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View Diary: Leaked deal memo from grand bargain talks show threat to Social Security, Medicare, safety net (633 comments)

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  •  The first thing the President has to do... (24+ / 0-)

    Is make it clear that there is no may they get 3 to 1 cuts over revenue now.

    Elections have consequences...as I recall a certain Republican said after his narrower 2004 reelection.

    Raise taxes on those who can afford it now.  Normalize rates for capital gains, making them the same as earned income rates.  Eliminate the cap on the Social Security tax.  

    Cut later when the economy is strong.  And never, EVER, touch Social Security and Medicare.  No need to cut Medicaid or food stamps either.  Those will come down on their own when the economy is better.

    And every penny that can be should be squeezed out of the military before domestic spending is touched.  We're not buying more security as the spending goes up...just more redundancy.  Half the defense budget is just post 9/11 prozac at this point.

    That's my idea of a balanced approach.  Hell, after you cut defense and fix taxes, we might not need to cut another dime.

    And if the GOP fights...and they will fight, to they death, to protect their wealthy clients...take the fight to the country.  Let the GOP make their case for raising taxes for  98% to protect low taxes for 2%.

    "I don't give them Hell. I just tell the truth about them and they think it's Hell."

    by Notthemayor on Mon Nov 12, 2012 at 02:45:12 PM PST

    •  Tricare lost their contract to lowest bid (4+ / 0-)
      Recommended by:
      3goldens, corvo, Mr Robert, antirove

      competitor recently.  Link below

      Tricare loses contract to UnitedHealth Care

      "Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen." Mort Sahl

      by maggiemae on Mon Nov 12, 2012 at 02:57:16 PM PST

      [ Parent ]

      •  That's a damn shame. (6+ / 0-)

        The mother of an ex had Tricare from her late husband's 20 years in the Air Force reserves.  

        He died relatively young from cancer.  She died at 70 from the same.  Mill town outside Pittsburgh, air thick with smog most of their lives.  You get the picture.  Both were smokers too, which didn't help.

        She got great care thanks to Tricare.  I'll bet it added years to her life.

        I'd like to see the Congress farm out their health care to the lowest bidder.

        Yeah.  That'll happen.  Why does the GOP fight harder to destroy than our guys fight to save?

        "I don't give them Hell. I just tell the truth about them and they think it's Hell."

        by Notthemayor on Mon Nov 12, 2012 at 03:08:20 PM PST

        [ Parent ]

      •  United Health can be OK (1+ / 0-)
        Recommended by:
        maggiemae

        I was on their Medicaid plan for more than a year. They were pushing some proactive programs -- they called me up periodically to see how I was doing, and did I need help managing, and all that. (I didn't, but it's the kind of checking-in that can keep some people out of hospitals.) I thought they were pretty reasonable, as health insurance companies go. Apparently they're making a push to manage Medicaid programs and Tricare would be another similar type of contract.
         

        •  Difference in this case is they have no (0+ / 0-)

          existing departments to handle some existing military programs and are starting from scratch.

          "Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen." Mort Sahl

          by maggiemae on Tue Nov 13, 2012 at 11:19:04 AM PST

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    •  Almost (7+ / 0-)
      That's my idea of a balanced approach.  Hell, after you cut defense and fix taxes, we might not need to cut another dime.
      Test out your own scenarios at (last year's) interactive budget tool.  I tried, and by sticking religiously to liberal orthodoxies it won't QUITE balance.  In my scenario,  I had to return middle-class taxes to pre-Bush levels AND I had to limit Medicare growth.
      Budget Puzzle: You Fix the Budget
      Try it.  It's instructive.  

      "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

      by lgmcp on Mon Nov 12, 2012 at 03:05:17 PM PST

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      •  I did that a while back. (1+ / 0-)
        Recommended by:
        lgmcp

        Don't remember the results exactly.  I've got a link that was supposed to save my results but it doesn't work.

        I don't think I cut any domestic spending.  I might have raised some taxes below $250k.

        I'll have to try it again and see if I can replicate my result.

        "I don't give them Hell. I just tell the truth about them and they think it's Hell."

        by Notthemayor on Mon Nov 12, 2012 at 03:10:56 PM PST

        [ Parent ]

      •  you have to limit health care inflation (6+ / 0-)

        That's really not an option. Health care inflation is the keys long-term budget problem. The ACA is a good start on that, by the way.

        If you restore the Clinton rates, and add a surtax for millionaires, you're essentially done.

      •  You know how to limit Medicare growth? (4+ / 0-)
        Recommended by:
        lgmcp, corvo, AoT, apimomfan2

        Put money into preventative care now.  Keeping people healthy by offering them more healthy options is a hell of a lot cheaper then treating them for the rest of their lives after they develop multiple chronic conditions.

        Research backs this up, and it's being taught at all levels of nursing, but we haven't broken through into swinging public policy much.

        •  Preventative care only saves money (4+ / 0-)
          Recommended by:
          gramofsam1, lgmcp, Joieau, VClib

          on an individual basis.  If you give Fred preventative care costing $1000, and Fred would have gotten a condition costing $50,000 to treat, you've saved money on Fred.

          However, if you give everybody that same $1000 preventative care, and only one in 100 would have gotten the condition without that preventative care, you've lost money.  You put out $100,000 to prevent a condition that one person would have gotten costing $50,000.  

          Let me be clear: Preventative care is a very good thing, and I'm all for it.  It just is not always a money saving approach on an overall basis.  Saving money should not be the point of preventative care.  Saving lives is the point.

          •  Given the state of American health (1+ / 0-)
            Recommended by:
            lgmcp

            I'd be incredibly surprised if you didn't save money overall.  If Fred were the only one in his area on whom you saved 49k, you'd still break even providing that same level of preventative care to 49 other people just to be sure you caught Fred.  The reality in America is that there are likely 20 Freds out of every 50 people.

            Preventable chronic conditions run rampant throughout America.  Fred is not just 2% of the country.  It's not a coincidence that healthcare costs have exploded right alongside obesity rates in the US.

            •  It depends on the cost of the prevention, (2+ / 0-)
              Recommended by:
              lgmcp, VClib

              the cost of the condition being prevented, and how many people you give the preventative care to so as to prevent one condition.  

              Obviously, cheap preventative care that prevents a whole host of conditions that happen with frequency (maybe like preventing people from smoking, or preventing obesity) does save money overall.

              More expensive preventative care that prevents a more rare condition (colonscopies?) not so much.  

              The math is going to work out differently for different types of preventative care.  But I gave you the example to show that saving money overall for the system is not, and should not, be the deciding factor in determining whether, for example, to provide coverage for preventative care.  If money were the justification, more expensive prevention, like some types of cancer screenings, might not be justified.  That's why the only legitimate justification can and should be saving lives, not money.  

            •  See the links and quotes supporting my contention (1+ / 0-)
              Recommended by:
              VClib

              in my comment below.  

              •  I did, although I'm not sure the CBO understands (1+ / 0-)
                Recommended by:
                lgmcp

                the concepts in the medical sense, since they refer to screening procedures.  Screening procedures (colonoscopies, and the like) are not actually primary/preventative care.  In healthcare terminologies, those are 'secondary' care, just as treatment of existing disease is tertiary care.

                Primary care is about encouraging healthy behaviours and beneficial supplements, secondary is about screening people to determine who might have what, and tertiary is treating those you determine to have something.

                So public policy to expand primary care would be things like setting up or subsidizing gyms and pools, creating running tracks and bike lanes, programs to provide healthy foods and vitamins, and so on.

                While, as you point out, secondary care screening programs of various sorts (colonoscopies, mammograms, etc) are more expensive, since most of them take expensive machinery and highly trained people to figure out what the results are saying.

          •  I'm not sure that's accurate (0+ / 0-)

            If that was all preventative care did, it would never be touted as a needed change.  I am pretty sure that overall preventative care reduces health care costs.

            I think your scenario where only 1/100 is helped is probably not reflective of reality.  There will be other conditions that will be averted within that group.  

            •  Ok here's some backup (1+ / 0-)
              Recommended by:
              VClib

              See here:

              “The evidence of hundreds of studies over the past four decades has consistently shown that most preventive interventions add more to medical spending than they save,” Russell concludes.
              How can this be? The idea that prevention saves money feels intuitive. “When we think of prevention, we tend to think of the individual who benefited,” Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however, discounts all the mammograms that didn’t detect cancer and didn’t prevent anything and all the individuals for whom weight management programs didn’t work. All those costs add up to the point that most preventive interventions cost more than they save.
              and here quoting the CBO:  
              But the Congressional Budget Office last week issued a statement on health care overhaul that dismissed the notion that prevention saves money. Prevention “would have clearer positive effects on health than on the federal budget,” the CBO said.
              More on the CBO conclusions here:
              Obviously successful preventive care can make Americans healthier and save lives. But, Elmendorf wrote, it may not save money as Democrats had been arguing.
              "Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive.
              "For example, many observers point to cases in which a simple medical test, if given early enough, can reveal a condition that is treatable at a fraction of the cost of treating that same illness after it has progressed. In such cases, an ounce of prevention improves health and reduces spending — for that individual," Elmendorf wrote. "But when analyzing the effects of preventive care on total spending for health care, it is important to recognize that doctors do not know beforehand which patients are going to develop costly illnesses. To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. … Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."
              Elmendorf offered this assessment in a letter (you can read it HERE) to Rep. Nathan Deal, R-Ga. Rep. Frank Pallone, Jr., D-N.J., Henry A. Waxman, D-Calif., and Joe Barton, R-Texas, were cc'ed.
          •  Wrong. You spend preventative care $$ (0+ / 0-)

            to prevent/reduce disease where it makes economic sense.  Target the population. Hypertension screening and flu shots in at risk populations are very cost effective.

            This save money on a population basis; not just an individual basis.  (Individuals make up a population.)

          •  Not all people on Medicare (1+ / 0-)
            Recommended by:
            lgmcp

            have multiple chronic conditions, but they are over the age of 66, when preventive care is less effective because the patients are elderly and getting steadily more elderly.

            The coverage was intended for the inevitable downhill march of aging humans toward the grave. Cognitive and physical decline catch up with everyone eventually if they didn't manage to die young. End of life care is not cheap, but most people will need it unless we're willing to let our elderly population die alone in abject poverty and suffering without even the most basic care. For-profit insurance companies are entirely willing to allow that - this is NOT something the 'free market' can be called upon to provide.

      •  Returning tax cuts to pre-Bush levels... (1+ / 0-)
        Recommended by:
        lgmcp

        is liberal orthodoxy.  People don't like to hear it, but taxes need to go back up.  

        The rates under Clinton were quite fair, with the exception that capital gains should be taxed as ordinary income and taxes on those making more than $500,000 should be much higher, with a graduated scale going to 75% on over 10 million in income.  Estate taxes should also be much higher.  

        •  Agreed on all counts (0+ / 0-)

          and personally I neither needed nor wanted the middle-income taxes that Bush gave me OR the additional ones that Clinton gave me.   And don't even get me started on the deep unwisdom of the payroll tax "holiday".

          "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

          by lgmcp on Tue Nov 13, 2012 at 08:27:05 AM PST

          [ Parent ]

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