So much in politics these days comes down to the delusions held by conservatives, whether they come from Fox, talk radio, a crazy lady writing on Facebook in Alaska, or random voices in their heads. Issues rarely seem to come down to real differences in opinion these days. Instead they are based upon the differences between reality and the delusions of conservatives. The claims of “death panels’ provides an excellent example of this. Greg Sargent has been analyzing a recent Research 2000 poll which asked if people believe the health reform proposal contains “death panels.” Sargent noted these results among Republicans:
Yes: 26
No: 43
Not sure: 31
In this case the number of Republicans who are not sure of something which has no basis in reality is a significant finding. Adding up those who believe this false claim with those who are unsure totals 57 percent of Republicans being unaware of the facts. He also noted that only eight percent of independents accept this claim. In addition 16 percent are unsure with 76 percent of independents realizing this is untrue. The numbers are even stronger for Democrats with 88 percent answering no.
These findings are related to other findings in the poll which show that a sizable number of Republicans believe Fox is a reliable source of information and also do not get news from other sources. During the height of the Soviet Union I doubt that Russians were as gullible as to the reliability of Pravda as Republicans are with regards to Fox.
Factcheck.org also debunked a conservative ad today which contains false claims about care for the elderly as well as several other false claims being used to scare seniors. Of course this won’t change the mind of those who are brainwashed by the right. They are told that any objective source of information is actually a biased liberal source making it almost impossible to alter the views of those on the far right with the facts.
While they show far more understanding of the actual facts, blind ideology might also become a problem from the left with threats to block health care reform if it does not contain a public plan. In some cases this is because some on the left see a public plan as a back door way of achieving a single payer system. This is somewhat unrealistic considering how watered down the public plan already is and how few it is likely to actually cover.
The question remains as to what will happen if we reach a point where the only item before Congress is a proposal with significant improvements but without a public plan. Will liberal Democrats will really let a good bill go down to defeat over this? Some liberals are beginning to question the wisdom of this. For example, Matthew Yglesias has popularized an idea to split health care reform into more than one bill:
One bill, a filibusterable non-reconciliation bill, would set up the basic framework of a health insurance “exchange” on which individuals and small businesses could get insurance. It would feature an employer mandate, some kind of sad co-op, and some not-very generous subsidies. It would be subject to various kinds of regulation including the White House’s key eight points of consumer protection. It’s a bill liberals would find horribly disappointing, but you could imagine it getting sixty votes in the senate.
Then if you get that done, all you need is a second bill. At that point, changing the co-op rules to make it work like a real public option, making the subsidies more generous, expanding Medicaid, and other wholesome progressive stuff all becomes budget-relevant material that can be done through reconciliation with only fifty votes. It’s not clear at this point that the public option has fifty votes in the senate, but it’s close, and I’m reasonably certain that the votes could be found if the procedural path existed.
I fear that such a strategy would only give Republicans even more motivation to filibuster the first bill, but if this were to play out I would suggest one change. The second bill should not expand Medicaid but eliminate it and move Medicaid patients into a public plan. The goal of universal health care should be to provide a decent basement level of care for all Americans without keeping many in a second class status in Medicaid. Even backers of a Republican plan support the idea of giving “lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance.” This is one Republican idea which Democrats should seriously consider.
Folks I need your help. If we are going to get a government option we must turn the tide. Instead of complaining about those dirty tricks the conservatives are playing we must go on the offensive. How you ask? My idea is to use scare tatics just like they do. See My Answer To Sarah Palin on facebook and get the word out. flood the internet with insurance companies rejections, turning down common proceedures as experimental, post every law suite you can find they yhey lost. Print their ceo and upper management salaries and bonuses and corp profits. Expose which hospitals they own. Go on the offensive the other side expects us to just sit back and cry. Lets let them know what they are standing for. The public wanted a government option before they started to scare them it won’t be as hard as it looks to scare them back to our side. Then once the ball is rolling our way (after Labor day and we must pound once twice a day till then) we start exposing the liars and the techniques like bring conservative forieners to host the Limbaugh radio show and tell horror stories. One more thing the government option is more like Blue Cross Blue Sheild than it is like medicare or medicade people just don’t understand the it is just a competitive plan to Cigna and United Health etc that will make them streemline their plans and actually pay for something. Please help start today
I think that most conservatives in the Senate would be closer to Judd Gregg’s CPR than they would to the Coburn bill. Even Gregg, however, makes lots of high-minded noise about getting low income Americans off Medicaid… though he would rather cut it entirely and force people into the insurance market unprotected than consider alternatives. I certainly agree that expanding the Medicaid rolls, as a substitute for a public option, would be a pretty unpalatable alternative.
Medicaid really is second-class health care, and many hospitals and clinics treat Medicaid patients very differently than the rest of their patients. Discussion of Medicaid really needs to include ways to improve or replace it, not ways to expand it as it exists now.
Even I think that, and I don’t know if there is anyone who comments on this blog further out on the left than I am. I know I’m further out on the left than Matt Yglesias.
I surprised that for the most part liberal supporters of health care reform are not considering this, and even see expansion of Medicaid as a favorable part.
I agree with moving Medicaid recipients to a public plan, or even vouchers for private plans (to promote competition), but since there will be a period of development of the public plan, and it needs to be working on a cost par with Medicaid or lower, I would suggest a phase in approach to rolling Medicaid into the public option.
I am amazed that Democrats were so quick to give in on the public option, and that Republicans were not more upset about Medicaid growth. Isn’t the big complaint about how much this going to cost? Why not cut that half trillion dollars of Medicaid expansion, at least until we see how well the public option performs? It may be that the public option is effective enough to move people from Medicaid, increase eligibility, and all without the cost increase currently proposed.
Whatever is done will be phased in over several years, and even if they went along with moving Medicaid patients into the public plan I’m sure that this would be phased in as well.
Vouchers for private plans instead of moving them into the public plan would also achieve the same goal. If Republicans feel more comfortable with this solution I am perfectly happy with it.
Considering the above comments, I should modify them a little before being too hard on liberals who see expansion of Medicaid as a good solution. At least the House bill does call for improving Medicaid reimbursement on primary care services which might help.
“I surprised that for the most part liberal supporters of health care reform are not considering this, and even see expansion of Medicaid as a favorable part.”
A lot of younger, white collar professional liberals have no idea what the heck ‘Medicaid clinics’ in the inner city are like or how Medicaid patients are frequently handled in the medical system. They are every bit as sheltered as Republicans who think a $7500 tax deduction will cover someone’s medical expenses for a year.
Uh, there are some very well educated white collar professional liberals who know quite well how Medicaid works and how the beneficiaries who frequent the clinics are treated – who know that Medicaid works better than you seem to think. Some of us know this, because we work in that system. As for the notion that Medicaid patients are treated differently or worse than other patients, please stop with this nonsense. Which state Medicaid programs are you referencing?
Steve,
There are also those of us who practice medicine who know that what you say is untrue. In addition, most who have contact with the system realize this. Defending a failed government program by making such claims which are totally untrue really does not help the cause of establishing effective programs. Comments such as yours are the reason why many people do liberal arguments and do not believe that there are any government programs which work.
Ron, I’m still waiting to find out what state you are referring to. Please be specific before making generalizations like this.
Steve,
I am not referring to any one state. Do you really think that doctors don’t talk with colleagues in other states, use the internet, or even read newspapers?
This “generalization” is a reality-based comment on the condition nation-wide. As long as a program is under-funded and pays physicians less than it costs to meet our overhead and adequately care and bill for treating a patient Medicaid patients will be second class citizens. Either doctors will avoid seeing Medicaid patients or will have to take short cuts to avoid losing too much money.
When Medicaid patients are not accepted by many in private practice and frequently wind up in what you refer to as “the clinics” their care is going to vary widely. Usually this will range from mediocre clinics which are trying to get by on insufficient reimbursement to outright Medicaid mills which churn them through to submit bills while providing substandard care.
You can deny it all you want, but that is the reality of the situation with Medicaid. True health care reform with universal care should provide Medicaid patients the same level of care as those who are insured.
“Which state Medicaid programs are you referencing?”
Ron is basing his comments, as he has said, on his general knowledge of the system as a doctor who speaks to other doctors. So he is not referring to any specific state.
I have seen the system in two states, California and Tennessee. In the former, my father worked as an elgibility worker for MediCal (the California Medicaid program) for more than a decade before taking early retirement because he couldn’t stand refusing coverage to people who really needed the help because of the sometimes arbitrary and often illogical eligibility requirements. ‘MediCal clinics’ in Los Angeles are frequently mills cycling through as many patients as possible to bill as much as possible, with a very low quality of care and very little follow-up. Someone of this is not the fault of the clinics, which are grossly overburdened, but some of it is.
I live in semi-rural Tennessee now, where all of the clinics and most of the practices in hospitals are entirely private and mostly simply refuse to see Medicaid patients. Which means that their only choice is to join uninsured patients in overburdening hospital emergency rooms. There aren’t even any ‘Medicaid clinics’ here.
Where’s the “Liberty” in a national healthcare plan? Who are THEY to tell me whether I can keep my current plan?, and if I choose that direction, why do I have to pay for TWO plans?(my current plan, AND the public plan)
There is no liberty in telling somebody what they can and can’t do with their own hard earned assets.
Bruce,
Nobody is saying you cannot keep your current plan. The point is to offer more choices to those who do not have a plan which provides adequate coverage–and to prevent your plan from dropping you if you get sick. You don’t have to pay for two plans. You would continue to pay for your current plan. Those who choose the public plan would pay for it. The public plan is to be financed from premiums collected from those who choose it.