Monday, February 10, 2014

Defund Medicaid Expansion Now

My message to hospitals, insurers, fellow-citizens and legislators who still want to fund the expansion of Medicaid deceptively known as "The Private Option" is simple: Keep your thieving hands out of our children's pockets.  Government officials and hospitals are using scare tactics to try and sustain their access to your children's future earnings.  Hospitals, I hope you stay open.  But if you need more government debt laid on my children's future in order to stay open, then I say shut your doors right now.  If that's the price, you don't deserve to stay open.

At some point, our economy has to start operating on a sustainable basis. It is just not sustainable for industries and institutions that can't stay afloat without the government writing a bunch of IOUs to keep operating.  Find a way to operate within your means or sell out to someone who can.  Don't expect my kids to pay for your desire to escape painful adjustments to the market.

One of the original positive claims about the so-called "Affordable Care Act" was that it started out very close to budget neutral.  That is, it would not add very much to the crushing debt burden that our generation is selfishly, irresponsibly, and unsustainably running up for all manner of "free" government goodies.  Because America's credit was good, too many of us have been corrupted.  We have gone from responsible citizens to a mob demanding "free" stuff from the government.  Nothing is free of course, its paid for by someone, and unprincipled politicians soon arose to cater to the demands of an unprincipled population.  The goodies were handed out, and the bills were passed onto the next generation.   May God forgive us!

There cannot be a more cowardly or feckless way to pay for vote-buying than through the use of debt.  Little children and the unborn, who have no vote to defend themselves against the looting of their future earnings, are robbed by low-life politicians who pass off their sickening child abuse as some sort of noble act.   And the Free Stuff Mob believes it is free because they want to believe it.  They believe the lie for the reason most lies are believed- because facing the truth involves short-term discomfort.  We as a society are not just failing a test of character here, we are failing the next generation.

Originally, Obamacare was to cost just under $1 trillion taxpayer dollars for the first ten years and was to pay for that amount mostly through raising $500 billion in taxes and cutting $491 billion from Medicare.   Those numbers assume that millions of young healthy people with good jobs sign up for coverage and pay highly inflated premiums.   Should that fail to happen, the cost goes much higher.   It is mostly failing to happen, because most healthy young people don't have good jobs.   Those who do are loaded down with debt from college and cannot afford to pay the enormous costs of the "Affordable" care act.

But even if things go as planned, in the second ten years, the cost goes up to $2.85 trillion, and we don't know where we will get the extra money.   And as for the proposed $500 billion in tax increases, Obama has already blinked on the bulk of it when he unilaterally changed the law without authorization from the legislative branch and delayed the "Employer Mandate" for at least one year.  We will see after tax time what happens with the individual mandate.  The rest of the taxes that are supposed to pay for it come from taxes on medical equipment.   On a highly inelastic good paid for by the government, those increases in taxes are going to go right back into increases for medical treatment.  In other words, those taxes are a sham.   They will just drive up the cost of care that much more than anticipated, leaving the net effect of the tax at zero.

And what about the $491 billion in cuts to Medicare?  Most of it has not happened yet.  They back-loaded the cuts and front-loaded the spending, as the almost always do, to get a final number that sounded better.  Many of those "cuts" they counted were things that have been repeatedly scheduled in the past, but never followed through on.   Reimbursements to physicians is the big example.  If they push that one too much harder, people will have coverage, but won't have access to care.  That is already starting to happen with Medicaid.

So Obama has blinked on some of the taxes already, and others will simply drive up medical costs and thus do nothing to fund Obamacare on net.   The cuts are almost all in the future and most of them are things that Congress has consistently backed down on cutting at the last minute and would harm access to care if they were cut anyway.   And even if all that had worked out, there is no plan to pay for the increases for the following decade.  Basically, Obamacare is now on track to be just another debt-financed expansion of government.

It may be hard for some voters to sort all this out, because of the brazen way in which some politicians and media in this state are repeating the claim that the "Private Option" is not Medicaid expansion.  This is false.  The so-called "Private Option" is Medicaid expansion. They have a temporary (expires in 2016) waiver from the Obama administration to direct the flow of money a little bit differently than the traditional way Medicaid money has flowed in the past, but it is still a Medicaid program, funded with federal Medicaid dollars, subject to Medicaid guidelines, and directed by the Arkansas Department of Health and Human Services, just like the regular way of doing Medicaid. This is Obamacare in a hat and sunglasses, and in 2016 the hat and sunglasses can come off.

We will not reduce the number of our population on Medicaid by implementing the so-called "Private Option", we will greatly increase it, mostly with able-bodied adults.  Instead of one Medicaid program we will have two, the traditional one that pays providers directly, and another which uses insurance companies to stand in the middle and take a cut.  The total population in the two programs will be much higher than the population in the one previous "traditional" Medicaid program.

I am just amazed at the brazen way in which some Republican legislators have tried, and are still trying, to make the false claims that the "Private Option" is not an expansion of Medicaid and that it somehow undoes or opposes Obamacare. One hundred percent of the Democrats in the state legislature voted to fund the Private Option.  Would they have done that if it really was opposition to Obamacare?

The latest in all this is the claim that there was nothing they could do to stop the implementation of Obamacare in Arkansas because it was "already the law." That was not what they said when they were running for office on a platform of opposing the expansion of Obamacare, but its their story now and some of them are sticking to it, much to the disgust of those of us who have taken the time to find out what is really going on.

They could not have stopped some things about Obamacare, but they could have stopped the key part of Obamacare which entailed expanding Medicaid.  This was not a part of what was "already the law", that they had no choice about.  They had to agree to expand Medicaid.  And they did agree to it, some of them are just not honest enough to admit that this is what they did when they came up with the "Private Option" label.

You are witnessing the "big lie theory" put into practice when they make these claims. There was and is much that states can and have done to block the implementation of much of Obamacare in their states. Most of the Republicans in Arkansas just decided to rework the split of the looting so that big insurance and the hospital systems got a bigger cut and go with a plan which combines all of the worst features of Obamacare and crony capitalism.

Obamacare was structured so that if states expanded Medicaid they got what looked to them like "free money" for a few years.  Since most politicians can't see past the next election, it looked like a good deal to them.  On the long term though, it commits Arkansas citizens to increased costs not just as federal taxpayers but as state taxpayers.   Obama structured the funding to be like the bait on a fish-hook, and they took the bait.   The state numbers will look good for a couple of years as the federal numbers look worse, then they will both look worse.

The economy stinks right now.  Past government overspending has put a debt-overhang on the economy that is dragging us down.  I understand that some people are in  a desperate situation.  If you have to use it, use it.  But even if you have to take the coverage, I implore you to vote against the politicians who put it in place.


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