Justifying Cruelty

As yesterday’s post pointed out, Perry and the Texas GOP Left Me Out, there are many hard working Texans who are being denied Medicaid because of ideology. GOP state Sen. Charles Schwertner’s recent Op-Ed is an attempt to try and justify the cruel decision of the GOP to deny expanding Medicaid in Texas.

Schwertner focuses mainly on one aspect of the study relating to emergency room visits.

Earlier this month, Science magazine published the results of a randomized, peer-reviewed study detailing Oregon’s experience in expanding Medicaid to the same population of independent, able-bodied adults that Texas is now asked to consider. Despite showing no improvement in measurable health outcomes over the study’s two-year timeframe, those enrolled in Medicaid were actually shown to use their local emergency room 40 percent more frequently than a control group of the uninsured. The factors driving this result are twofold — convenience and a lack of access to alternative primary care.

An uncomfortable truth of American health care is that, while most people only use the emergency room for legitimate medical emergencies, many also use it for the same reason they use fast food drive-thrus and video-on-demand — it’s convenient. Despite their considerable expense, emergency rooms will treat anyone who walks through the door, require no appointments, and are open 24 hours a day, something of great importance to those who are either unwilling or unable to seek primary care during normal business hours. Since Medicaid enrollees share no cost burden for their medical care, they also have no incentive to seek that care in a less costly setting.

While that’s true, it’s not a surprise, More emergency room use isn’t necessarily bad.

I’ve written about the OHIE so many times, I’m not wasting time praising it. Let me say that I have no problem believing these results. Unlike many others, I’ve never really believed that increasing insurance coverage leads to less ED use.  There are tons of reasons people use the ED over primary care. (See a 2010 post here http://theincidentaleconomist.com/wordpress/when-the-emergency-room-is-your-only-option/).

Improved access will lead to, well, increased access. Emergency room care was never free, no matter what people heard in the media. Telling people that they can NOW go to the emergency room with coverage should lead to MORE people going to the emergency room. Increased access does not always mean decreased spending and more primary care.

Moreover, until someone proves to me that the increased ED use was unnecessary, I don’t know why anyone would assume it’s a bad thing. If our goal is to increase people’s access to the health care system, getting more people insurance (like Medicaid) is a good tool for that. If our goal is to help people make more effective use of the healthcare system, increasing coverage isn’t necessarily going to be as good a tool.

The goal of Obamacare is to help people, and that’s what’s always scared the right wing ideologues.  If people again see that the government can actually help people they’re ideology is doomed.

There was also good news in the study which Paul Krugman pointed out, Medicaid Nonsense.

Busy day, no additional blogging until much later. But you should be reading The Incidental Economist on the Oregon Medicaid study that’s creating a lot of fuss today. Basically, budget woes forced Oregon to allocate Medicaid access by lottery, giving a rare randomized experiment. Those who got Medicaid suffered much less financial distress and less depression; they received more preventive care; but on some (not all dimensions) their health wasn’t significantly better than those who lost out in the lottery.

Somehow, conservatives think this is a big win for their opposition to universal health insurance. Why? What it suggests is that the health benefits of ANY kind of health insurance are somewhat hard to identify over a two year period; so, are you about to give up your own insurance, or is your best bet that having that insurance is still a very good idea? And the financial benefits are a big part of that! Since you are going to treat your illnesses, better not to bankrupt yourself in the process, right?

Oh, and until now the claim of right-wingers has been that Medicaid actually makes you sicker; serious researchers have always said that this was a case of selection bias, because sicker people got Medicaid — and now we have confirmation: those who got Medicaid were at least somewhat healthier than those who didn’t.

Above all, you should bear in mind that if health insurance is a good idea — and you are nuts if you let this study persuade you otherwise — Medicaid is cheaper than private insurance. So where is the downside?

And Ezra Klein had this to say about the study, Here’s what the Oregon Medicaid study really said.

Here’s what we can say with certainty: Medicaid works as health insurance.

That might seem obvious. It’s actually not. A big criticism of Medicaid is that it pays doctors so little that it’s essentially worthless because no doctor will see you. But the Oregon residents who won the Medicaid lottery got much more health care — including preventive health care — than the residents who lost it. They also saw catastrophic health costs basically vanish.

[…]

The problem with the Oregon study is that it doesn’t help us figure out how to make health care or health insurance better. We don’t know if the results speak to the health care you get through all health insurance or just Medicaid or if they’re just an artifact of the study’s timeframe and sample size. We don’t know if different ways of designing insurance programs would lead to radically different care outcomes (we actually tried a randomized study on that question in the 70s, and the answer, at least then, was “not really”). And so we don’t know whether we’re seeing a problem in Medicaid, an inconvenient truth about medical care, or something else. Worse, we don’t know what to do next.

But we could find out. Studies like this one don’t need to be so rare. The government could put a very small amount of money — say, one percent of the federal budget — toward designing and conducting them across all areas of public policy and the results would help us spend the rest of our dollars much more wisely. There’s no reason the Oregon experiment has to be a unicorn.

I think that’s a great point, we need more studies to see how things are actually working.  No one thinks Obamacare is perfect, and as most government programs, will be changed going forward.  All the ideologues have been calling it a failure since it passed. That Schwertner and the like would discount the good news in the study – of how people are actually being helped – and overly focus on the negative is not surprising. That’s what they do when they’re trying to justify cruelty.

John Carter & The GOP’s Misplaced Priorities

Congressman John Carter (R-Round Rock) has his priorities misplaced. In an interview with Roll Call Carter tells what the GOP’s strategy will be in 2014, GOP Negotiator: No Immigration Overhaul This Year.

Boehner told the conference and the press last week that leaders and committee chairmen will produce a blueprint outlining agreed-upon principles for overhauling the nation’s immigration system, leading many to speculate that votes on the issue could be held later this year.

“I’m opposed to voting on a bill this year,” said Carter, who was a member of GOP leadership last Congress. “I was in conference when John announced that. It was a surprise to me as much as it was a surprise to anybody else.”

[…]

Carter added that the votes could leave Republicans vulnerable to primary attacks from the right, especially if, as is expected, the changes take on the question of the legal status of some 11 million undocumented immigrants living in the United States.

“I personally think this is the wrong time from our standpoint to go forward on immigration,” he said. “It’s an election year. I mean Texas is in the middle of primaries right now.”

That said, Carter would contribute to policy change efforts if he is asked, he said. His views on timing do not necessarily mean he will oppose bills if they come to the floor.

At the end of the conversation, (from the audio), Carter was pressed on why he thought it was a mistake.

Top of the bill being that it’s not good politically for the country?
Carter: Top of the bill being that it changes the subject.
From Obamacare?
Carter: There you go.

It’s an election year now and Carter the GOP, and the tea party want no part of immigration reform. They don’t want the base of the party to stay home in November, and they believe passing immigration reform would do that.  They also believe that what worked n 2010, will work again in 2014. 2010 Redux. Why Not?

They need to turn out white senior citizens who hate Obama. They figure if it ain’t broke, they’re not going to fix it. We’ll see if they’re right.

Carter last year said this about immigration reform in the local Chamber of Commerce news.

“Economically for the state of Texas, there is probably no bigger issue right now in Washington D.C.,” Carter said, explaining that Texas has the largest influx of immigrants of any state.

The only thing that’s different from when Carter made that statement is the calendar.  It’s now an election year and immigration cannot be allowed to, “capture the media cycle”.  Economics aside, the immigration issue, is about people, families and most important human dignity. Keeping immigrants in the shadows, because it’s not good politics for the GOP in an election year, shows exactly what the GOP’s priorities are.

Just as keeping their cruel, and failed plan of trying to take away health insurance from the millions that are now insured, front and center in 2014 does. Obamacare enrollment has been growing faster in Texas since December.  Also over 200,000 more Texans would have health insurance had Perry and the GOP allowed Medicaid to be expanded. We can only imagine how many tens of thousands more Texans would have health insurance had the Texas GOP not been fighting against Obamacare from the beginning.

But what Carter and the GOP’s cynical political ploy shows is that they’re not concerned about working to solve problems.  They’re only concerned about keeping things the same as they are now.  We cannot move past these two issues, and many more, if we keep electing the same people to office.  If again, too many of us who don’t vote and don’t get to the polls in November then nothing will change.  The sad truth is that the only way they can repeat their success of 2010, is if we allow them to do it again in 2014.

Here are several ways to combat that, 9 Ways to Channel Your Inner Activist in 2014.

And be sure and check our Carter’s opponent in 2014, Democrat Louie Minor.

If The Government Helps the People They Lose

Kuff tells it like it is on Perry and the GOP when it comes to health care in Texas, Rick Perry doesn’t want people to get health insurance.

It takes a certain level of sociopathy to say something like that when you are the Governor of the state with by far the highest number of uninsured people, and you’ve been Governor for thirteen years without doing a single thing about it. Except for all the things you’ve done to deny health insurance to people, such as the CHIP cuts and our famously stingy Medicaid eligibility requirements and onerous enrollment processes. Hey, remember when we spent a couple hundred million dollars outsourcing our Health and Human Services Commission and gave the money to a private firm that didn’t know its ass from a pencil eraser? Those were the days, my friend.

The antipathy towards health insurance comes through in everything Rick Perry – and David Dewhurst and Greg Abbott and the rest of the sorry lot – does, from imposing needless burdens on navigators to refusing to expand Medicaid to refusing to implement an exchange, and on and on. If there were some honest ongoing effort over the past decade-plus to do something about the millions of uninsured in Texas, that would be one thing. But the record, and the inactivity, speak for themselves. There’s really no other way to characterize it. Millions ofpeople have become insured around the country, but all we get here is rage and denial.

Oh, and bad journalism, no doubt influenced by the lying and obfuscation. Do make sure you click those two links and read the stories, which have now coaxed an apology for the half-assed job they did from the Star-Telegram. Senators Sylvia Garcia and Rodney Ellis have more.

I would add that it’s not just that Perry doesn’t want people to have health insurance, but that he doesn’t want them to have government insurance or insurance that is subsidized by the government. They want to make sure that the American people don’t get the idea in their head that the government can actually do things to help them.  As long as someone is paying for it themselves and it’s coming from an insurance corporation he would have absolutely no problem with it.  It’s just that people getting health care from their government is abhorrent to him, and always has been to the wing-nuts.

This is the same fight we’ve been having since the inception of the New Deal under FDR.  Author Lane Kenworthy has an excerpt of his new book, Social Democratic America, here America’s Social Democratic Future.  He does a great job of explaining what’s got conservatives in an tizzy.

Obamacare, as the law is commonly known, is the most significant reform of the U.S. health-care system in half a century. It aims to increase the share of Americans who have health insurance, improve the quality of health insurance plans, and slow the growth of health-care spending. But the fight over the law is about more than just health-care policy, and the bitterness of the conflict is driven by more than just partisan polarization. Obamacare has become the central battleground in an ongoing war between liberals and conservatives over the size and scope of the U.S. government, a fight whose origins stretch back to the Great Depression and the New Deal.

The passage of Obamacare has caused such controversy in part because it seems to signal a new stage of government activism, leading some conservatives to oppose it as a decisive and possibly inexorable turn to the left. “Precisely because the Affordable Care Act is the realization of a half-century long liberal dream,” the conservative commentator Peter Wehner wrote recently in The Weekly Standard, “if it fails, it will be a crushing blow not just to Barack Obama but to American liberalism itself. Why? Because Obamacare is in many ways the avatar, the archetype, of modern liberalism. That’s true in terms of its coercive elements, its soaring confidence in technocratic solutions, its ambition to centralize decisionmaking, and its belief that government knows best.”

Such apocalyptic arguments vastly overstate Obamacare’s practical significance. But they also obscure the more interesting reality, which is that the ACA represents another step on a long, slow, but steady journey away from the classical liberal capitalist state and toward a peculiarly American version of social democracy. Unlike in, say, northern Europe, where social democracy has been enacted deliberately and comprehensively over the years by ideologically self-aware political movements, in the United States, a more modest and patchy social safety net has been pieced together by pragmatic politicians and technocrats tackling individual problems. Powerful forces will continue to fight those efforts, and the resulting social insurance policies will emerge more gradually and be less universal, less efficient, and less effective than they would otherwise have been. But the opponents are fighting a losing battle and can only slow down and distort the final outcome rather than stop it. Thanks to a combination of popular demand, technocratic supply, and gradually increasing national wealth, social democracy is the future of the United States.

Health care should be a right in our country.  To them Obamacare, which is not government run health care,  is a total repudiation of what they stand for, no matter how many people it helps. What they are for is privatization, which always costs more.

Privatization takes inherently governmental functions — everything from national defense to mass transit and roads — and turns them over to the control of private actors, whose goal is to extract maximum revenue while costing as little as possible.

Republicans have long advocated this in the name of free markets — saying that privatizing government services reduces the size of government. Democrats express more mixed support, but they sometimes go along for the privatizing ride.

Yet it isn’t true, as a general rule, that privatization shrinks the public sector. When investor demand for high returns is combined with the natural monopolies of public assets, what often results instead is citizens finding themselves saddled with high fees and poor service.

Even more perniciously, selling infrastructure such as toll roads puts the coercive power of the state in the hands of private actors. We have great public assets built by prior generations. We should and could be building a better country for our children, rather than liquidating what we have.

Some might call that looting, not liquidating.  It’s about ideology for them, and not about finding solutions.  There’s no tax cut that can be passed to give people health care, so there out of ideas.  They have no policy proposal to insure the uninsured.  All they have is bad things to say about those without insurance, and to keep trying to destroy Obamacare.

This is why in Texas we must have new leadership.  It’s the only way the uninsured will get insurance in Texas.