California Healthline is of the somewhat optimistic opinion that they’ll pass the doc fix* before it expires March 31st. The House wants a delay of the individual mandate: the Senate wants… whatever it is that is telling Harry Reid what to do today. Personally, I don’t care if they pass a permanent version fix, or let the current one lapse: either way, Congress would stop getting to use it as an accounting trick to make the annual deficit look smaller.
People in the health care field may, of course, have a different opinion on best outcomes. But from a budgetary point of view the doc fix is a monster. Kill it one way, or another.
*I described the doc fix… last March. As you can see, I have mellowed slightly on the subject since then. I mean, when you’re already covered in mud and slime, what’s a little more?
Don’t believe me? Then maybe you’ll believe that notorious right-wing Tea Party rag The New York Times:
To the list of problems plaguing President Obama’s health care law, add one more — fraud.
With millions of Americans frustrated and bewildered by the trouble-prone federal website for health insurance, con men and unscrupulous marketers are seizing their chance. State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act.
Madeleine Mirzayans was fooled when a man posing as a government official knocked on her door. Barbara Miller and Maevis Ethan were pitched by telemarketers who claimed to work for Medicaid. And Buford Price was almost caught by another trap: websites that look official but are actually bait set by fly-by-night insurance operators.
This is a remarkably vicious article from the Washington Post… which is to say, it only attacked the Republican candidate for Virginia governor once and even then waited until about the sixteenth paragraph to do it. Apparently, the Post did not like Terry McAuliffe’s performance at the Northern Virginia Technology Council, particularly when compared to Ken Cuccinelli’s; and that disapproval seems to have slopped over on their reporting of some of the other stupid things that McAuliffe’s done lately. Case in point:
McAuliffe also seemed to back off what had sounded like a solemn vow: not to sign a budget that does not include money to expand Medicaid under the Affordable Care Act. GOP leaders have said the campaign promise amounts to a threat to shut down the government given opposition to expanding the health-care program in the Republican-dominated House.
Asked whether he really meant that he would not sign a budget without the expansion, McAuliffe said: “I always say, ‘Please make sure you send a budget that has the Medicaid expansion.’ ” He has left off the “please” in at least three campaign appearances.
For the record: there is not a chance in Hades that any Democrat governor would dare shut down a state government in the run-up to the 2016 election. Too damaging to the national Democratic party’s likely narrative, you see.
Background: the ‘doc fix’ is one of those things that happens in Dizzy City with alarming regularity. Basically, it was set up in order to control Medicare costs by linking Medicare subsidies to doctors to annual growth; if costs rose too high, Medicare payments to doctors would shrink. Nice feedback loop – only thing is, the first year it was supposed to come into effect (2002) the medical lobby started screaming, and it turns out that the medical lobby has a lot of money for lobbying. So since then the government has been ‘fixing’ the ‘problem’ on a year by year basis so that Medicare payments to doctors would not be reduced (this cost the government $30 billion last year, by the way). And if you’re wondering why they simply don’t fix the numbers permanently, or let the cuts go in fully… well. It turns out that the CBO is required to assume that Congress is NOT going to extend the ‘doc fix’ until it actually does, which means that the budget (when we have one) can actually get away with not taking that $30 billion into account when it comes to calculating expenditures. Thirty billion here, thirty billion there: add it all up and pretty soon we’re talking about real money.
With me so far? Good. So let’s kill the ‘doc fix.’
Gov. Scott Walker announced Wednesday that he won’t propose expanding Medicaid services in Wisconsin, breaking with other Republican governors who decided to accept federal money for an expansion as offered under the health care overhaul law.
And, from later in the article:
So far, six Republican governors have agreed to the Medicaid expansion, while fourteen have turned it down.
Which means that it was those six Republican governors that have been doing the breaking, Sparky. And every single one of ’em is keeping close to the exit, setting it up so that the legislature could tell ’em no, or both.
Sheesh. The media we have today!
More detail on what Walker’s doing. vlt.tc/pgtUsing exchange subsidies in lieu of Medicaid dollars.
I’ll spare you a summary, as no actual semantic content was exchanged in this clip: Wolf Blitzer kept pointing out that nobody over 55 has no reason to worry about the Ryan plan, and Debbie Wasserman Schultz kept falling back into classic Zombie Mode. Honestly, it lacked only the hands-outstretched and a moan of “Rrrrrrrryyyyyyyaaaannnnnnnnnnnnnnnnnn” to make it classic Romero on Debbie’s part.
One of the more… interesting… beliefs that seems to have spread along the Online Left lately is that their forthcoming campaigning against Paul Ryan’s budget reforms (henceforth to be sneeringly dismissed as ‘Mediscare’) is a clear winner for them. And if you ask them why, the members of the Online Left who are smart enough to avoid saying “Because we think that the population of the USA is made up primarily of idiots*” will instead say “Because we’ve been winning special elections with that issue.”
…Really? OK. Let’s look at the special elections for the 112th Congress, then.
Odd in that it – like the May recess, come to think about it – came and went without a plethora of stories about how citizens flooded* town halls across the land to ritually burn the Republicans at the stake over Paul Ryan’s Medicare/budget reform plan. Which is actually quite surprising, given that we were more or less promised Armageddon along those lines. Almost as surprising as the lack of stories of Democrats capitalizing on their supposed killer political advantage by holding their own town halls. Instead, we got… nothing much, really. Dribs and drabs, but nothing special.
Then again, I lie: this is not surprising. The Organized Left’s greatest problem is that it has everything that it needs for a populist movement except for actual people; and they’re constitutionally incapable of spawning protests that are organic, self-organizing, self-sufficient, and capable of growth. And every time that they get distracted enough that protesting slips from from the top of their to-do list, it shows.
*For a given value of ‘flooded.’ By Tea Party standards even the Easter ‘protests’ were more like a slow-draining sink.
Not exactly: the Politico reports that, in wake of forty-two Senators sending a letter indicating that Sir Donald Berwick is simply unacceptable for the job of Centers for Medicare and Medicaid Services (CMS) head*, Senate Democrats have made an answer to that by… giving up trying to get Berwick nominated. There’ll be no fight, no confirmation hearing, no standing on what the Democrats consider ‘principle.’ They’ll just let him keep going until later in 2011. I’m not fully checked out on the minutiae of recess appointments, but presumably the President can make another recess appointment for Berwick during the next time that the Senate is in recess for long enough.
But that’s not really the point; the point is that it’s clear that one thing is true in the 112th Congress that was also true in the 111th. To wit: Democrats won’t fight. Oh, sure, when they have the votes they’re the toughest guys in the room, and will be happy to walk all over you: witness that ludicrous strutting over passage of Obamacare back in 2009. But the second that they don’t have a sure thing, Democratic politicians cave (see the defeat of the Obama tax hikes during the lame duck session). They cave – or, as we’re seeing in the states, Democratic politicians run away. Because Democratic politicians are cowards, from top to bottom. And here’s the fun part: we know it. Which is why those forty-two Senators sent the letter. Which is why Senate Democrats caved on the cuts in the current CR. Which is why they’ll break later on the budget. They just don’t know how to be brave and fight for their beliefs**.