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Reposted from jmkiru by aigeanta

On some level, all our services, all the resources and functions of our society, are optional.  Many we've had for so long we simply accept them, others are contentious points of debate, others are pie in the sky dreams for some, and dread nightmare for others.

  None the less, everything is to some degree, a choice.  A police force is not mandatory, nor is the fire department, nor the armed forces... each of these at one point or another, was created to solve a problem.  

 People often differed on what problem they were solving, but they agreed on the solve.  For example, does the law exist to safeguard liberties, or mandate compliance with accepted norms?  Do we build prisons to punish or to reform, or just to separate the dangerous people from the regular folk, or maybe some combination of the three?

  Even after a solve is chosen, it's scope can change - should the police protect everyone, or just taxpayers?  Should illegal immigrants be protected by the laws of the land, or is their presence here a more terrible crime than whatever was done to them?  If you can't pay the fees for the fire department, should they save your house anyway?

  Then there's healthcare.

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Reposted from nyceve by aigeanta

There was a free health clinic recently held in Los Angeles. Dr Mehmet Oz was one of the volunteer doctors, and he's written a particularly scathing and brutal article in Time magazine about what he witnessed. It's appropriately entitled, Enough is Enough.

I've been to many free clinics around the country, and to participate is both an honor and a life changing experience, even for a clinician, like Dr. Oz, who's undoubtedly seen terrible things in his medical career.

 It's life changing because though you think you may understand in some intellectual sense, how bad things are for 50 million Americans unable to access basic healthcare, to see,and feel and touch people who are walking around with terrible disease, and in physical pain, is to enter a terrible and depraved world that should not exist in our country.  But it does.  A world within the United States of America, that exists solely because we have a political system, totally owned by special interests and controlled by Wall Street.

Because we live in a country where healthcare is rationed by the ability to pay, and for-profit health insurers buy access to lawmakers who vote to maintain the awful status quo. The rich live, the poor and middle class die, or delay much needed care, simply because of cost and because healthcare in the United States remains a privilege not a right.

The middle class are saddled with health insurance policies requiring impossibly large out-of-pocket payments, deductibles and premiums, which for all intents and purposes, puts healthcare out-of-reach for many.  This is our uniquely American way of rationing care.

Dr. Oz writes:

The smell was unmistakable. I recognized it immediately – a fungating infection. It’s what happens when a cancer breaks through the skin and the puss oozes out and aerosolizes, producing an unsurprisingly foul odor. This is what late-stage cancer looks like if left unchecked, like many cancers were 100 years ago and still are today in the developing world. But I encountered this case this month, and Yvonne, the woman who sat crying before me, lives in Los Angeles. She lost her job two years ago, and when her insurance expired, she was too ashamed to seek help for a mass she felt in her right breast. Now the tumor had replaced her entire breast and blasted through the skin. Being cared for now — so late in her illness — was surely not what she would have wanted; and just as surely, it could have been avoided. How did we let this happen in America?

Indeed, how did we let this happen in America?  In Los Angeles, in the middle of the largest city in the richest and most morally bankrupt country on the planet.

I've been asking myself this for many, many years.  I've been wondering as my health insurance premium skyrockets another 20% this year, how long I will be able to hold on.

I chuckle that Democrats passed a bill called the Affordable care Act, and these same Democrats are perplexed that public support is plummeting as premiums are skyrocketing.

I remind myself after reading the  Amicus Curiae brief submitted by AHIP in partial support of certiorari review, (which I urge all of you to read), that we should all heed the warnings of Wendell Potter who tells us the insurers want a mandate with no regulations.  

The AHIP brief is urging the Supreme Court to review the severability of the individual mandate from the rest of the ACA on an expedited basis.  Take home AHIP message, without a mandate, they're walking. Just as Wendell said, insurers want a mandate and few or no regulations.

Dr. Oz continues his unsparing look at our collapsed system, "But simply having been down this road before does not mean you’re ever fully prepared for it."

Dr. Oz has volunteered at other clinics, and he's correct, you never, ever get used to witnessing the deadly depravity of political indifference.  The political class looks the other way as American citizens struggle to get basic health care. The political indifference to our basic human needs has permeated like a malignant cancer into every nook and cranny of this country. No wonder Americans are finally standing up--rising up, and screaming like Dr. Oz, enough is enough!

My radio crackled, and I was called to see David, a 25-year-old overweight Latino man with a blood sugar of 355, far above the tolerable level of 100. He had come to the clinic because of eye problems, a common complication of diabetes, but he had not seen a health care professional as an adult and did not appreciate the classic symptoms of frequent urination, constant thirst and lethargy. I pressed on his gums and pus poured from abscesses cause by the untreated elevated blood sugar. As I walked him to the dental clinic on the floor of the arena, he asked insightful, targeted questions about his condition, a conversation that should not have happened by chance at a free clinic. The simple advice David collected could help him avoid the rusting of his blood vessels and the amputations, kidney failure, strokes and heart attacks that would otherwise define his life and cost the health care system much more than a timely consultation. I witnessed the surreal effect of David’s teeth being treated where pro athletes usually dribble basketballs until a young mother asked me about a problem with her mouth. She had come to the clinic because, while her children had health insurance from the state, she was not covered.

"If enough people start to say enough" And for me (nyceve), this is why we must Occupy wall Street.

Yes, Dr. Oz, finally, at long last, millions of Americans are risking arrest, and worse, injury, and police brutality and saying with one collective roar, "ENOUGH!"

Surgeons like me have to be irrational optimists, so I am going to apply this trait on a grand scale. If enough people start to say enough, we will get somewhere. I love working among the selfless people who staff these free clinics, who show patients that someone cares about them. But every time I finish a day’s work, I silently pray it will be the last one we need. Get to know the Yvonnes and the Davids, and then let your frustration guide us to an America where free clinics are the stuff of history and the simple dignity of the chance to be healthy is the living reality.

I want to end by reminding everyone what my friend and fellow health care warrior Nicole Lamoureux-Busby, Executive Director of the National Association of Free Health Clinics says about the patients who come to the clinics run by the organization she leads.

About 83% of NAFC’s patients come from a working household but cannot afford health insurance. We have had patients who were working multiple jobs but had to choose between the high cost of insurance payments or putting food on the table for their family. While there are patients who lost their jobs in the bad economy and come to our clinics for care, a large majority of our patients are actually underinsured or uninsured, but not unemployed.

Our free and charitable clinics work daily throughout the nation to try and meet the overwhelming needs of the uninsured population. Our clinics do so with little to no state or federal funding but through volunteers and generous donations. It is truly the story of neighbors helping neighbors, hope for the uninsured and volunteerism at its best.

Reposted from nyceve by aigeanta

Given the terrible police brutality in Oakland, I wrote a comment in brooklynbadboy's diary about the wonderful NYPD police captain I had the pleasure of working with yesterday. Several people suggested I should write a diary because we need to highlight the good police officers.

Captain John D'Adamo carefully and with great respect, guided the healthcare protesters as we marched from Zuccotti Park up Broadway, through Washington Square Park, up Fifth Avenue, across 14th Street to the now shuttered St. Vincent's hospital.

Not one arrest, not one sharp word, not one bad moment--thanks to Captain D'Adamo's skillful leadership, and a committed group of peaceful protesters.

I've written several diaries about terrible and reprehensible police behavior especially the police violence on 47th Street during the Occupy Times Square protest on October 15th.  So fairness requires that we praise, 'New York's finest', when indeed they behave responsibly.

NYPD Captain John D'Adamo is a magnificent template for how a police officer and public servant should work with unarmed Americans simply exercising our right to assemble and peacefully protest. Certainly the healthcare marchers were fortunate to witness and be recipients of his calm leadership yesterday, as we marched for single payer healthcare.

Our march began at Zuccotti Park.  The captain escorting us (Captain D' Adamo) was beyond professional. He was superb!

That's me up at the front in the beginning of the video standing next to DrSteveB.

He told us at the outset, "I'm here to help you guys get to where you need to go. Just work with me, and I promise I'll get you there". And he kept repeating this for four miles and four hours. "Just work with me and I'll get you there." We gave him a map and he'd keep doubling back (he was about a half block ahead of us), asking which side of the street we wanted, where did we want to turn, he told us if he spotted an obstruction ahead, etc, etc. He was helping us, assisting us, arrive safely at our destination.  He and the officers under his command, were consummate professionals.

I felt so assured by Captain D'Adamo, that I asked him if he was assigned to us for the entire march. He said, he'd be with us for however long it took to arrive at our final destination.  I felt very relieved knowing he would be the supervising commander because it was clear, he was there to assist and protect us, not to harm us.

I was what is called a 'pacer' and was stationed right at the head of the march.  I was wearing an armband, and the Captain knew I was one of the organizers.

He had four Community Police officers, literally walking four abreast in front of us,  clearing the sidewalk.  These community officers moved obstructions in front of the line of march, and politely asked pedestrians coming in our direction to move aside.

We had probably 25 motorcycle cops in the street, and three helicopters overhead.

I stayed in pretty constant communication with Captain D'Adamo, who, as I said, was with us all the way to the now tragically shuttered, St Vincent's Hospital.  When some of the marchers spilled a little into the street, I stepped out to get them all back on the sidewalk, and the Captain thanked me for helping him.

When we got to 14th Street, we were linking up with about 150 additional protesters. We advised the Captain of this, and he huddled with us figuring out the best way to "marry", in his words, the two marches into one big group.  He was going out of his way to make this smooth--for him, his officers, and us.

After we got to St Vincent's with no arrests, I spent time talking to this good police captain.  I wanted to thank him for being so totally cooperative from the minute he got assigned to our march.

I am certain that if we had had a bad captain, things might have not been as smooth as they were.

As the supervising officer, the Captain sets the tone of mutual respect. If the Captain is polite and respectful like Captain D'Adamo, I believe, the protesters respond accordingly. And if they don't, shame on them.

In this case, the police totally facilitated the march, they cooperated--more than cooperated-- the NYPD guaranteed us our First Amendment rights.

Reposted from DrSteveB by aigeanta

Below is video from last night's Countdown with Keith Olbermann show that featured clips from the march in New York City organized by Healthcare for 99% working group at OWS, PNHP, Healthcare-Now and others.  It also has the interview by Keith of yours truly (oy, I gotta learn to not say "uhmm").

Our march started from Zuccotti Square, encircled the for-profit insurance company WellPoint at 1 Liberty Plaza, and then marched up Broadway. At its peak we were at least three blocks long, with estimates others tell me (I was at the front and could not see behind me since we were so packed) of over 1,000. There were separate meet-ups at the for-profit WellCare offices (110 5th Avenue; near Union Square) of about 100 people, and then ending at the site of the closed St. Vincent’s site, with about another 100 people there.  I should note that this was completely peaceful rally and march, escorted courteously (in this instance) by the NYPD.

Healthcare segment starts at about the 0:34 second mark:

Doctors, Nurses and other healthcare workers support Occupy Wall Street because we want our patients to be healthy.

We support OWS because the private health insurance industry exemplifies the central complaint of the OWS movement: unchecked corporate greed threatens human needs.

We support OWS because economic and social inequalities make our patients sick.

We support OWS because we’re tired of being ashamed when we have to treat our patients differently based on the types of insurance they have and what kinds of treatments they can “afford.”

We support OWS because we believe in facts and evidence, and facts and evidence show us that a profit-driven health insurance industry is unhealthy for everyone except for CEOs and stockholders of those companies.

We support OWS because most of our legislators, held hostage by corporate money, consistently refuse to pass health policies that save lives and money, like single payer legislations.

We support OWS because the health care economy—like the overall economy—has more than sufficient resources to take care of everyone, but everyone is not taken care of due to the unfair siphoning of resources by profit-driven corporations.

We support OWS because we took the oath to do no harm, and our corrupt political and economic systems are doing all of us harm.

We support OWS because we are hopeful that we can change our society.

This second clip is local activist video showing the inspirational end of the march at the site of the closed St. Vincent's Hospital, featuring Katie Robbins of Healthcare-Now.

I will be at the Physicians for a National Health Program annual national meeting and leadership training in D.C. this Friday and Saturday. The theme is "Next Steps for Single Payer Advocates in the Obama Era".

Tell me in comments, what message should I bring to my colleagues?

Update: now with more flickr:

Physicians for a National Health Progam for the 99%

more from Health for the 99% march on 10-26-2011

more from Health for the 99% march on 10-26-2011

healthcare for the 99% at St. Vincent's

Reposted from nyceve by aigeanta

I went to Occupy Wall Street the other day. It's remarkable.  I haven't seen anything like this since the 1960s during the peak of the Vietnam War. Something is happening, it's real, you can feel it in the air.

This extraordinary collection of photos published in The Atlantic, from around the United States, will scare the 1% and their politician (from both parties) enablers.

You should see the tour buses pass by on Broadway, packed with tourists from around the world, their fists hoisted in the air in solidarity.  Most of these tourists have affordable health care in their industrialized countries, we don't.

We are told, the protestors are angry.  No, no, it's way, way worse than anger.  Garden variety anger can be contained, what's happening is uncontainable. Anger is the understatement of the century. This is way, way bigger than anger, this is a fight for survival. Our country is in free fall. Either we change it, or we're finished.

So here's another reason why we must continue to occupy Wall Street.  Here's why we won't go away.

I got my health insurance renewal.  Here are the horrifying numbers.

The premium is up from $500 a month, yeah you heard me, I'm paying $500 a month. My renewal is $565 a month. That's a 13% increase.  But that's just the beginning.

My office visit co-pay has increased from $50 to $60 per visit, that's a 20% increase! So now I pay another $60 for every office visit, this is on top of my monthly premium.  And I'm one of the lucky ones. I live in New York, and the bastards have to sell to anyone who can pay for their junk products. Most Americans with the list of pre-existing conditions that I have, would be told, go away, we won't insure you.

And now we're learning that high deductible junk insurance will become the norm.

Very simply, my friends, the reason for this is because, high deductible junk insurance is how the for-profit health insurers make more profits.  They make their profits on the backs of the 99%, who can only afford to buy their junk products.

It's really and truly that simple.  They sell us (the 99%) a very, defective product, which may be somewhat more 'affordable', than any of their other defective products, but which requires such high out-of-pocket costs, that we (the 99%) don't use it.  So the insurers collect our premiums, and we have an insurance policy which is essentially worthless.

And all this is happening as incomes plummet.

The middle class is being pummeled, destroyed. Our income is dropping precipitously, as health insurance premiums, and everything else we need for simple survival is sharply escalating.

Between June 2009, when the recession officially ended, and June 2011, inflation-adjusted median household income fell 6.7 percent, to $49,909, according to a study by two former Census Bureau officials. During the recession — from December 2007 to June 2009 — household income fell 3.2 percent.

The media is confused. They're scratching their collective feeble heads. What's the message of OWS, they ask?

1.  It's not Occupy Wall Street any longer, it's spreading organically to every nook and cranny of this county.

2. The enemy is government owned by the corporate special interests, which gives us defective legislation which benefits Wall Street not the American people, like the Affordable Care Act.

3. Wall Street has not been punished, not one arrest for causing the collapse of world economies and throwing millions around the world out of work.

4. Why is the United States the only industrialized country with for-profit healthcare, where you have to be part of the 1% to even get care?

Message to the government, be scared, the people/the peasants are restless.

Reposted from joedemocrat by aigeanta

I started reading a book Uninsured in America. In 2003 and 2004, the authors traveled to several states to talk to uninsured. Americans.  

I'm most passionate about health care and poverty issues, so I wanted to write a diary about the book. This is a really emotional and moving book that lays out the plight of the uninsured.

One tragic term in the book is known as "the health care death spiral." Tragically, once a person enters the health care death spiral, it is difficult to escape.

From the introduction:

Individuals are pulled into the death spiral through many different portals. Corporate restructuring, outsourcing, divorce, family crises, chronic illness, serious accidents, and racial discrimination are some of the most recognizeable doors. Indeed, given the number and diversity of enterances, all Americans, except for a small number of extremely rich individuals are vulnerable to the death spiral's pull

These are all common reasons people lose their health care. We no doubt have kossacks who have lost their health care for all these reasons. When you lose your health care and can't afford prevenative care or needed care for illnesses such as diabetas, hypertension, cancer, HIV, mental health, etc. a person gets sicker and when you get even sicker it is that much harder to get gainful employment with health benefits. Some people have had their health permanently damaged to the point they are unemployable. Still, others have died. This is not only immoral, but I doubt it saves any money in the long run.

Sadly, there are more portals into the health care death spiral than out.

Am I exaggerating?  The authors note:

We don't see corpses on the streets of Chicago or Des Moines because when people get sick enough, they are hidden in emergency rooms and end stage treatment wards. In a bizzare economic and ethical twist, the chronically ill, if uninsured, are allowed to deteriorate to the point at which hospitals are legally required to take them in. They are covered if they have terminal cancer or renal failure, but not before

Another hideous practice by hospitals and medical providers mentioned in the book is where providers have arrested and jailed unisured patients who didn't show up at court hearings about their debt. Why didn't they show? Several reasons - people in lower wage and temporary jobs often have trouble getting and/or affording time off work, and they understandably feel the situation is hopeless and nothing can be done.

And as part of this downward spiral, America's uninsured are increasingly found in hospital emergency rooms, homeless shelters, and prisons. People who can't pay for prevenative care or necessary routine care are forced to wait until a potentially life threatening or irreversible medical emergency arises and seek care in an emergency room. Then, if they are considered disabled, they are eligible for Medicare.

The uninsured are increasingly losing their homes or are evicted from apartments and are now found in homeless shelters. And our prisons are increasingly filled with people who have committed petty, non-violent drug offenses. Because we classify substance abuse as a felony rather than a health issue, many former inmates can't find employment once released making it even harder to get out of the health care death spiral.

This book was written before the Affordable Care Act passed. This bill will help millions when fully implemented, but will still leave millions vulnerable and in need. The number of uninsured Americans is expected to drop from 50 million to about 21 million. And, if we hadn't passed ACA some estimates are the number of Americans without health insurance would have risen to 59.7 million by 2015 and 67.6 million by 2020.

In addition, one million more young adult are insured. More significantly, the ACA increased funding for Community Health Centers. These centers currently serve 20 million Americans. That number will hopefully double to 40 million by 2015.

I realize this community was divided about if the ACA was worth passing. Yes, the bill got watered down. I think the more important question is is where do we go from here?  How do we best finish the job so that health care is a right and not a privilege for EVERYONE? The provision to allow adult children to stay on a parent's policy until age 26 has proven both helpful and popular. Should we expand that to adult children and siblings of any age?  With subsidies to those families?  Could we get another couple million people covered that way?  What about even more funding for community health care centers which seem both popular and helpful?  Could the federal government forgive the student loan debt of both doctors and nurses who agree to spend X years treating patients in a Community Health Center?

And finally - The Road To Medicare For All May Be Paved Through The States.

In regard to the health care bill being watered down, the health care debate has gotten watered down or moved way to the political right for 30 years now. In the 1970's, the debate was between the Democrats single payer proposal and President Nixon's employer mandate. But the insurance industry fiercely opposed single payer and the business elites opposed the employer mandate. As corporations gained political influence, it became very difficult if not impossible to pass legislation unfriendly to them.

So the real debate is how do we take our country back especially in the Citizens United age?  The political right regrouped in the 1960's and accomplished just that. They moved the political debate way to the right. Ideas that were considered ultra right wing in the 1960's became centrist. We will succeed only when we moved the political debate to the left and what is progressive today becomes centrist tommorrow. And to do that we need to build a formidable political infrustructure - a whole separate diary. That will require a coalition and for progressives to be united!

Reposted from National Nurses Movement by aigeanta

More than 1,000 nurses from all across the United States rallied together outside the San Francisco Federal Reserve today, and their message was clear. The damage done on Main Streets everywhere in America from the current economic crisis should be fixed by those largely responsible for allowing it to unfold in the first place, and the American dream can and must be restored through making sure everyone pays their fair share – especially those on Wall Street who have been involved in the most speculative and risky transactions

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Reposted from Tomtech's Ramblings by aigeanta

Three years ago, and after 9 months of battling my local Hospital District, I won health care for myself and others in my county. I knew the war wasn't won but that was as far as I could go under the rules. I have the opportunity to battle them again and I hope some of my 320,000 friends here will give me some advise while I prepare for battle.

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Reposted from Susan Grigsby by aigeanta Editor's Note: The magnitude of human suffering that would be obviated by Medicare for All should be obvious by now. But if it isn't, please read this diary about the excruciating pain experienced by one man and his family as he died of treatable cancer because he was uninsured, and the trauma of listening to Republican Tea Partiers cheering on the deaths of people like him. -- aigeanta

To all of those tea-jadist assholes at last night’s GOP debate: I don’t generally like to use profanity, but I fear that English is above your comprehension level, so in terms you might better understand, may God damn your worthless souls to hell for all eternity.

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Reposted from madame damnable by aigeanta Editor's Note: I like how this author stated it: "They have the "I've got mine, screw you" attitude. I prefer the "We're all in this together" attitude myself." Yup, that about sums it up for me! -- aigeanta

As further cuts to the budget are being proposed, the idea of raising the age of eligibility for Medicare from 65 to 67 is being discussed in such a way as to seem inevitable, despite studies that show it would not save any money. People are so sick by the time they get Medicare that more money must be spent on advanced disease care. Jump below the squiggle for more discussion. Actually, since I can't jump, please climb down carefully, checking for safe hand and foot holds.

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Reposted from Joan McCarter by aigeanta Editor's Note: See? The for-profit health insurers are clamoring for a loss of Medicare benefits from the most profitable sector of society: the elderly. That's because they pay dearly for private insurance. We can't let these corporations obtain their profit at the expense of our budgets and health. It's just not right. -- aigeanta
emergency room sign

Last week the American Hospital Association's lobbying for a hike in the Medicare eligibility age made news. The primary motivation expressed then was to attempt to stave off deeper provider cuts that would hurt them in exchange for benefits cuts. That's a big part of it, but of course the larger issue is much more straightforward: profit.
The Health Leadership Council, a consortium of 47  health industry leaders including Aetna, Pfizer and the Cleveland Clinic, endorsed today to raise Medicare’s eligibility age from 65 to 67, phasing in the change by two months annually.  Raising Medicare's eligibility age is one proposal in  a four-part package of Medicare reforms up for vote, including creating a new exchange-like marketplace and increasing the cost-sharing for seniors who earn more than $150,000. You can read the full proposal here.[...]

There's a pretty simple explanation for why hospitals and some insurers would favor raising the eligibility age: Hospitals receive higher payments from private insurance than they do from Medicare. The payments that hospitals receive from private insurers are 28 percent above the break-even point for providing treatment, according to a recent report from the Blue Cross Blue Shield Association. Medicare pays only 91 percent of what it costs a hospital to provide care.[...]

"At this point we're dealing with a situation where, if something raises money and it's not raising money from me, than its not a bad thing," says Ian Spatz, a senior adviser on the health care industry at the law firm Manatt. "If it's something that's not directly cutting you, that's better."

The pushback on the policy proposal, rather, is likely to come from other stakeholders. States, employers and seniors would all suffer if the Medicare eligibility rules were changed. It would shift about $11.4 billion in new costs to those parties while saving the federal government only $5.7 billion, according to the Center on Budget Priorities and Policy.

Since it's always worth repeating, yes, the on-paper savings for the federal government are $5.7 billion. And the costs for everybody else, $11.4 billion. But that's money in the providers' and insurers' pockets, so no wonder they're cheering this idea.

Reposted from slinkerwink by aigeanta Editor's Note: This is a bad solution for the wrong problem. The best solution is single payer and the right problem is for-profit health insurance. -- aigeanta
Most of this article is behind a subscription wall at the Financial Times, but here are the relevant portions, which are rather alarming. These sorts of deep cuts to Medicare and Medicaid will not help those who desperately rely on these programs for health care, and neither will these cuts help President Obama look good to independent and moderate voters. They only instead serve to further undercut his chances at re-election in 2012, and these cuts are of his own making.
Barack Obama is expected to lay out a plan next week that would cut several hundred billion dollars from Medicare and Medicaid, the large government healthcare schemes for the elderly and the poor, as part of a pitch to cut future deficits by more than $1,500bn.Senior White House officials said the US president would base a detailed blueprint for fiscal reform, which is to be delivered on Monday, on an earlier speech he delivered in April on deficit reduction.

Here is more below from the article:

During those discussions in July, the White House had agreed to $425bn in cuts to Medicaid and Medicare – with $150bn extracted from Medicare providers such as doctors and hospitals, $150bn coming from Medicare beneficiaries, and $125bn coming out of reforms to Medicaid, administration officials said at the time. Among the menu of policy ideas to reach those targets were an increase in the eligibility age for Medicare. Allowing Medicare more flexibility to negotiate drug prices with pharmaceutical groups and preventing special deals delaying the entry of generic drugs into certain markets could also be part of the plan.

Mr Obama’s plan could also feature a change in the way the US government measures inflation, switching to a less generous chained-consumer price index. The biggest impact of this measure – which could save between $250bn and $300bn over ten years – would be felt by recipients of Social Security, the retirement scheme. During the failed July talks, the White House agreed to put that change in place starting in 2015, but with protections for low-income workers.

The administration has also signalled there would be “discussion” of tax reform in Mr Obama’s recommendations to the committee – particularly on the corporate side. Business lobby groups are pushing the administration to propose a target for a lower corporate tax rate compared to the current 35 per cent level, which would then open the door to an agreement to eliminate subsidies and tax breaks for businesses.

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