Let’s Agree

Let’s stop subsidizing the wealthy. Stop crony capitalism. Stop corporate welfare. Means-test our entitlement programs.”

The above quote was not said by some wild- or starry-eyed liberal. It was said by the Buddha of budgetary knowledge on the right, Paul Ryan, on ABC’s This Week last Sunday. 

In the spirit of the New Year and New Beginnings, let us end this year with a note of agreement. I agree with Mr. Ryan that we should stop crony capitalism—the only kind there will ever be without adequate public attention—and stop corporate welfare—corporations are doing just fine, thank you—and we should means-test our entitlement programs—especially Medicare, which is, as Paul Ryan knows very well, the biggest driver of our long-term debt problem. 

And Paul Ryan also knows very well that the plan he advanced earlier this year—which nearly every Republican this side of the Asteroid Belt voted for—would end the system created in 1965, even if the name would live on. (No matter what Politifact says.) Let’s all at least agree on that. 

And let us agree that the current Medicare system, which took more than 50 years to bring into reality, should be preserved. After all, it was signed into law by a Texan, Lyndon Johnson, and was supported by almost half of the Republicans in Congress at the time. 

So sensitive are Americans to perceived government interference, that even the sainted FDR dared not force the issue of public health insurance—which he supported—before the enactment of his social security bill was assured in 1935. And despite Missourian Harry Truman’s efforts to get the job done—President Johnson would eventually credit “the man from Independence” for those efforts and make the 81-year-old fighter the program’s first enrollee— it took another generation before folks without means could rest a little easier knowing they had at least basic health insurance they could afford, when they were on the unprofitable side of life. 

And among those who could rest a little easier were my parents. My dad, who was 56 years old when Medicare was passed, worked all of his pre-heart attack life. My mom worked full-time at home and part-time at what she called the “dime store.” Were it not for Medicare, well, the alternative for them would have been and, for me, remains, unthinkable.  Let’s agree that, for them and millions of  people like them, access to affordable government health insurance made—and for now, still makes—America a better place in which to live.

Truman, in a special message to Congress in November of 1945—1945!—said there were “certain rights which ought to be assured to every American citizen.” One of them, he said, was “the right to adequate medical care and the opportunity to achieve and enjoy good health.” What a shame, more than 65 years later, we are fighting over The Affordable Care Act, which guarantees Americans, sick or well, rich or poor, the right to health insurance, or rather the right to purchase health insurance from profit-minded private insurers. It is, by no means, a fulfillment of the vision of liberals, old or new. But it ain’t nothing. 

And yet we fight. Let’s agree to stop fighting about something so necessary. 

Truman said: 

In the past, the benefits of modern medical science have not been enjoyed by our citizens with any degree of equality. Nor are they today. Nor will they be in the future—unless government is bold enough to do something about it. 

People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. 

He didn’t must make that statement in 1945 without evidence to back it up. And he had plenty: 

The people of the United States received a shock when the medical examinations conducted by the Selective Service System revealed the widespread physical and mental incapacity among the young people of our nation… 

As of April of 1945, nearly 5,000,000 male registrants between the ages of 18 and 37 had been examined and classified as unfit for military service. The number of those rejected for military service was about 30 percent of all those examined. The percentage of rejection was lower in the younger age groups, and higher in the higher age groups, reaching as high as 49 percent for registrants between the ages of 34 and 37. 

Think about that. And think about the health of those back then who were in their forties and fifties and sixties and beyond. Truman, understanding that the child is father of the adult, said that it is “important to resolve now that no American child shall come to adult life with diseases or defects which can be prevented or corrected at an early age.” 

Let’s agree that health care involves inter-generational agreements. Old folks, let’s make sure the young are cared for, even if their parents are not rich. Young folks, let’s make sure the old are cared for, even if they lack wealth. All of us are either young or getting old. The Affordable Care Act is simply a part of these inter-generational agreements—without which any modern and civilized society cannot continue to be modern and civilized. It ought to be without controversy, or at least without animus. 

But it’s not. We have folks around the country, and folks in Congress, who are fighting for the repeal of the Affordable Care Act with a kind of religious zeal, as if to lose the battle would mean the end of a God-blessed America. There are even some radicals who would move us back to not only 1964, before Medicare, but to 1934, before Social Security. They would leave the non-rich at the mercy of charities or family and friends, of whatever means. 

But if we can’t finally agree, as Paul Ryan seemed to suggest last Sunday, that entitlements—Social Security, Medicare and Medicaid—are a permanent part of our social fabric and that in order to afford them we may need to, among other things, means-test them, then I’m not sure there is anything we can agree on as a civilized nation.

As Harry Truman said so long ago, our government needs to be “bold enough” to do something about inadequate health care in our country.  All he was really saying was we-the-people need to be bold enough.

Bold enough to agree.

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10 Comments

  1. There is no doubt Medicare has been a life line for tens of millions of Americans. Neither I nor any conservative I know has ever said otherwise.
    Republicans and conservatives have been calling for means testing Medicare and Social Security for years but each time it was presented the left wing of the democrat party, Pelosi, Reid, Frank, Waters, et al screamed holy hell, started the fear machine and rather than reforming two systems that mean so much to so many kept them on their bankrupting course just spending more and more and more.
    The Affordable Care Act is being fought not because it has a noble goal, but because it is bad legislation. It makes wild assumptions (Congress will actually CUT physician/provider pay 30%, the long term care part was feasible, the IRS access to information and on and on) and it doesn’t lower the cost curve. It only adds more to the rolls and grows government involvement.
    Medicare part D the prescription drug benefit is the ONLY Medicare program coming in UNDER planned cost and it is doing it because of private insurance competing for subscribers. Something that would only improve as the baby boom generation begins to retire and the pool increases many fold.
    Ryan’s plan doesn’t end the concept of Medicare and health care for our nations elderly, it merely reforms it and makes it financially stable. And remember before screaming that the $6500 isn’t enough to buy a policy, that CURRENT Medicare subscribers already pay additional THOUSANDS every year in PREMIUMS to the federal government and Medi-gap insurance coverages. (the public would know that if you weren’t censoring and banning my comment on your “domesticating the dogs” post)
    So yes, I agree that crony capitalism should stop and means testing of benefits is long overdue.
    How about “let’s agree” that if a blog is on a public forum page, ALL comments that meet Globe criteria get posted for pubic consumption without censorship by the blogger? (If you’re really serious about this whole “New Year, New Beginning” thing.)

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  2. ansonburlingame

     /  December 30, 2011

    Duane,

    To me there is a much more fundamental agreement that is needed between left and right in America. You have heard it before.

    WE MUST AGREE TO LIVE, NATIONALLY, WITHIN OUR MEANS.

    If we cannot pay for programs on a continuing and sustainable fashion over the years (or days, weeks and months as well) then the programs MUST restructured to meet that fundamental requirement.

    No more ” We need it, no matter how much it costs”. No more “tax the rich” to try to pay for everything when such taxation will NEVER meet all the needs created by any society.

    More specifically, Ryan did NOT go as far as I have suggested to be able to afford Medicare and SS as we have it today. Yes we must means test both programs. But we must also remove the income cap on SS and Medicare taxes. NO CAP on income is my suggestion and pay the 7.5% all the way “up” to whatever reportable income is revealed on tax returns.

    Maybe, just maybe those TWO steps, means testing and no income cap on Social Insurance Taxes MIGHT save SS and Medicare as we know it today for people over 65.

    But Medicare for all, forget it, Duane. Sure I would “like” to have it. But I see no way to afford it and you have not yet shown such a path forward while remaining to live within our national means today and tomorrow.

    And NO I will not agree to “give you” another $2 or more Trillion to “create jobs”. You already have gotten about $4 Trillion and look what happened with “your way” over the last three years.

    As well, one thing you said above about “crony capitalism”. with which I also agree. You said it needs “public attention” to keep it in check. GREAT and I agree. Let’s publicly beat the heck out of “greedy capitalists”.

    But actually you want far more tham “public attention” You want GOVERNMENT FORCE to contain it as well. Nope, not my solution. It restricts freedom and liberty far too much for me and many other Americans today, it seems.

    Anson

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  3. @ All,

    Duane’s post, in my opinion, makes the case very well that in a stable, civilized society it should be the role of government to ensure high-quality healthcare for all citizens. Why? Because it is not human nature to save very large amounts of money to offset the risks entailed by contingencies they would rather not think about anyway, contingencies such as intensive care and open-heart surgeries. Anyone who has lived more than a couple of decades should recognize that. Another thing about the issue is that healthcare is not a service that is amenable to cost-control by the market. People don’t shop for healthcare like they do for a car – when they need it, time is the critical factor. This is why I can’t buy Anson’s call for “freedom” in this problem. When the system is rigged against the consumer, which the medical industrial complex is, then freedom is an illusion.

    Geoff makes some good points above, albeit laced with emotive language. If we are going to start anew for 2012, allow me to suggest that we resolve to tone down the emotion, to make discourse more factual and less a contest.

    Geoff is right that Medicare as it is costs too much, and that the ACA does not fix the cost problem either, but he makes the implicit assumption that subsidizing private insurance, as in the Ryan plan, would be a satisfactory solution and that it would reduce costs. However, according to Politifact and the CBO, it would do just the opposite. They said,

    “First, private plans would cost more than traditional Medicare because of the net effect of differences in payment rates for providers, administrative costs, and utilization of health care services,” said CBO’s report on Paul Ryan’s plan. “Second, the government’s contribution would grow more slowly than health care costs, leaving more for beneficiaries to pay.”

    The CBO estimates the net federal premium support payments for a typical 65-year-old would be $8,000, or 39 percent of Medicare spending per enrollee, under the program that would be established by the GOP’s “Path to Prosperity.” That means the total cost of providing health care benefits (premium and other costs) to a typical 65-year-old in such a plan would be about $20,500 in 2022. The beneficiary would pay $12,500 in out-of-pocket costs.

    Using CBO projections, the folks at Kaiser did the math, and determined that if a person who turned 65 in 2022 were to remain in the traditional Medicare system, the out-of-pocket costs would be just $5,630 – a full $6,870 less than it would be under the new program.

    Kaiser explains it would cost more money to provide benefits under the Republican proposal “because private plans have higher administrative costs and typically pay higher fees to providers than Medicare.”

    My conclusion: the present system, including the ACA, is unaffordable and the Paul Ryan plan is even worse. Extending Medicare to all ages, sorry Duane, would have the same problem, unless that is, if the government were given pricing power in the medical market, but it seems to me that such would be equivalent to the Public Option, the only solution that makes sense to me. The bottom line is a tough one in that any viable solution will have to slash industry profits by half, which is why industry lobbyists sank the Public Option in the first place.

    The full Politifact article is in this link.

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  4. ansonburlingame

     /  December 30, 2011

    Jim,

    Now you acknowledge the real problem of universal HC, public option, Medicare for all, single pay, whatever.

    We have our American standards of HC set in “stone” so to speak. And that “stone” costs $2.8 Trillion, plus or minus a year.

    Americans generally refuse to agree to receive less than what they already receive. It might be their salary, their government benefits, their insurance benefits, etc. Americans generally want “more” not less than what is already on the table before them.

    Now figure out a way for ALL Americans to receive LESS from government than they already do, and you might have a chance at instituting real reform that is affordable. But without broad agreement to receinve “less” from government, well there is the “cliff” right in front of you across the whole spectrum of govenment “benefits” and defense as well.

    anson

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    • @ Anson,

      You said,

      Americans generally refuse to agree to receive less than what they already receive. It might be their salary, their government benefits, their insurance benefits, etc.

      Exactly. What you have defined, IMO, is “the tyranny of the majority”. DeTocqueville called it “the one pervading evil of democracy.” I don’t have a solution to that. When YOU do, please let let us all know.

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  5. ansonburlingame

     /  December 31, 2011

    To all,

    Jim, there IS a solution and it is called LEADERSHIP.

    What is the first thing a leader must do. He or she must define, very carefully the problem to be addressed. No obfuscation, no spin, no “politics” just a simple statement of the FACTS.

    As I have “preached” for over a year now the problem with the U.S. federal government is it spends too much money, far more than it can possibly “take in” in revenues.

    Don’t believe me then go to http://www.thefiscaltimes.com/Columns/2011/12/30/The-Federal-Balance-Sheet-Understates-Our-Problem.aspx#page1

    Yes, a link, one posted on my own blog by Herb Van Fleet. The author was the Comptroller of the U.S. for 20 years during both GOP and Dem administrations (88- 2008).. Based on our federal government’s own report it shows how hugh our financial hole has become, at least $65 Trillion dollars in money obligated by Congress but not collectable in revenues. It went up by $4 Trillion just last year as well.

    You see, as I “howl” over a $1.3 Trillion deficit in 2011, a now official number it seems, the REAL deficit was $4 Trillion, hidden in an obscure government report, quietly released with no public comment on Dec 23, 2011. Astounding is it not???

    Our own government tells us such woe, yet NO ONE in the government speaks about such matters, publicly.

    Right there in our faces is the PROBLEM, in my view and I have yet to hear a leader or prospective leader “tell it like it is” to the American people. Many on this blog will even probably say “so what” in view of such information, as well.

    Well a good leader would let NO ONE get away with a “so what”. He would assemble all parties concerned and say “Here is the problem. Stop arguing about THAT point. NOW how do we fix it?”

    Now I don’t care how LARGE a problem might be. All problems CAN be fixed with tenacity and good leadership. JFK did exactly that when he said “We are going to the moon in this decade”. Few believed such was possible until we watched Neil Armstrong walk on the moon’s surface in 1969.

    Well, Jim, we need a President that will stand and say “THIS, the $65 Trillion number IS OUR PROBLEM”. He then must stand and say “THIS is how I will start to fix it”.

    We then as the people being lead watch that number come DOWN day by day as the federal government makes spending and revenue decisions, always with that huge number in mind and how far and fast it decreases.

    But you see, Jim and others, as we squabble on these pages over “nickels and dimes” the reall problem is so much larger that none of us can get our arms around it.

    Well it is possible for a man to eat an elephant. But he must do so one bite at a time. But while we all argue, the NUMBER just keeps on going up and up. THERE, Duane, is the curve that MUST be bent, NOW. Just how deep is a $65 Trillion “cliff” I wonder?

    Richest nation in the world my hind foot. Not with that kind of balance sheet!!!

    Anson

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  6. ” we must agree, nationally, to live within our means” AB, 2011. Nothing could be more true. When we talk about America, people always say that they live within their means so why can’t our government. This got me thinking about a time in my young adult life when I learned the hard way about spending more than I could afford. My first time from home, single, and living it up. New car, clothes, parties, road trips…..
    Well, when it was time to pay the Band as they say, I did 3 thing:

    1) Sold some of my valuables and payed on my 2 credit cards. The most valuable item was a prized gun that I enjoyed very much.

    2) Stayed home on some week ends and found other ways to spend my time. More time at the Base Gym, learned to cook a little, drank cheap beer, etc.

    3) This is the one no one ever mentions, but I had to increase my income to pay for all my mistakes. What did I do? I worked 2 part time jobs so that I would have more money coming in to pay off my debts.

    This is probably normal procedure for most people in a similar spot. Will our government do the same?Congress has tried to duplicate my first task by trying to privatize many things. However, I have never owned a gun as nice as the one I sold. Second, they can stop spending so much. This was the most difficult challenge for me as it is with Congress. I made a valiant effort, but the gym closed around 9:00 PM. My third task was the easiest for me. I worked security for a minor league baseball team and security at rock concerts. The perfect jobs for a young man. Kept me out late, I was near all the fun. But at the end of the day it helped the most because I simply was able to pay off my debts, I learned my lesson, and have never held another part time job again.

    Make of this what you wish, and a Happy New Year to all.

    Kabe

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  7. ansonburlingame

     /  January 2, 2012

    Kabe,

    I agree with your sentiments 100%.

    But you may well receive a lecture from Duane, that personal financies are different than managing government financies. I get that response ALL the time and disagree with it very strongly at a fundamental level.

    NO ONE can keep spending more than they or “it” makes over time and ever hope to thwart “basic economic laws” a phrase I have frequently used in the past.

    We, all of us, in America, today are facing a $65 Trillion HOLE (Ok, plus or minus a “little bit”). Said another way in the same link above, each and every American is “in hock” for about $550,000 due and payable some day.

    And the crazy thing is NO ONE talks about that number nor does ANYONE propose how to fix it, “on bite at at time”.

    And ALL I hear on this blog is spend MORE, MORE, MORE, for now and we will “get around later to the bigger problem……” OK, liberals, WHEN and by how much will you start real programs to fix the $65 Trillion problem, one bite at a time.

    ALL of your tax the rich schemes only decrease the rate at which $65 Trillion goes UP each year, not DOWN. And we could tax the rich for 100% of their income and net worth as well forever and not resolve that $65 Trillion problem.

    The ONLY way to do so is put the government, every day, on a sustainable footing such that money in NEVER exceeds money out, except in “dire” emergencies (nuclear attack on the homeland, maybe) and then IMMEDIATE (almost) repayment of debt incurred for such emergenices.

    The rest of the time we focus on “eating the elephant”, not because anyone likes “elephant”. NO, it is a matter of national survival, in my view.

    Anson

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  8. AB,

    I am afraid that some taxes will have to go up to pay for our sins. That was part of my analogy for step 3 of my personal crisis, raising income to speed up the process. But please note that I said it was my last part time job. I never put myself in that position again, as our country shouldn’t either.

    Kabe

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  9. ansonburlingame

     /  January 3, 2012

    Kabe,

    I as well agree revenues must go up at some point. It is which ones and when that we might disagree upon. The details are of course all over my blog.

    AB

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