Medicare crisis

Part of the new federal  health care plan will be funded by cuts to Medicare, the existing government program that pays for health care for the elderly.  Already, though, an increasing number of doctors are  refusing to take on Medicare patients because the payments are too low.  And starting on January 1 those payments are scheduled to be cut  a whopping 25%.   From The Washington Post:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate (SGR) and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the increasingly steep cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to persuade Congress to suspend the 25 percent rate cut that the SGR method will require next year.

via Doctors say Medicare cuts forcing them to shift away from elderly.

Does anyone have a solution for this?

How government agencies avoid competitive bidding

Are you an Eskimo from Alaska?  Are you part Eskimo?  Do you know an Eskimo?  (That term, by the way, according to Wikipedia is NOT pejorative when referring to the Alaskan tribes.)  If so, you can start a company and get a government contract without having to compete for it.  Then you can sub-contract the actual work to other companies, pocketing millions for yourself.

That’s one of the ways the federal procurement process avoids having to comply with time-consuming but money-saving laws about taking the lowest bid .  From The Washington Post:

United Solutions and Services, known as US2, had just three employees and several small contracts for janitorial services and other work. It was based in a four-bedroom colonial, where the founder worked out of his living room.

But the firm had one quality the Army prized: It was co-owned by an Alaska native corporation (ANC) and therefore could receive federal contracts of any size without competition, under special set-aside exemptions granted by Congress to help impoverished Alaska natives.

On Sept. 2, 2008, US2 was granted a deal worth as much as $250 million – 3,000 times the $73,000 in revenue the firm claimed the year before. The contract enabled the Army to quickly fund a wide array of projects, including a global campaign to prevent sexual assault and harassment, without seeking outside bids.

US2 could not do the work by itself, though. With the Army’s knowledge, the firm subcontracted the majority of it to more established companies, a Washington Post investigation has found.

Federal rules generally require prime contractors on set-aside deals to perform at least half of the work, something US2 did not do on more than $100 million worth of jobs, according to interviews with Army officials and an analysis of federal procurement data.

via Alaska native status gave tiny, inexperienced firm a $250 million Army contract.

The Liberal Conspiracy Theories

Glen Beck has been pushing his conspiracy theories.  Now the liberals are doing it.  They are unable to imagine that there is anything wrong with their president or with their economic theories.  So many of them believe that the Republicans and their business allies,  to ensure that the president will not get re-elected, are deliberately sabotaging the economy.  From Michael Gerson:

If a president of this quality and insight has failed, it must be because his opponents are uniquely evil, coordinated and effective. The problem is not Obama but the ruthless conspiracy against him.

So Matt Yglesias warns the White House to be prepared for “deliberate economic sabotage” from the GOP – as though Chamber of Commerce SWAT teams, no doubt funded by foreigners, are preparing attacks on the electrical grid. Paul Krugman contends that “Republicans want the economy to stay weak as long as there’s a Democrat in the White House.” Steve Benen explains, “We’re talking about a major political party . . . possibly undermining the strength of the country – on purpose, in public, without apology or shame – for no other reason than to give themselves a campaign advantage in 2012.” Benen’s posting was titled “None Dare Call it Sabotage.”

So what is the proof of this charge? It seems to have something to do with Republicans criticizing quantitative easing by the Federal Reserve. And opposing federal spending. And, according to Benen, creating “massive economic uncertainty by vowing to gut the national health care system.”

One is tempted to respond that it is $1 trillion in new debt, the prospect of higher taxes and a complicated, disruptive health-reform law that have created “massive economic uncertainty.” For the purposes of this argument, however, it is sufficient to say that all these economic policy debates have two sides.

Yet this is precisely what the sabotage theorists must deny. They must assert that the case for liberal policies is so self-evident that all opposition is malevolent. But given the recent record of liberal economics, policies that seem self-evident to them now seem questionable to many. Objective conditions call for alternatives. And Republicans are advocating the conservative alternatives – monetary restraint, lower spending, lower taxes – they have embraced for 30 years.

via Michael Gerson – Liberals resort to conspiracy theories to explain Obama’s problems.

The proletariat votes Republican

Statistical slicing and dicing of the election results shows what I had been saying:  Blue-collar workers, who used to be Democrat’s base, are now overwhelmingly voting Republican.  Higher income folks are voting for the Democrats.  These class dynamics, of course, fly in the face of leftist political theory.

Democrats remained strong in areas with the party’s core of minorities and higher-educated whites. But movement of white working-class voters away from the party is a concern for Democrats, especially because of President Obama’s traditional weakness with those voters.

Republicans’ success with the blue-collar vote and the high enthusiasm of the tea party gives it a fired-up base headed into 2012. But in a presidential election with higher turnout, the party might have trouble winning a majority with those voters alone. It certainly can’t rely on that bloc to carry the party into the future.

Democrats largely held on to their high share of the vote in the country’s densest places. The party captured 54 percent in counties with populations of more than 500,000 people, compared with only 49 percent in 1994. In smaller counties, Democrats’ share of the vote slid to 39 percent this year from 43 percent in 1994.

Much of the reason for the Democrats’ decline in less-dense areas can be attributed to the party’s trouble attracting white, working-class voters. Exit polls showed that Democrats lost white voters without a college degree – one way to measure blue-collar voters – by almost 30 percentage points in House races.

via Political divide between coasts and Midwest deepening, midterm election analysis shows.

The article, which is putting the best construction on everything for the Democrats, says that the Republican dominance among low income white people will not last long, since that demographic is shrinking.  I don’t know.  With the current economy, that number may just skyrocket.

And it doesn’t look like the Democrats will try to win back their base as long as they give off the classist vibe, the sense that all of those uneducated voters, those ignorant white trash rednecks, just don’t belong among their betters.

So what about THIS debt-reduction plan?

Yet another bipartisan commission is proposing a plan to cut the federal deficit.  What do you think of this one?  From  co-chairs Pete Domenici and Alice Rivlin:

To ensure a more robust recovery, we propose a one-year “payroll tax holiday” for 2011, suspending Social Security payroll taxes for employers and employees. We also would phase in the steps to reduce deficits and debt gradually beginning in 2012, so the economy will be strong enough to absorb them.

We would stabilize the debt held by the public at less than 60 percent of gross domestic product, an internationally recognized standard; reduce annual deficits to manageable levels; and balance the “primary” budget (everything other than interest payments) by 2014.

We would dramatically simplify the tax system, establishing individual tax rates of 15 and 27 percent (from the current high of 35), cutting the corporate tax rate to 27 percent (from 35 today), ending most deductions and credits while simplifying the rest, and ensuring that nearly 90 million households no longer have to file returns. To reduce the debt, we would supplement our spending cuts with a 6.5 percent “debt-reduction sales tax.”

We would strengthen Social Security so it can pay benefits for the next 75 years by gradually raising the amount of wages subject to payroll taxes; slightly reducing the growth in benefits for the top 25 percent of beneficiaries; raising the minimum benefit for long-term, low-wage workers; indexing benefits to life expectancy; and changing the calculation of cost-of-living adjustments to better reflect inflation. We would not raise the age at which senior citizens can begin receiving benefits.

We would control health-care costs – the biggest driver of long-term deficits – by reforming Medicare and Medicaid while, starting in 2018, capping and then phasing out the tax exclusion for employer-provided health care. We would reform medical malpractice laws and help address the health costs tied to rising obesity by imposing a tax on high-calorie sodas.

We would freeze domestic discretionary spending for four years and defense spending for five, both at 2011 levels, and then limit their future growth to the rate of growth in the economy.

Finally, we would cap domestic and defense discretionary spending (with tight exceptions for true emergencies) and trigger across-the-board cuts if the caps are breached; enact a strict pay-as-you-go statutory rule for tax cuts or expansions of entitlements; and enact long-term budgets for major entitlements while creating a Fiscal Accountability Commission that would recommend policy changes every five years if entitlements are exceeding their budgets.

via Pete V. Domenici and Alice M. Rivlin – Payroll tax holiday and other measures to reduce the debt.

The Social Security payroll tax holiday for an entire year would be enormously popular and would put extra money in people’s paychecks immediately.  Maybe that would be the boost the economy needs.  I like the flat tax in principle, but I worry that eliminating charitable deductions (if that’s part of it; the article doesn’t say) would hurt churches and other good causes.  And wouldn’t a 6.5% “debt reduction sales tax” hurt the economy, taking away the good other parts of this plan might do?  Caps and freezes would probably be good.

Again, what do you think?  Do you have better ideas?

Religion blocks consumerism

In another odd experiment, it seems as if religious people are less susceptible to buying things according to their brand, which to secularists is often a means of enhancing status and self-worth:

Prof. Ron Shachar of Tel Aviv University’s Leon Recanati Graduate School of Business Administration says that a consumer’s religiosity has a large impact on his likelihood for choosing particular brands. Comsumers who are deeply religious are less likely to display an explicit preference for a particular brand, while more secular populations are more prone to define their self-worth through loyalty to corporate brands instead of religious denominations.

This research, in collaboration with Duke University and New York University scientists, recently appeared in the journal Marketing Science.

There is considerable statistical evidence that consumers buy particular brands to express who they are to the outside world, Prof. Shachar says. From clothing choices to cultural events, people communicate their personalities and values through their purchases.

Prof. Shachar and his fellow researchers decided to study the relationship between religiosity and brand reliance. . . .

Researchers discovered that those participants who wrote about their religion prior to the shopping experience were less likely to pick national brands when it came to products linked to appearance or self-expression — specifically, products which reflected status, such as fashion accessories and items of clothing. For people who weren’t deeply religious, corporate logos often took the place of religious symbols like a crucifix or Star of David, providing feelings of self-worth and well-being. According to Prof. Shachar, two additonal lab experiments done by this research team have demonstrated that like religiousity, consumers use brands to express their sense of self-worth.

via American Friends of Tel Aviv University: Shopping Religiously.

I suppose this simply proves that religious people are not as “worldly.”  It also suggests how pathetic it is to be “worldly,” having to turn to corporate logos as a substitute for religious symbols.

HT:  <a href=”http://www.futurepundit.com/archives/007649.html”>Future Pundit</a>


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