are least able to bear it.
I am an optimist. I believe in the people of my community and my state – good people who are working hard toward better lives for themselves and their families. We need to see ambition and optimism from our leaders including an understanding of that phrase “promote the general welfare” from the US and North Carolina constitutions. Taxation is not a win-lose game and neither is good government. When we spend our resources wisely on education and enhancements to quality of life, we all win. When wages go up, so does demand for products and services. It is time now for North Carolina to reclaim our dual heritage as a pro-business and progressive state.
THE REPUBLICAN PORCH STEP
I had an uncle old enough to be my grandfather who cleared land, cut lumber, and built the home on his Tennessee farm with his own hands. As visitors approached, he warned them not to use the steps on the side of the porch. “Those are Republican steps.” he would say, “They look solid but if you trust them they’ll let you down.” Since handing over the legislature and the governor’s office to Republicans, a lot of North Carolina voters are learning what he meant. Republican candidates said it was time for a change after generations of Democratic control, pointing out numerous scandals and sloppiness in governance by one party. Republicans promised openness in government, less intrusion on personal liberties, lower taxes, improvements in public education and more jobs. Governor McCrory ran a campaign based on economic development and less intrusive government. Sadly, their actions don’t resemble their promises.
The actual Republican agenda appears to have three themes. First and foremost, hold on to power, even if that requires depriving citizens of their rights. The second theme is to financially reward supporters and punish opponents. The third is to impose the social and religious values of their extreme base on all North Carolinians.
Republicans are cementing their grip on power. By gerrymandering our districts they won 69% of North Carolina congressional seats with 49% of the votes. Now they are proposing laws designed to discourage voting by citizens they think are likely to support the opposition. They have proposed laws to:
- Take away the $2500 per dependent tax credit from parents of college students who vote where they go to college (and live for most of the year).
- Eliminate early voting on Sundays, which is especially popular among African American churches.
- Cut back early voting to one week.
- Restrict the number of early voting locations.
- End the practice of registering and voting on the same day.
- Pass a voter ID law, designed to deter voters who don’t have a driver’s license.
Republicans propose to financially reward supporters and penalize opponents. They want to cut corporate taxes, estate taxes, and income tax rates and pay for the cuts by expanding the scope and amount of the sales tax. By taxing food and other necessities then cutting taxes for corporations and those with higher incomes they can redistribute income from the working poor to the Republican base. There are proposed laws to reward generous Republican contributors by legalizing sweepstakes cafe gambling and payday lending (sponsored by our own Senator Tillman). They passed a law allowing hydraulic fracturing for natural gas while severely limiting the liability of companies for pollution of ground water and land, even if it is caused by intentional violation of safety regulations.
Then they punished the poor – perhaps with the notion that most poor folks either don’t vote or vote for Democrats. They reduced unemployment compensation for the long term unemployed and raised college tuition, making upward mobility for those with low incomes even harder than it was before. Their funding cuts increased financial problems for our public schools. Their solutions include allowing charter schools to hire uncertified teachers without even doing background checks (Senator Tillman again). They rejected $15 billion dollars of federal money to pay for Medicaid expansion through 2019. That punishes the poor who need health care along with the hospitals and doctors who are required by law to provide emergency services whether they are paid or not. The Medicaid expansion would create 25,000 new jobs, mostly in the private sector. Do Republicans think voters won’t miss those jobs or notice that we still have to pay our $15 billion in federal taxes? At one time we were fighting a “war on poverty”. Now it feels like Republican leadership is fighting an undeclared war on the poor.
The third element of the Republican agenda has been to impose the social and religious values of their extreme conservative base on the rest of the population. Randolph County’s own Allen McNeill co-sponsored a bill to exempt North Carolina from the US Constitution and allow government establishment of an official religion. You can find it on the legislature’s website or just Google “HJR 494”. One proposed imposition on personal freedom is a requirement to provide written notice to a spouse two years in advance and attend state approved counseling before filing for divorce – even in cases of domestic violence. There is a bill requiring doctors to get written consent from parents before providing pre-natal care to a pregnant minor or answering questions from minors about STDs or birth control. And one of the first acts of the Republican majority was to encourage a constitutional amendment which prohibits the state from recognizing same-sex marriages or unions – even those performed in states where they are legal. Soon they will be spending our tax dollars to defend that useless amendment in court.
As candidates, Republicans promised less intrusion on personal liberties, lower taxes, improvements in public education and more jobs but they are delivering something quite different. Like my uncle’s porch steps, they looked reliable but they are letting us down.
THOUGHTS ABOUT THE UNINSURED
What should happen when a person with no health insurance and little money needs a major health care service? Let’s imagine it for a fictitious person. Sara is a 61 year old widow who has two part time jobs, one at a restaurant and the other at a dry cleaning establishment. Neither provides health insurance. Her annual income from both jobs is about $28,000. She has little money saved and will have only social security income if she is forced to retire.
Recently Sara has had severe pain when she stands for the extended periods required by her jobs. Her doctor referred her to an orthopedic surgeon. Sara delayed follow-up because of the cost but recently her pain increased enough that she spent money for an office visit. The surgeon determined that Sara needs a hip replacement. The price of the hospital and physician fee is about $40,000 which is well beyond her means. Sara fears she will soon be fired from her jobs because she can’t be on her feet for long periods.
Should Sara be able to get the surgery that would correct her problem? Is “no” an acceptable answer? If the answer is “yes”, who should pay for it? Today, one of two things would happen. Sara might have to do without the surgery. The other possibility is that the doctors and hospital will replace her hip without payment and try to pass the cost along to those who will pay. If there are too many patients like Sara, the hospital will fail financially and many doctors will move to more prosperous communities.
There are 50million uninsured Americans today with little or no ability to pay a large health care bill. http://aspe.hhs.gov/health/reports/2011/cpshealthins2011/ib.shtml Many residents of Randolph and Montgomery Counties fall into that category. As we get ready to vote next month, I hope that Sara and the millions like her will accompany our consciences into the voting booth: a man delaying a hernia repair that he needs, a woman who feels a lump in her breast and hopes it is nothing rather than seeing a doctor today; someone who skips the colonoscopy where a polyp could be removed before it becomes colon cancer. Some of us are the uninsured. Most of us know them personally.
Two Republicans, Teddy Roosevelt and Richard Nixon; and three Democrats, Harry Truman, Bill Clinton, and Barack Obama have pushed for laws to provide health care for all who need it. In a very messy legislative process President Obama finally got a law passed which gets us most of the way there. Republican opposition was absolute and they blocked the legislative process at every turn; preventing the dialogue that could have improved and simplified the bill. From the beginning their stated agenda was to prevent the President’s re-election rather than to collaborate in governing for the benefit of all.
President Obama is praised by some and vilified by others. Critics point out that the law is complicated and imperfect. That is true. Advocates, me included, point out that when the new law is fully implemented it will be a vast improvement over what we have today. The debate should not be about repealing it; instead we should be deciding how to improve it. In particular, we need initiatives to reduce the cost of health services so that they will be more affordable.
We need today’s Republicans to step up to the responsibility of proposing workable ways to provide more service for less money while covering the uninsured. It IS achievable. Every other developed nation has accomplished it while spending less than we do now. http://www.oecd.org/dataoecd/52/42/49188719.xls . We can do it too. Those nations set a clear policy of universal coverage and designed economical ways of achieving the goal. Mitt Romney knows that. He is the architect of a Massachusetts program which is nearly a twin to ObamaCare. But he and Renee Ellmers, and the Republican Party have abandoned the humane ideas of Roosevelt and Nixon. While doing that, they also deserted the uninsured, the poor and the middle class.
Did you know that more family bankruptcies are caused by health care bills than by home foreclosures? http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf It is the uninsured middle class and the poor who will bear the burden of a Republican victory this November. Have you heard talk of “class warfare”? Well, this is it. The Republicans want to repeal a law providing health care for the uninsured while cutting taxes for the wealthy. That is economic warfare on the uninsured middle class and the poor. Otherwise, Republicans would have a proposal for how to provide health care. They have also abandoned the doctors and hospitals that are required to provide emergency service with no payment. And in their proposal to “block grant” Medicaid they have deserted the disabled and frail elderly. They pledge to cut federal Medicaid funding. Two thirds of Medicaid spending is for nursing home patients who have depleted their personal resources. Much of the remainder is for childbirth or medical care of sick children.
We can’t afford all things for all people. There will always be two or more levels of care, with the wealthy able to obtain services not available to others. But we can afford to provide most needed and effective services to everyone; and we can find ways to get our costs down. Achieving that will require a national commitment of voters and political parties over a period of many years. It begins with implementing the law that was passed after a century of effort and it should continue with gradual improvement. We are Americans and we are up to the task if we will commit to it.
How will you respond to Sara’s need and to the needs of millions like her? We should take Sara and our consciences along with us when we go to the polls. There, but for the grace of God, go I.