A consequence of last year’s Supreme Court ruling that upheld Obamacare — but allowed states to opt out of the Medicaid expansion — is that we would see GOP state governors placed in a real dilemma: They could either accept the Medicaid expansion and receive billions of dollars for their state health care systems from the Federal government at the risk of enraging their far-right base of supporters. OR the governors could reject the Medicaid expansion, leaving millions without coverage but still being able to say they stood up to that evil socialist plot to destroy America. Decisions, decisions...:
Talking Points Memo
What The ‘Obamacare’ Decision Means For Medicaid
Sahil Kapur June 28, 2012, 4:58 PMIn a surprise move in its decision to uphold the ‘Obamacare’ mandate, the Supreme Court declared that states may opt out of the law’s Medicaid expansion without losing all federal funds for the program.
“In the 47 year history of the program, there has never been a successful challenge to any of the Medicaid expansions, so this was rather unusual,” said Ron Pollack, director of the consumer group Families USA.
The decision is expected to at least slow down implementation of the new Medicaid provisions. If states refuse to participate en masse, it could lead to significantly fewer people than the projected 17 million being covered under the Medicaid expansion.
The Supreme Court held that the Medicaid expansion in itself constitutional. But it essentially decreed it a new program, which means states cannot be punished for turning it down. The court rejected the Obama administration’s argument that states must accept the expansion or risk losing all federal Medicaid funds.
“The practical effect is that it will make the Medicaid expansions go more slowly,” said Sara Rosenbaum, a professor of health law at George Washington University. She added that it may be left to future courts to determine which parts of the Medicaid expansion count as a new program and which parts are merely additions to the existing one.
Republican governors will face pressure to reject the Medicaid expansion or risk being accused by conservatives of willingly embracing a big part of ‘Obamacare.’ But there’s an incentive in the other direction; namely: a huge cash gift from the federal government, which covers the full cost of the first three years of expansion.
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One of the problems with not accepting the Medicaid expansion is that a key assumption behind the cost-cutting in Obamacare centers around the idea that Medicaid receipts to hospitals would go down per patient but there would be more people covered by Medicaid overall. Hospitals could make up the lower per-patient revenue with higher volumes. In the states that don’t expand their Medicaid coverage, however, the hospitals will still get paid less per Medicaid patient but they won’t get the increased volume of patients due to the increased coverage. So it isn’t just uninsured poor people that are in the cross-hairs of this fight. The hospitals get hurt too, along with their staff and patients. Non-profit hospitals that serve large numbers of Medicaid patients will be especially hurt:
Bloomberg
Hospitals Prepare to Cut Care in Medicaid Opt-Out States
By Stephanie Armour — May 14, 2013 12:06 PM CTWith 15 U.S. states opting out of President Barack Obama’s Medicaid expansion, hospitals that treat poor and uninsured patients are asking the government to delay $64 billion in planned funding cuts.
Medicaid funds to hospitals with a disproportionate share of low-income patients will be cut 50 percent, or $14.1 billion, from fiscal 2014 through 2019, according to draft regulations to be published in the Federal Register tomorrow. The American Hospital Association wants to delay by two years the start of the cuts for Medicaid and for $49.9 billion in reductions by Medicare, the health program for the elderly and disabled.
“They decided not to look at the effect of health care reform,” Tom Nickels, senior vice president for federal relations in Washington for the hospital association, said in a telephone interview today. “They don’t penalize states that have chosen not to expand.”
The reductions are mandated by President Barack Obama’s Affordable Care Act, and were supposed to be offset by an increase in the number of patients who would gain insurance through an expansion of state Medicaid programs. With some Republican-led states deciding not to cooperate, a loss of funding without a gain in more insured patients would hamper hospitals ability to keep caring for underserved populations.
“It’s a kick in the gut,” said John Bluford, chief executive officer of Truman Medical Centers in Kansas City, Missouri, which estimates it may lose as much as $150 million in Medicaid payments over seven years. “These are real dollars. It would wipe out our margins.”
Tenet Profit
The rules being circulated this week show Medicaid would reduce the so-called DSH payments by $500 million in the fiscal 2014 year starting in October. For 2015, $600 million more would be cut with the annual reductions reaching $5.6 billion in 2019.
For the first two years, the funding cuts won’t be based on whether states have opted to expand Medicaid. Tenet Healthcare Corp. (THC), the third-largest for-profit hospital chain in the U.S., estimated in February the Medicaid and Medicare cuts would cost it $35 million in government payments in the fourth quarter. Dallas-based Tenet has 26 percent of its beds in Florida and 20 percent in Texas, both states where the Republican governors have opted not to expand Medicaid.
HCA Holdings Inc. (HCA), the largest for-profit U.S. hospital chain, has 25 percent of its beds in Texas and 25 percent in Florida, according to said Brian Tanquilut, an analyst at Jefferies LLC in Los Angeles.
Saving Grace
For-profit hospitals like Tenet are unlikely to pass along the costs of the cuts to consumers in the way of raising rates to non-government payers, Tanquilut said. “They’ll eat it.”
Cuts in the Medicare DSH payments also will be offset by a separate April 26 regulatory proposal that would lead to a 0.8 percent net raise in overall Medicare payments for services that elderly and disabled patients get after being admitted to hospitals, Tanquilut said by telephone.
The overall Medicare rate — which includes the Medicare cuts to hospitals that treat a large number of low-income patients — should keep HCA’s earnings before interest, taxes and amortization expenses within its February 2013 guidance, R. Milton Johnson, president and chief financial officer, said on an April conference call with investors.
The saving grace for for-profit hospitals, Tanquilut said, is that the Affordable Care Act will bring financial benefits that nonprofit and public hospitals like Truman Medical won’t see. Large, urban hospitals that provide the biggest share of charity care and treat more Medicaid patients are most at risk, Moody’s Investors Service Inc. said in a March 14 report.
Tight Bind
With only about one-fifth of their patients having commercial insurance, these safety-net hospitals typically have profit margins of about 2.3 percent, a third of the industrywide average for all hospitals, according to 2010 data from the National Association of Public Hospitals and Health Systems. Losing Medicaid funding and not gaining more insured patients would swing that margin from a profit to a loss of 6.1 percent.
Hospitals may try to recoup losses by limiting the amount of care they provide to the uninsured or reducing staff, John Graves, an assistant professor at the Vanderbilt University School of Medicine in Nashville, Tennessee, said by telephone.
“They’re in a tight bind,” Graves said. “They have to recoup those losses through fewer services, shutting down.”
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Death By A Thousand Cuts Indirect Hostage-Taking
To the surprise of many, the Obama administration called for a delay in the Medicaid cuts for states that opt-out of the expansion. So are the hospitals out of the danger zone? Well....another predictable consequence of all this is that, given the choice to expand healthcare coverage for poor people vs sticking it to Obama, sticking it to Obama was going to be a clear winner in a lot of states. What wasn’t obvious, however, was that the GOP might be willing to shut down the Federal government in order to stop Obamacare’s implementation. Granted, they were most likely going to threaten to shut down the government over something, but limiting healthcare access to poor people was never the obvious play from the GOP’s playbook:
Talking Points Memo
Conservatives Step Up Push To Undercut GOP On Obamacare
Sahil Kapur September 13, 2013, 6:00 PMObamacare is becoming a huge headache for the Republican Party.
Conservative advocacy groups are rallying behind House legislation backed by 43 Republicans to threaten a government shutdown unless Obamacare is defunded, undercutting GOP leaders’ efforts to lock in low spending levels by goading the party into a self-defeating confrontation.
Within 24 hours of its Thursday release, Sen. Mike Lee (R‑UT) threw his support behind the bill, as did the well-funded groups Club For Growth, FreedomWorks and Heritage Action.
“The Club for Growth strongly supports the legislation offered by Congressman Tom Graves to save America from Obamacare,” said Chris Chocola, the group’s president, boasting that “momentum is building” to stop the health care reform law.
House GOP leaders, who have few votes to spare, are determined to pass their proposal to continue spending at sequestration levels and force a Senate vote to defund Obamacare without risking a shutdown. House leadership is open to tweaking the specifics but they want to achieve three goals: continue the sequester, give Senate Republicans a chance to fight Obamacare and maintain leverage against the health care going into the debt limit fight. The 43 Republicans behind the Graves bill haven’t implicitly committed to opposing leaders’ version.
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Conservatives, meanwhile, are undercutting — and infuriating — Republican leaders who want to be pragmatic about what they can achieve in the continuing resolution. Democrats, they recognize, are vulnerable on spending levels but won’t cave on Obamacare. As a result, if the hard right’s desires get in the way of reaffirming sequestration cuts (even temporarily), the GOP may lose on all fronts. Veteran Republicans realize the party out of power will be blamed if the government shuts down, and their negotiating hand weakened over how much it should spend upon re-opening.
The conservative opposition to Obamacare has become unappeasable and it’s tearing the GOP apart. The base is anxious to make a stand now because implementation of the law is set to accelerate on Oct. 1 and its major components poised to take effect on Jan. 1. Advocates privately gloat about their chances of sticking it to GOP leaders as they mobilize in favor of a standoff. Stare down President Barack Obama until he blinks on his own signature achievement, they demand of the GOP, even if it means shutting down the government. But Republican leaders aren’t optimistic that he’ll blink, and worry that initiating this battle could damage their already weak brand and threaten their otherwise secure House majority.
The House GOP leadership proposal entails a two-pronged bill to fund the government until Dec. 15 at sequestration levels and force the Senate to vote on defunding Obamacare. The Senate can reject the Obamacare component, as is expected, and send the rest of the continuing resolution straight to the president’s desk.
Republican leaders tentatively plan on bringing up a stopgap measure next week, and aides maintain an air of confidence about success. They face a tough road to securing the votes for just about any bill to keep the government open. Will they succeed?
“That remains to be seen,” said a House GOP leadership aide.
The latest proposal by House Majority Whip Eric Cantor to threaten a default on the US debt in place of a government shutdown threat is another very non-obvious play for the GOP to call at this point. It’s not actually all that out of character for the GOP, but threatening to default on the national debt unless we all agree to keep limiting health care to the poor isn’t the obvious best move for the GOP in this situation. Everyone is used to a little zealotry for the GOP at this point but this just might be another overreach:
TPMDC
Cantor: If We Can’t Defund Obamacare, Let’s Delay It
Sahil Kapur September 12, 2013, 10:40 AMIn order to persuade conservatives lawmakers to vote to keep the federal government funded past Sept. 30, House Republican leaders are proposing to stare down President Barack Obama over the debt ceiling by seeking a one-year delay of Obamacare.
At a closed-door meeting Tuesday, House Majority Leader Eric Cantor (R‑VA) floated a strategy to delay the rollout of Obamacare for one year in exchange for lifting the debt ceiling. The meeting was focused on pitching a plan that lets Republicans vote to defund Obamacare without risking a government shutdown if the Senate rejects the idea, a move that is meeting fierce resistance on their right flank, which wants to go further.
A senior Republican aide familiar with Cantor’s remarks said he was essentially trying to persuade his members that the debt limit, which the federal government is expected to hit in mid-October, provides a better opportunity than a threatened government shutdown to undermine Obamacare.
“He didn’t draw any red lines,” said the GOP aide. “He said it’s a better opportunity than [the continuing resolution] and a delay there is very doable.” The aide added that the concession wouldn’t necessarily just involve Obamacare; there could be other reforms. The aide admitted that it depends in part on what the president is willing to give up.
It all sounds far-fetched. After all, trading a government shutdown for default would be like trading a common cold for cancer. And it remains to be seen whether GOP leaders would let the economy collapse if they don’t get their way, or if they’re merely saying what they have to say to get through the shutdown crisis.
An upside to proposing the debt ceiling idea now is that it helps persuade Republican lawmakers not to withhold their support for keeping the government open. Cantor’s suggestion this week comes as Republicans are taking heavy fire from conservative advocates for refraining from risking a government shutdown over Obamacare. House leaders have postponed consideration of the continuing resolution until next week to build support.
Last month, Speaker John Boehner (R‑OH) floated the idea of delaying or defunding the health care reform law in a debt ceiling package. But he, too, stopped short of drawing any red lines. A leadership aide described it at the time as an “option.”
Despite the anti-Obamacare frenzy consuming their right flank, Republican leaders recognize that both a shutdown and default would be a disaster for their party, potentially threatening their House majority ahead of a mid-term election when they hope to win back the Senate. Their balancing act to satisfy conservatives enough to avert a shutdown but not to create expectations that threatening debt default is the way to go.
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Then again, maybe this isn’t overreach at all that we’re looking at. Maybe it’s really an incredibly sneaky plan to simultaneously limit access to healthcare for people (a core value held by much of the contemporary GOP base) AND blame it all on Obamacare. At least in some states...states that don’t accept the Medicaid expansion. Because by threatening to shutdown the government or defaulting on the debt over their opposition to Obamacare the GOP is still going to destroy the finances of hospitals in the states that refuse to accept the Medicaid expansion. That’s because that delay in the Medicaid cuts that the Obama administration agreed to in May can’t actually be implemented until Congress passes a budget. Now all they have to do is ensure that the public blames all the hospital closures and healthcare problems that results from these cuts on Obamacare and not the perpetual budget and healthcare warfare waged by the GOP which shouldn’t be too hard to do. If this wasn’t an accident, it was kind of brilliant. Except for the part about how the GOP has to explain shutting down the government or defaulting on the national debt. So it’s possible that the GOP is operating in “Mad Dog” mode right now, and given the larger debt battles that are swirling around this issue, this is potentially a much scarier story about politically and ideologically-driven attempts to restrict health care to poor people than stories about politically and ideologically-driven attempts to restrict health care to poor people normally are:
TPMLivewire
Without New Budget, HHS Finalizes $1.1 Billion in Medicaid Hospital Cuts
Dylan Scott 4:58 PM EDT, Friday September 13, 2013Because a gridlocked Congress won’t be passing a new budget anytime soon, the U.S. Department of Health and Human Services finalized a rule Friday for $1.1 billion in Medicaid cuts to hospitals under the Affordable Care Act, cuts that could hit hospitals particularly hard in states that don’t expand Medicaid through the law.
President Obama proposed postponing the cuts one year in his FY 2014 budget because not every state is expanding Medicaid as originally planned. The cuts, which are to payments for hospitals that perform a lot of uncompensated care, were included in Obamacare because the law would cover more people, decreasing the overall amount of uncompensated care.
The president’s proposal reflected the reality that 20-plus states have refused to expand Medicaid coverage under the health care reform law. If the cuts went into effect, hospitals in those non-expanding states would receive smaller reimbursements from HHS without the compensatory expansion of coverage.
But without a new budget from Congress, HHS wasn’t able to implement the president’s proposal.
“HHS has no flexibility to institute a delay of the DSH allotment reductions without congressional action,” the rule released Friday said.
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For those governors that still fear a dystopian world free of uninsured poor people It might worth reminding them that there would still uninsured people left in their states even if they accept it. It’s a long shot, but it just might work.
No manner what one may think about Obamacare, the Republican have nothing to offer. Even my dog understands that.
@David: What makes the whole situation even sadder is that the GOP used to have an alternative to offer before Obamacare was created. That alternative was, of course, Obamacare:
Here’s a nice preview of what’s coming:
If that sounds familiar, it’s because it’s a preview we’ve seen before:
What’s that? The Cleveland Clinic just announced a bunch of layoffs that are all caused by that dastardly Obamacare?
Uh oh, it sounds like Obamacare is a job killing destroyer of worlds...it’s just like Fox News warned us!
Oh wait, no it isn’t:
Ah, so it looks like all planned cuts to health care costs — including the reduction in Medicaid reimbursements and uncompensated care (payments for services to people without healthcare) that are vital to attempts to “bend the [healthcare cost] curve” — are going to be portrayed as some sort of sign that Obamacare is destroying healthcare in America...even in the states that reject the Medicaid expansion:
Well this is kind of interesting: the fight over Obamacare and the Medicaid expansion is creating a split between the Tea Party base and what’s left of the non-Tea Party contingent of the GOP. Denying health care to poor people and higher revenues for big businesses are rarely in conflict, but right now they are. And, to their credit, the Tea Party is advocating the non-revenue-maximizing policy. If senselessly denying health care to poor people wasn’t so morally reprehensible one could almost congratulate the Tea Party for their principled stance:
Ah, the Tea Party, fighting for the little guy. When you have patriots like this looking out for the common good having a government almost seems unnecessary!
It’s increasingly looking like the GOP’s grand strategy for the Obamacare government-shutdown debacle is going center around pretending that it’s the Democrats that are threatening a government shut down/debt default while simultaneously basking on the Tea Party glory that comes from obstructing the implementation of Obamacare. It’s a boldly strange strategy. Bombs away Teddy! You’re right on target:
This is kind of amusing: One of the consequences of rejecting the Medicaid expansion in states like Ohio and Texas is that the future cost of healthcare in those states is going to be a lot more dependent on the costs of the new private health insurance exchanges that are about to open. So these states should be cheering the news that the cost of these private options looks to be 16% lower, on average, than originally projected. Then again, maybe governors like Rick Perry in states that rejected the Medicaid expansion don’t feel like reminding people that — by forcing lower-income patients onto private health insurance instead of Medicaid and leaving more people uninsured than otherwise would be — they’re also pushing up the costs of private insurance for everyone else in their state:
Hmmm...so by denying the Medicaid expansion, governors like Rick Perry are increasing costs to hospitals AND the public at large. What’s not to love?
While this is obviously a decision rooted in love, it’s still not very reasonable. Maybe it’s a faith-based thing.
Ohio’s Governor Kasich ® supports Medicaid expansion. The problem is the GOP dominated legislature. My state senator (D) said on a local radio program that the legislature will not support the expansion because it’s associated with Obama and “Obamacare”. Period. Even Kasich knows this; he advised my senator not to invoke “Obama” in any discussion of Medicaid with the GOP legislators. He also told him to ouse term “Medicaid Reform”, not “Medicaid Expansion”.
@Kathleen: It’s one of those unsettling signs of the times that John Kasich is a voice of relative sanity. But here we are, where if you can refrain from comparing expanded healthcare coverage for the poor to the threat of Nazi Germany you’re damn near qualified to win a “Goodness” award.
In related news, the set of demands coming out of the House GOP in exchange for not shutting down the government just got a lot longer and crazier:
I’m glad to hear PBO and members of his administration calling them out for what they are. And, yes, the fact that Kasich seems relatively not bat crap crazy is scarey. How low is the bar!
According to Paul Ryan, it’s preposterous to believe that Obama won’t readily agree to negotiated with the GOP’s threat to shut down the government and/or default on the US debt. After all, these kinds of “negotiations” have been going on for years. This is all perfectly normal and expected behavior:
Yes, this is all just part of the standard governing process. Historically, every bill that the minority party found ideologically displeasing was treated like a hijacked airplane on a suicide mission heading towards the capital:
But there’s still the question of what the GOP leaders and their billionaire backers really want. Sure there are the obvious motivations: A good cry that just let’s it all out. Unconditional love. Feeling like you belong. These are all possible motivations. Another possibility, of course, is that all of this acting out is merely reflecting a pent up desire to fulfill a long held pledge...to drown people in bathtubs. So it could be a loyalty thing. But if so, normalizing the idea of a government shutdown and default is also sort of a necessity because when you publicly pledge to drown people in the bathtubs for years on end, the only way to truly accomplish that pledge is to convince enough of your neighbors that you are, in fact, protecting them by drowning people in bathtubs. You’re drowning the community for the greater good. And a great baby-step towards getting people to accept the idea of drowning the community is by first convince your neighbors that shutting down the government and defaulting on the debt are tiny prices to pay to thwart the existential threat presented by healthcare for the poor. Once you’ve accomplished that, drowning people in bathtubs doesn’t sound all that unreasonable.
Now that the House GOP has decided to follow Grover’s lead and demand a one year delay to the Individual mandate and creation of individual marketplaces. In return for the Democrats accepting this “compromise” the GOP will refrain from shutting down the government and/or defaulting on the debt. So, previously, we were informed by the GOP that Obamacare represented a mortal threat to the health of both the American economy and the American public itself. Now, it appears, a delay of the individual mandate for small businesses will give Congress enough time to fix all the kinks and create a positive, workable bill that can achieve bipartisan support. Time, it appears, really does heal all wounds. Health insurance coverage also helps with the healing process but it will have to wait. Because that’s how we roll.
What do you do when you’re hostage taking scheme isn’t going as planned? You take more hostages of course!
Yep, first you take more hostages, but that’s not all. You also need to strap yourself with even more explosives and then demand that negotiators on the other side publicly decry values they hold dear while slitting their throats on live TV. It’s only after your negotiators realize that you’re batshit insane that they’ll begin to take you seriously:
To reiterate: When being an insane asshole doesn’t get the job done, just be a bigger, even more insane asshole. Only then will you see your plans come to fruition:
Hostage-taking can be a fun and enjoyable experience for people of all ages. Just be sure to remember what you’ve been taught and everything should be fine.
And we’ve almost hit the “we’re going to do a ‘Grand Bargain’ and extract entitlement-cuts”-phase of the GOP’s principled opposition. How does an apparently suicidal madman with a nuke strapped to his chest pull himself off the ledge? By threatening an even bigger explosion once he gets more nukes and climbs back on:
We just have to wait and see at this point to find out the “Grand Bargain” talk being bandied about in the GOP caucus is about a “Grand Bargain” or a “Grand Bargain” but it’s unclear how it could end up being the former because that would sort of require the lead hostage negotiator dealing with a pack of suicide bombers agreeing to defuse the situation by putting on his own suicide vest and blowing it up in close proximity to the oldest and poorest hostages. It’s just not a very compelling offer.
One thing is becoming clear: by being as batshit crazy as they’ve been, Ted Cruz and the House GOP have managed to, uh, ‘position’ Grover Norquist and Paul Ryan as “compromisers” that are merely interested in the Ryan Budget. They’ll offer the only way out of this situation, and therefore be practical and reasonable:
Oh my, well it sounds like Grover is proposing something real in return for substantial entitlement cuts. It’s something grander than the possible resolution from the current Shutdown/default showdown. Grover sees the real “leverage” for the GOP residing in a negotiation of removal of the sequester that was put in place as a part of the resolution to the 2011 budget conniption fit.
Since the sequester is scheduled to stay in place even if the current shutdown/default crisis is resolved this isn’t a trivial concession. The sequester involves a large amount of unhelpful austerity policies. It is a grand bargaining concession indeed! Like the suicide bomber offering to remove the not only his new bomb-vest, but also his old one at the same time! How noble. And the only thing Obama and the Democrats have to do to get this awesome deal is agree to blow everyone up with the Paul Ryan Budget Plan. And hey, Grover suggests, why not just embrace the Ryan Plan as an act of preemptive defeat because, at some point, a Republican House and Congress will come along and implement the Ryan Plan anyways so the Democrats might as well do the implementation of the Ryan plan themselves if they want to get any concessions. According to Grover.
It’s a fascinating strategy we’re seeing unfold because Paul Ryan and Grover Norquist are now being cast as the ‘adults’ in the room relative the the Ted Cruzites. But Grover’s proposed “reasonable” strategy is, in his own words, centered around the same goal as Ted Cruz. “Everyone [in the GOP] agrees” on the same goals (the insane Ryan Plan) it’s over methods.
And the new method Grover is advocating for the GOP appears to involve publicly acknowledging that the GOP has adopted a permanent policy of pushing for entitlement cuts that will be much harsher than what the Democrats would dare consider. When Grover says “If I were him I’d trade some money off the sequester today for reforms in entitlements that take place a long time from now. Those reforms will be done by somebody. You might as well get something for them. Someday Republicans will hold the White House and the Senate and they’ll pass the Ryan plan. You might as well get something for it,” that sure sounds like the implementation of the Ryan Plan is non-negotiable with the GOP permanently. So the Obamacare fight is about the become the Obamacare + privatization of entitlements fight. What an awesome new GOP branding effort.
David Atkins has a good summary piece on why the GOP almost can’t win the showdown with the debt-ceiling/default: Even if Grover gets everything in his wishlist, the political “win” will be due almost entirely to threats and tactics. Actual public support for the Grover Norquist/Paul Ryan long-term vision for society only exists in the Tea Party base, and that same Tea Party base determines which GOPers actually end up in Congress due to overzelous GOP congressional redistricting in 2010. And as David points out, long-term spending policies are relatively easy to change as some point (as evidence by the demands for long-term entitlement cuts by Grover & Friends...it’s self-apparent that these laws can change).
So even if Grover wins in the short-run, Grover can’t really win in the long-run unless the US is somehow prevented from ever reversing Norquist-inspired policies. And preventing a reversal of Grover’s laws is going to be increasingly difficult as the GOP’s traditional voting base shuffles off to demographic oblivion. In other words, the stable political equilibrium for the GOP over the next decade (due to gerrymandering) that is driving the current shutdown fever is simultaneously destabilizing the GOP’s long-term prospects by forcing deeply unpopular policies.
Sure, it could be argued that the US is aging overall and the elderly have historically voted for the GOP. But the elderly of the future may not be so pro-GOP when they have no meaningful Social-Security or Medicare. Grover & Friends can’t really have a viable electoral future unless doing things like privatizing entitlements actually leads to a more secure future for the vast majority of Americans. It’s not just demographic trends that are ruining the GOP’s long-term viability. Grover’s far-right socioeconomic utopia had better actually work because the “implosion of goverment would be fun and awesome!”-meme only works as long as a society is still wealthy enough to afford the government programs needed to avoid mass poverty. The “government isn’t the solution, it’s the problem”-meme isn’t going to be a very easy sell after you’ve already trashed the government. It’s kind of like the GOP’s current Obamacare conundrum: Telling the populace that Obamacare would destroy lives and ruin the nation is a pretty easy sales pitch...as long as Obamacare is never allowed to actually come into effect.
While the GOP’s long-term troubles are, generally, a sign of hope for the future, they also raise a chilling question: If the GOP’s oligarch-run utopia really does become an electoral impossibility, would folks like the Koch Brothers and Peter Thiel even be willing to just sit back, makes tons of money, and relinquish their peculiar dreams for dominating the future of humanity? Or will smashing economies for power and profit be replaced with smashing economies for revenge? Then again, maybe the elites will finally drop the mask, smash the economy into the ground and shift their focus to a completely different set of solutions to problem of winning elections...the kind of solutions that don’t require elections. Or maybe the solution will something like what’s going on in the eurozone. But potentially much bigger.
Paul Krugman has a post that highlights the serious existential damage the GOP is risking to itself with the shutdown/default crisis entering its second week. It’s becoming increasingly difficult for a growing number of stakeholders in the GOP to avoid the reality that their party has gone insane in a highly destructive manner with potentially long-term repurcussions:
Part of what makes the GOP’s aggressive public abandonment of the “we’re the adults in the room” mantle is that it was always sort of inevitable that it would come to this. Or something kind of like this...some sort of seemingly unresolvable crisis. It was just a matter of the timing and the particular nature of the crisis. While the current shutdown/default crisis is clearly a crisis of choice future crises that threaten the very foundations of the socioeconomic structure of society may not be so voluntary because the entire socioeconomic paradigm being put forth by the far-right architects of the Tea Party — billionaires like the Koch brothers and Peter Thiel and their partners on Wall Street — is a deeply unsustainable paradigm that necessitates both economic and social collapse. Is that by design? Who knows, because these Tea Party billionaires are clever but also kind of nuts.
Some sort of systemic collapse isn’t inevitable just because of corporate-driven policies that are guaranteeing ecological collapse (which will eventually kill any society). A collapse of some sort is also being made inevitable by the ideological opposition to the existence of an empowered, well-informed middle-class operating in a meaningful democratic system. A middle-class with a real opportunity to earn a living wage and have time to do other things with their life too. How are the market-driven societies of the future — where capitalism replaces democracy and education is limited to those with parents that can pay — supposed to operate with mass unemployment and poverty and minimal consumer demand? We know that economies can function with mass poverty and gross inequalities but there aren’t really any examples of those economies functioning well and in ways that solve long-term problems. Without a government making investments for the future and providing some sort of meaningful level of support of the populace, where exactly is the feedback loop in the economy going to come from where the profits accrued by the top 0.01% are fed back into the economy? What’s going to drive the demand on behalf of the poor? Because there will be a lot of them. The billionaires planning on replacing government must have plans to do so. They should flesh them out more.
And how do the Koch Brothers and Peter Thiels of the world propose to address the reality of robotics and automation dramatically upsetting the balance between the supply and demand of labor between the elites and the rest of us? Is the global economy going to be dedicated to building bigger and better castles and yachts and the robots to protect them? You can only employ so many people to run the robots that build Elysium, so where does everyone else fit into this picture? Is it going to be billionaires living in their private cities and private societies vs everyone else living in larger, crappier quasi-privatized public societies where the government services are provided by companies owned and operated by the people that live in the private cities? Is there any convincing case publicly put forward by the top 0.01% that this endless race of the bottom won’t result in socioeconomic cannibalism?
And if the Tea Party’s billionaire benefactors haven’t made the case for how their utopian future could possibly work then when are we going to see a revolt by the millionaires and billionaires against folks the Tea Party billionaires? Are even lower taxes for plutocrats worth the risk of social upheaval? If everyone can agree that poverty and the availability of advanced technology exacerbates the threat of terrorism and social upheaval then why is that the top 1% don’t view their Tea Party leaders (the Koch and Thiel-like figure especially) as vital threats to their futures? They’re selling an austerity future as the way forward permanently. It seems like an insane long-term strategy for the vast majority of millionaires and even billionaires.
Imagine if the Gulf monarchies didn’t even bother trying to provide some sort of basic welfare to the populace but instead just allowed for mass poverty while the Sheikhs accrued even more of the national wealth. How long would those governments have lasted?
These larger questions of the general sustainability of the Tea Party paradigms are even more relevant now that the “defund Obamacare or we shut down the government” fight in Congress has morphed into a larger “defund entitlements or we shut down the economy” war. It’s a long-term paradigm that’s alarmingly close a kingdom without a social contract. The only social contract in this Libertarian Tea Party future one can really see is the promise that legal contracts are enforced by the law. That’s pretty much it. Everything else is left up to the “free-market”, friends and family, or luck in the kind of future being offered by the people like Grover Norquist and Paul Ryan. And those two are the visionaries in the movement so what they say envision is potentially the future. It’s scary.
Why would we expect that kind of society to result in anything other than a highly fragmented economy of a handful of ‘haves’ and hordes of ‘have nots’? How many millionaires and billionares can exist in a society with just a handful of ‘haves’ and hordes of ‘have-nots’ plus lots of robots? Some millionaires and billionaires will be there, by definition. But how many millionaires and billionaires will exist in Tea-topia society that abandons a social safety-net and embraces harsh “you’re on your own, get a job if you want your disease treated, slacker!”-policies, say, 30 years from now compared to a society that, for instance, actually tries provide people with some meaningful economic and political power and resources — so the robots have something to do other than chase people and the masses aren’t just utterly screwed — and also provides general social justice that can’t otherwise be achieved through the “free-market”. Which society will have more millionaires and billionaires a generation from now?
That kind of multi-decade timeframe is what we need to be considering in the US now that the government shutdown fight over Obamacare has begun to morph into a GOP threat to default on the US debt unless the nation agrees to the kinds of significant long-term entitlement cuts/privatizations that earn Grover Norquist’s approval. This is a continuation of the divide-and-extort strategy championed by Grover and intended to hand control of society over to Grover’s Tea Pary billionaire backers and create a borderline anarcho-capitalist future. That’s where this crew wants to take us and it’s a multidecade-long process.
Robotically enforced cardiovascular-fitness regimes are, of course, fantastically silly scenarios to think about. But it wasn’t that long ago that the idea of debasing the dollar would just become this casual thing that political parties do when the party really really doesn’t want to have to admit to their political base that the party has been lying to them for years about a particular law. These are nearly unthinkable political threats that are being made routine and in no instance have we seen any real indication that the GOP is interested in giving up this “give us what we want or it’s shutdown/default!” strategy now or for good. Even if there was a giant cave by the Obama administration next week and a massive long-term entitlement cut was agreed upon in order to free up this budget/existential impasse is there any reason to believe this wouldn’t happen again at the next opportunity? Or at least during the rest of the Obama administration? Or during any future Democratic administration? No matter what they say? The Tea Party’s billionaires and their far-right cohorts around the world have been making it abundantly clear for years that they’re intent on fundamentally reshaping society. If the eurozone experience is any indication, these folks are really really serious. So who knows how far they’re willing to go to press an austerity agenda but, at least in some of the worst case scenarios, your surviving grandchildren (the poor ones) will be in really really good shape and that should cut down on healthcare costs.
Ok, yikes. Now they’re telling us that not raising the debt ceiling “would bring stability to world markets”:
So does that mean that I can just start selectively not paying back my creditors (specifically US creditors) once I decide to get ‘decisive’ about tacking my debt? Because that might actually be a really popular policy pivot although I’m not sure it would calm the markets. Maybe it’s like 11-dimension Chess, Tea Party-style at work. On the other hand, keep in mind that the full description of Rep. Yoho’s comment on the awesomeness of a default was:
That sounds awfully similar to one of the popular memes floating around in the right-wing-o-sphere about how refusing to raise the debt ceiling won’t force a default at all because there will still be plenty of money left over to pay the interest on the debt with existing revenue streams. All we have to do is casually slash or eliminate federal programs and entitlements to balance the budget. We’ll just have to suddenly decide that right now is a really important time to suddenly sucker punch the economy and create our own little GOP Troika of one to implement the Ryan Plan. That’s all (because if we don’t we’ll go bankrupt very soon). Once the Troika is satisfied, the debt-limit will be lifted and everything will return to the new normal. Elections had consequences. Now it’s all fun and games.
With polls showing 70% disapproval for the GOP’s handling of the shutdown/default crisis, you have to wonder how how much time was spent planning this whole thing. Because it’s not like there’s been a lack of time. Or money. Or experienced secret plotters:
It’ll be interesting to learn how much direct involvement Peter Thiel has with “Team David” in the showdown between a band of plucky billionaires and the Obamacare Goliath. After all, Thiel views social safety-net policies — like women voting — as social cancers. He was also an early investor in Cruz Co. So this seems like exactly the kind of issue that we should expect to receive more than just of spoonful of that sweet sweet Thiel sugar.
It looks like the “What, me worry?” Congressional Brigade is still accepting members:
When folks like Veronique de Rugy — from the Koch-financed Mercatus Center — are questioning your debt-ceiling showdown tactics you know you’ve entered overreach-territory. Enjoy the ride.
It’s time to get excited! America’s own lil’ homegrown Troika-system of Billionaire Justice is coming soon:
Part of what’s making this latest round of acting out by the GOP so disturbing is the number of notable people that seem more than willing to just suddenly publicly endorse the notion that selectively not paying interest to US creditors wouldn’t be damaging to the US credit and credibility at all. In fact, the argument goes, global community might be even more confident in the US because we would have engaged in preemptive eurozone-style austerity to demonstrate to the world how responsible we are as a nation. Plus, the argument goes, if we don’t immediately make radical commitments to dramatically scaling back the safety-net for generations to come, the US will soon suffer a crisis of global confidence and fall into hyper-inflation and the Weimar 2.0.
That’s the growing meme and sure, the “hyperinflation! Too much debt!” arguments have been a regular part of US politics for decades, but are we now witnessing the introduction of “hey, there’s no such thing as default...just helpful austerity!” as part of the new New Normal? A new Amerozone Truism? Now, apparently, the world gets to know that every time one of the US’s political parties decides an uncrossable budgetary line has been crossed, the government shuts down until a Super Committee is created to overhaul the social safety-net? Can’ just being sorry be enough? Are cabals of billionaires that take things into their own hands and smash them really necessary? And...Yes, such cabals are apparently necessary.
And just today, we have reports of a respected Harvard economist dismissing concerns about a default and making the exact same claim that a selective default would be just fine. It raises the question: Is the debt-bug up everyone’s ass of the brain-eating variety? Because that sounds like a public health concern that calls for expanded healthcare coverage.
Oh wait, never mind. That respected Harvard economist was Martin Feldstein. Parasites ate his brain years ago. So it may not be a brain-eating parasite infestation, although it still leaves open the question of what’s causing the uptick in mass-insanity levels. BodyThetans? Maybe?
Just because a band of homocidal puppets go on a rampage doesn’t mean you can automatically blame the Puppet Master. Maybe the Puppet Master has a perfectly good excuse for the rampage. Or not. Either way, you can’t blame the Puppet Master:
So if we can’t blame the Puppet Masters when their puppets go on a rampage maybe we could at least require that they get something like liability insurance for the puppets? Would that be acceptable? Ah, that would probably be a ‘no’.
A somewhat surprising twist in the recent hostage-taking pivot by the GOP — from demanding an end to Obamacare to demanding major reforms to social security and Medicare — is that it seemed to be a pivot towards a policy position that explicitly attacks America’s youth in a such a way that the GOP gets virtually all of the blame. When it was just a fight about defunding Obamacare at least the GOP could posture in a way that seemed to say “hey uninsured young people, we’re stopping Obamacare in order to save you from the horrors of health insurance”. But now, thanks to the new demands that the US now suddenly implement long-term entitlement cuts, it’s going to be a lot harder for the GOP to walk away from this situation without looking like a cabal that hijacked the normal democratic process in order to wage a long-term attack on young people’s retirements. It’s a high-risk response to the much feared “demographic Winter” for the US far-right. You can’t have your preferred brand of mindless tribalism dominate the future political landscape when your tribe is systematically alienating the future members of the tribe. And now the grand hostage-taking strategy being advocated by thought-leaders like Grover Norquist is to take attention completely away from the Obamacare fight. Instead, they’ll refocus on offering the Democrats a short-term lifting of the debt-ceiling in exchange for partial implementation of the Ryan Plan to be phased in over decades. That appears to be the offer Grover is now pushing as ‘Plan B’:
What a deal! Who wouldn’t be tempted by “temporary and limited lifting of the sequester to allow some more spending now, in return for reducing some of the $64tn (in present value) of the unfunded liabilities in the future”? It’s an especially tempting offer coming from the guy that recently suggested the Ryan Plan was going to be implemented no matter what, it’s just a matter of time. Oh goodie!
It’s still unclear, though, how America’s youth is going to appreciate the Ryanization of their financial futures as the payout for the whole hostage-taking thing since it seems to involve handing their futures over to Wall Street. Sure, that kind of fully Ryan-compliant grand bargain is unlikely to happen in this
firstsecond pass, but as Grover promised, it’s coming. It’s just a matter of time. Bit by bit, the financial security if today’s youth gets traded away for decades to come in exchange for those awesome Norquist revenue increases. And lots of future debt-ceiling fights.Since this is all just a taste of future safety-net fights to come, it raises the question of just how far the GOP is interested in going in terms of privatizing the future entitlement system of the youth because any short-term agreement is implicitly a long-term agreement to repeated hostage-taking sessions. The long-term visions is pretty important for at least the short-to-medium-term because the US is apparently going to be forced into some sort of New Koch and Tea Deal via legislative capitulation or the US is going to be forced into insolvency. So what are the long-term terms of the deal being offered to the US? Especially the youth? Do any of us get to know? Is there at least a fixed crazy-rate that young adults to rely on in their far-right thought leaders while these leaders are planning the youth’s retirements or is it one of those fancier loans that just follows the crazy-market? Because the crazy-market looks scary.
I read today that Kasich may use an Executive Order to accept Medicaid expansion.
@Kathleen: Yep, and now the next step, if Kasich chooses to go through with the executive order, would be to seek the approval of a seven-member GOP-dominated Control Board. And, according to Ohio’s Senate President Keith Faber, if the board rejects Kasich’s order he can either reverse the executive order or Ohio’s entire Medicaid system will go bankrupt. ‘Tis the
SeasonNew Climate of Endless Shutdown Showdowns and Happy Healthcare Holidays! At least in Ohio:Paul Ryan, the GOP’s official “adult in the room”, just dropped the mask a little more. In addition to holding on to their dreams of repealing Obamacare, he’s encouraging the GOP to “completely rethink government’s role in helping the most vulnerable” and “completely rethink government’s role in our lives”. Considering that radically overhauling and privatizing the government has been a GOP OCD fetish for decades, you have to wonder if there’s anything new that Paul thinks we should rethink...
Hmmm...something tells me this “complete rethinking” called for by Paul Ryan involves a lot of old thoughts:
In related news, now might be a good time to start rethinking your personal moral paradigm. It’ll ease the existential angst in the event of a thoughtless future.
Hi, Pterrafractyl: Here is the latest on Kasich/Medicaid (from 10–12 edition of Cincinnati Enquirer)It’s intersting to me that Right to Life and Chamber of Commerce support the expansion:
COLUMBUS — Gov. John Kasich’s plan to use a seven-member board to expand Medicaid has drawn praise from Democrats, while infuriating tea party Republicans, who say Kasich has abandoned the base that elected him – voters he may need in 2014.
After failing to win support from Republicans in the full General Assembly, the Kasich administration on Friday asked Ohio’s Controlling Board to let the state accept federal money to expand Medicaid to as many as 366,000 new Ohioans. On Oct. 21, a Kasich appointee and six state legislators – four Republicans and two Democrats – will vote on the administration’s proposal.
“At this point, I’m pretty much good with whatever realizes Medicaid expansion for the state of Ohio,” House Minority Leader Tracy Heard, D‑Columbus, said this week, summing up Democrats’ reaction. A spokesman for Kasich’s presumptive 2014 gubernatorial opponent, Cuyahoga County Executive Ed FitzGerald, called Kasich out for his inability to get a bill through the Legislature, but said getting health care coverage for low-income Ohioans was “what ultimately matters.”
Kasich’s former Republican supporters, tea partiers such as Union Township’s Ted Stevenot, accused Kasich of bypassing the Legislature and ignoring voters who elected him.
“How can he campaign over and over again that he’s against Obamacare and then turn around and do this?” said Stevenot, who is president of the Ohio Liberty Coalition. “At a certain point, enough is enough.”
What is the Controlling Board?
Take our poll: Should Gov. John Kasich use the Controlling Board to expand Medicaid?
Tell Kasich where you stand using the Enquirer’s “Talk to Your Government” tool.
What you’re telling Kasich about using the Controlling Board to expand Medicaid
The disagreement between pro-Medicaid Republicans such as Kasich and anti-Medicaid conservatives is a challenge for GOP leaders trying to keep the party together. Matt Borges, chair of the Ohio Republican Party, on Friday released a statement that sought to embrace both sides and focus on the “shared missions” of overcoming Democratic opponents.
“Conservatives all oppose Obamacare,” Borges said. “On the separate matter of Medicaid, good conservatives have worked to make the program better.”
Letting the full Legislature make the decision on Medicaid expansion would have been ideal, Medicaid supporters and opponents agree. But federal money becomes available Jan. 1, and Kasich’s administration has decided it can’t wait any longer.
“From the beginning, we viewed this as a partnership with the Legislature,” said Greg Moody, who has overseen Kasich’s Medicaid expansion efforts. “The vehicle of the legislative Controlling Board seemed the most direct route to get this done on time.”
The move is legal, supporters say: One of the Controlling Board’s routine functions is to approve increases in federal money, including requests from the state Medicaid Department.
But it’s unusual to use the board for what is essentially a policy change: expanding Medicaid to adults who earn less than 138 percent of the federal poverty level – currently less than $32,500 for a family of four. Any Controlling Board approval is expected to invite a court challenge, and Kasich’s action might be enough to push a conservative Republican into a primary to challenge his 2014 re-election bid, Stevenot said.
The sevenControlling Board members, contacted by The Enquirer this week, were generally coy about how they would vote. Kasich needs four “yes” votes. With the approval of his appointee and, presumably, the two pro-Medicaid Democratic legislators on the board, he would need only one of the four Republican lawmakers.
While none of the GOP lawmakers on the board are vocal Medicaid supporters, House Speaker Bill Batchelder, R‑Medina, is expected to replace at least one of the House Republicans before Oct. 21. That will likely get Kasich the votes he needs.
A group of Republicans, plus organizations such as Ohio Right to Life and the pro-free-market Cincinnati USA Chamber of Commerce, support Kasich on Medicaid expansion.
Subs for the Controlling Board may come from term-limited House members who are members of that group: Rep. Ross McGregor, R‑Springfield, openly supports expansion, and Rep. Lynn Wachtmann, R‑Napoleon, this week told The Enquirer he was open to extending Medicaid benefits to the additional group of Ohioans. Rep. Gerald Stebelton, R‑Lancaster, is also thought to be willing to consider expanding Medicaid; The Enquirer was unable to reach him Friday.
The Kasich request asks for 18 months of federal Medicaid money, worth $2.5 billion. That’s because the board’s authority is limited to each two-year spending cycle, said Moody, Kasich’s Medicaid-expansion point person. Unless the General Assembly passes a bill expanding Medicaid for the long-term, the governor’s administration would have to renew its request with the Controlling Board when the state spending cycle resets in June 2015.
Many Republicans have been wary of Medicaid expansion because they’re worried the federal government could back out on its commitment to pay for 100 percent of the new Medicaid members’ care through 2016, phasing down to 90 percent after that. The Kasich request includes a line that affirms the Controlling Board would only be accepting the federal money, not agreeing to use state money if federal funds disappeared.
“If that financial situation somehow changes,” Moody said, “state funds will not be used to supplant the coverage of this group.”
Here’s the link to the story: http://news.cincinnati.com/apps/pbcs.dll/artikkel?NoCache=1&Dato=20131012&Kategori=NEWS010801&Lopenr=310110079&Ref=AR■
@Kathleen: It looks like Ohio Right to Life’s support for Medicaid expansion is the exception to the rule. One reason the Chamber of Commerce’s support for the Medicaid expansion might not be entirely unexpected (although still unexpected) is that, unlike groups like the Club for Growth, the Chamber of Commerce has so many local chapters that have to at least pretend to have the interests of local businesses in mind that rejecting the Medicaid expansion is like saying “please go die” to many local healthcare economies. Local people too.
@Pterrafractyl: I was surprised, too, by Ohio Right To Life support. We’ll see what happens. I was initially told by ACA hot line that I would qualify for Medicaid, so I have a stake in the expansion being accepted.
@Kathleen: Fortunately, based on today’s reports, it sounds like Ohio’s Medicaid expansion is expected to pass the seven member Controlling Board. Let’s hope that’s right, because as Senate President Keith Faber reiterated today, if the board doesn’t pass the expansion Ohio’s Medicaid system goes broke. So it sounds like the situation is that either folks like yourself will become eligible for Medicaid or Medicaid in Ohio acquires a nasty case of Tea-Party-shutdown-itis and no one gets Medicaid because Tea-Party-shutdown-itis is potentially fatal:
And be sure to send the following article to your friends and family that may not understand how important the Medicaid expansion and Obamacare/ACA is to Ohio’s hospitals. It does a great job of laying out why it is that the Medicaid expansion isn’t just required to save lives and prevent medical-related bankruptcies. It’s needed to save the jobs that the GOP and Tea Party claim to care so deeply about. It also explains how an additional $95 billion in Medicare cuts on top of those already in the ACA (including an $11 billion cut in Medicare fees to hospitals due to the sequester) has been impacting healthcare providers across the nation. The refusal to accept the Medicaid expansion has been a major factor in forcing cuts to hospitals’ staffs and services but it’s far from the only factor:
Note that the last section of the article — the part about the problems of unpaid bills potentially growing and impacting hospitals even more under the ACA/Obamacare because you’ll have more people signing up for insurance with deductibles that they can’t afford — has an unspoken but pretty clear implication: For the Affordable Care Act to work, we kind of need an economy that pays workers enough to actually save the thousands of dollars needed to pay their deductibles. In other words, in contrast to the fevered concerns about Obamacare creating a nation of poor people dependent on the government, the reality is that the ACA/Obamacare simply can’t work in a broken economy that doesn’t pay growing numbers of low-income workers enough to save for that eventual expensive healthcare cost. It might take a decade or more of ongoing trends of low US savings and wage stagnation — with the resulting impacts of lower Medicare and private reimbursements due to an inability to pay the deductibles and starving hospitals — before the ties between the cost of healthcare and gross inequality and long-term economic hopelessness for people left out the New Economy becomes part of the national conversation.
So, on a positive note, it’s possible that one of the lessons the US eventually takes away from this whole experience is that living wages are required for the sustainability of the US’s healthcare system if the US decides to avoid a single-payer solution and continue pushing most individuals towards private insurance plans. It also means that the economic pain inflicted by crazy politicians is systematically poised to trickle down to the hospitals (sequesters, reduced Medicaid coverage, etc) but also bubble up to the hospitals as the economic consequences of mass insanity percolates through the economy.
Will valuable lessons be learned about the relationship between paying a living wage and living in a decent economy that can maintain a viable healthcare sector? Probably not, but something is probably going to be learned from this Obamacare default-debacle. Maybe it’ll be a positive lesson although it’s quite possible it’ll be negative. A confused mishmash of positive and negative lessons that in no way lead to coherent solutions for the challenges of the day is also very possible so we’ll just have to wait and see.
Returning to the topic of Ohio’s Medicaid expansion: Good luck Kathleen. And good health too. With the way things are going good luck and/or good health may be a requirement for decent healthcare so such salutations that include “and good health” may become obligatory. The new economy, like the old economy, still sucks. It may or may not become a costlier and deadlier economy. That will depend heavily on things like whether or not a state accepts the Medicaid expansion and generally cooperate and creating a viable future.
Or maybe these state-based battles over healthcare and the social contract will become moot because the GOP in the House preemptively tanks economy...
....
Good luck and good health Kathleen!
Well, now that
this flickthis flick has finally ended, it’s on to the next obvious question: When’s the sequel?! Because that flick was sweet! I haven’t been that transfixed with horrified befuddlement since Mulholland Drive.So when is all the bickering, bombast and betrayal returning to the big screen?
What’s that?? The next shutdown debt ceiling breach could be as soon as February 7th? Wow, that’s a pretty ambitious schedule. Are they filming these sequels all at once? Because that sounds expensive. And if the GOP hasn’t been planning a sequel, then who are they going to find to direct a February sequel on such short order? It would take someone with Peter Jackson’s fantastical vision and David Lynch’s flair for otherworldly torment. That isn’t a directorial position easily filled, especially when some of the top talent in modern American horror recently expressed disinterest.
Hmm...who could it be that could fill such shoes on such short notice....?
Hmmm...
Oh man, this sequel could be awesome.
Now that a sequel to the Great Shutdown Default is looking increasingly possible in 2014, one of the big questions for all the Alt Hist Horror fanboys is going to be whether or not the sequel will include a new villain. Especially a villain with a weapon just as powerful as Obamacare. Maybe Bane with a new secret weapon? How about Scarecrow makes some sort of pro-public-health anti-Gay gas? Just think of the possibilities. So many possibilities.
BizzarObamcare is coming for you in 2014.
Pterrafractyl: Thanks so much for the good wishes and additional information. As a side note, a friend of mine who is in the medical field (she trains hospital personnel in the new medical records software required for Medicare reimbursements)said that many people are conflating doctors’ resistance to the new software with resistance to ACA implementation. The two events are not related. Some doctors have closed their practices because they didn’t want to use the software for record keeping. Right wing email chains are claiming they’re closing practices because of ACA. Thanks again!
@Kathleen: Well, according to one of the GOP’s top 2016 presidential candidates that happens to be a doctor, spreading misinformation amongst your fellow citizens can be totally acceptable behavior. And that apparently includes misinformation about healthcare policies:
Spreading misinformation is what good patriots do!
Get ready for the next manifestation of the GOP’s plans for healthcare reform:
Here’s an important update regarding the impact on the healthcare systems in states that refuse to accept the Medicaid expansion: Nothing has changed. Hospitals and patients in those states are still extra-screwed and it’s getting worse:
Yep, if people can’t afford to pay their out-of-pocket expenses, hospitals will be increasingly on the hook for the costs. And if the economy sucks, it’s even worse for the health of the healthcare system (and people) because more and more people are either going to be pushed into the Medicaid-Gap No-Man’s Land, or they just be driven into financial distress from the crappy economy and unable to cover their deductibles. It’s a reminder that that any real long-term reform of the US healthcare system is going to require an end to the larger problem of socioeconomic cannibalism.
Until then...
Well, now we know a little more about the GOP’s alternative to Obamacare: Free Keggers with that Creepy Uncle Sam. Hopefully you won’t have much more than a sore muscle, though, because he appears to mostly just offer massage therapy:
If this seems like the kind of healthcare option you’re looking for but you missed the event don’t die too soon because it sounds like we can look forward to a more free “Freedom School” experiences in the future. From sea to shining sea.
Remember this threat from Senate minority leader Mitch McConnell back in July? If the Democrats remove the filibuster of pending judicial and cabinet nominees the republicans will remove the filibuster for everything once they regain control:
So if the filibuster was repealed for judicial and cabinet nominees, would the GOP really pledge to repeal Obamacare and everything else they could in the Senate using a simple majority if they retake the Senate in 2014? The president could still veto such a bill, but if the GOP takes the White house and a simple majority in 2016...bye bye Obamacare (and hello Norquistcare). And bye bye to just about any other social program (it’s all part of the Norquistcare package).
So the stakes for upcoming elections would potentially go a lot higher if the GOP actually took that pledge to go global in their nuclear response. But would they actually make that pledge as part of the GOP brand if the Democrats decide to ‘go nuclear’ and end the filibuster for judicial and cabinet nominees? We just might find out:
Could a complete repeal of the Senate filibuster now be an implicit component of every GOP Senate candidate: vote for me, and we’ll get rid of all the filibusters and then nominate the most conservative Supreme Court justices we can possibly find. That type of electoral strategy could play well with the GOP primary voters and in gerrymandered House races, but will this new branding that make the GOP even more unrestrained work well for the part in the state-wide Senate races? It’s going to be really interesting to see how this impacts the GOP’s ‘brand’ because the filibuster is one of those things that’s given the GOP in the Senate an excuse to be slightly less crazy than their House counterparts. Are pledges to appoint more far-right Supreme Court justices really going to help the brand? Maybe:
Then again, maybe going full-scale nuclear won’t actually be part of the strategy. A quiet nuclear war might be their preferred option:
Hmmm...the emerging theme appears to be, “Vote for us and we’ll completely unleash the GOP Kraken! But don’t spend too much time thinking about, you simpletons”. It’s hard to say how this will play out in the campaigns, especially in 2016. But, from a purely political standpoint, it’s probably an improvement.
It turns out you don’t need a computer to conduct a denial of service attack against Obamacare. A phone will do:
It also tursn out that you don’t need a computer or phone to conduct a denial of service attack against Obamacare:
Huh, so the GOP is basing its electoral strategy for 2014 on the failure of Obamacare. At least according to the “playbook” memo. That sure sounds like the kind of political strategy that could benefit from some more denial of service attacks.
The millions of the still-uninsured must be really thankful that they aren’t being ‘placed on the Titanic’. That sounds awful:
In other news, extending unemployment insurance for the long-term unemployed is sort of like buying them a ticket for the Hindenburg...
Increasingly radicalized far-right movements can be quite a problem, but it’s especially problematic for the groups trying to harness that radicalism when the movement is literally dying:
Hmmm...well, maybe the GOP’s resolve to ‘speak up about abortion and respond forcefully against Democratic efforts to paint them as anti-woman extremists’ will make inroads with the youth vote and solve this pesky “aging, white radicals” problem. If not, there’s still no reason for a GOP freak out. They can always just retool Plan A again:
And if another Obamacare-shutdown doesn’t mesmerize the populace and expand the base, the GOP could always try to convince young voters that it actually cares about their civil liberties and futures. It’s a long shot, but it just might work:
Could we see a new young, hip, civil-liberties-loving GOP sweep the nation off its feet in 2014? We’ll see!
But either way, the GOP clearly has to make a pivot away from its socially conservative base and embrace its Libertarian future someday and right now might be as good an opportunity as the GOP will ever get to rebrand the party not as the last refuge of aging, white radicals but as the party of youthful revolutionary spirit...a sort of stopped clock for the future. So we should probably expect a lot more youth-friendly embraces of the Ron Paul/Rand Paul Libertarian wing of the party, especially if the upcoming “Obamacare-bailout shutdown” doesn’t go well. And who knows, we might even see a few more rebranding attempts by the Libertarians themselves as this trend progresses.
Still, the GOP should definitely avoid embracing its inner Libertarian too aggressively during this rebranding phase. That might solve the GOP’s “aging, white radicals” problem a little too soon.
Congrats GOP:
Mission accomplished!Mission accomplished!It’s only fool’s gold if folks find out:
*gasp* You mean poor people aren’t going to have to work quite as many hours in order to keep their healthcare? Well, there goes another great American tradition.
But don’t worry GOP, thanks to the brave actions of the state legislatures around the country that refused to expand Medicaid the great American tradition of working until you die in a ditch is being kept alive. And because the hospitals in those states aren’t getting the Medicaid patients they were expecting, hospital jobs are also being lost which can then be blamed on Obamacare! And these job losses are involuntary, just like they should be...none of that wussy Obamacare-“I don’t want to work so much because I’m old and need healthcare” nonsense.
Refusing to help: it’s the gift that keeps on giving:
Now you know why Arkansas’s GOP legislators are all excited.
A snapshot of our contemporary din:
Altruism. Is it bad or good?
If ongoing debates over the merits of altruism leave you feeling stressed out and concerned for the future, don’t let the stress get to you too much. Stress induced by an observed lack of empathy in others can be a self-reinforcing problem. Instead, find ways to de-stress as many other people as possible. How might we accomplish that? What should be avoided at all cost?
Those ‘death panels’ must be very busy these days.
“The GOP’s Most Cynical Anti-Obamacare Attack Yet?” That’s a pretty high bar. Let’s see how this one does:
OK, it’s definitely a double.
Just imagine how awesome healthcare could be in the US without the ‘awesome evilness’:
Well at least we don’t have to worry about states acting with complete impunity. It’s still a democracy under the rule of one man one vote and politicians that use the poor as a political effigy can still be voted out, especially by the people getting targeted by awesome evilness. Right? Maybe?
The National Republican Congressional Committee just issued a public cry for help over its inability to stop fixating on Obamacare. Fortunately, help is on the way! Ironically.
Ok then:
Well, at least these two attorneys general might accidentally expand access to healthcare. That may not have been their intent but, hey, it’s still sort of a good deed. Sort of.
The History of Mother’s Day 101. Lesson 1: The mother of Mother’s Day wasn’t very proud of her offspring.
Happy Mother’s Day:
Now you know: The second most popular holiday for giving gifts was created in the memory of the mother of its founder, Anna Jarvis, a peace activist who died penniless and broken in a sanitarium after trying to end the holiday after seeing it deviate from its roots:
Happy Mother’s Day.
So in the spirit of Mother’s Day, here’s a fun story about a man that used the memory of his mom to end but then re-embraced his senseless opposition to an offer by the Federal government to pay for the healthcare of a large number of uninsured poor people that are almost poor enough to qualify for Medicaid, but not quite. Happy Mother’s Day:
“Scott may have publicly claimed in 2013 that his position was about his “conscience” and deceased mother, but according to the governor’s new version of events, the rhetoric wasn’t actually sincere – his previous position was a calculated move to gain approval for his privatization plan.”
Extra-happy Mother’s Day.
And yes, instead of expanding Medicaid, Rick Scott, who made his fortune starting a chain of private hospitals, suddenly announced that the Medicaid expansion isn’t happening and his administration is now suing the Federal government over charges that the Feds are was trying to coerce Florida into accepting the Medicaid expansion by saying the “Low Income Pool” (LIP) program was supposed to be replaced by the Medicaid expansion would expire as scheduled.
But that’s not all. It turns out that Rick Scott just convened a commission to study how publicly funded hospitals spend their money. And the entire panel will be selected by the governor. And the last time Rick Scott convened a commission like this it recommended the widespread privatization of Florida’s hospitals. Super extra-Happy Mother’s Day:
Happy Mother’s Day.
Imagine that: Some public hospitals win, others lose with Obamacare. Specifically, if your state expanded Medicaid instead of kicking the poors, your hospital probably won. Otherwise...:
Wow! So in addition to turning down federal Medicaid dollars that the states’ tax-payers are legitimately owed, the states that refuse to expand Medicaid are forced to fill the gap with local funding:
And on top of all that, in the states that expanded Medicaid, hospitals are now facing more competition in the healthcare marketplace:
Lower taxes and increased competition. Head for the hills!