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President Fuck You continues drive to kill people by denying them Medicare

The bright side: Under pressure, the administration has backtracked on its vicious and reprehensible proposal to raise the Medicare eligibility age from 65 to 67. Here's what they're plotting instead. Izvestia:

The proposal also includes $580 billion in adjustments [Nice!] to health and entitlement programs, including $248 billion to Medicare and $72 billion to Medicaid.

Gee, that's great. Medicaid was supposed to be the backstop for all of us who won't be able to afford the junk insurance we're going to be forced to buy under Obamacare. Oh well. And the nature of the cuts? Well, given that the Ds are sneakier and more dishonest than the Rs -- who are quite open and honest about their desire to kill you -- you know it's got to be a complicated Rube Goldberg device, and so of course it is:

Administration officials said 90 percent of the $248 billion in 10-year Medicare cuts would be squeezed from service providers [who will nevertheless maintain the same level of care. Naturellement]. The plan does shift some additional costs to beneficiaries, but those changes would not start until 2017, and administration officials made clear as well that Obama would veto any Medicare cuts that aren't paired with [designdly evadable] tax increases on upper-income people.

To begin with, as usual in kabuki drama with Obama, this is not a baseline, but the top line. The merely awful is the best, and the outcome will be worse. From the same story:

All in all, the president's plan is as much an opening bid as it is a political statement designed to draw contrasts with Republicans, who control the House of Representatives.

As such, it was not intended as a compromise and did not include agreements Obama had reached with House Speaker John Boehner during failed deficit reduction negotiations this summer.

OK, now let's pick it apart.

First, did you notice where the cuts did not fall? That's right. Insurance companies. Under rentier capitalism, it's a moral imperative that parasites like health insurance companies -- who add no value to any transaction in which they engage -- must be enabled to suck the maximum rent from their helpless hosts. Heck, the state even helps strap the host down so the parasite can sink a feeding tube into a vein!

Second, did you notice where the cuts did fall? That's right. Service providers. In other words, if they can't kill you by raising the eligibility age to 67, they'll try to kill you by decreasing the quality of care.

Third, that 2017 date. Am I supposed not to worry about that? What is there about the new normal that gives me a reason not to worry? And isn't that date exactly the kind of thing that Obama would sell us out on in the course of the kabuki "negotiations"?

Finally, did you parse this sentence? "[A]dministration officials made clear as well that Obama would veto any Medicare cuts that aren't paired with tax increases on upper-income people." Sounds great, until you realize that everything is right back on the table. And such a deal! The top 1% trade something they can well afford to give -- some money -- for something the 99% can't afford to lose: Their health and their lives. But that's the kind of compromise President Fuck You excels at, right?

NOTE A sane political class, and a non-sociopathic elite, would be implementing Medicare for All, not cutting Medicare back. That would save the country a minimum of $350 billion a year, and would also save tens of thousands of lives. Of course, it's far more important to Obama that health insurance companies continue to collect rent, and that health insurance CEOs continue to collect fat bonuses, because the Ds really need the money, because, ya know, look over there! I understand this. Also, too, falling life expectancy is a policy objective in Versailles, so win win.

NOTE When I started using rhetoric like that in the headline, I thought it might be over the top -- moi? Lambert? -- as rhetoric, even if the obvious policy outcomes make the rhetoric true. But I'm seeing identical framing everywhere; it's not just me.

The insiders experienced the debt debacle as a sort of watershed or breaking point, the point when the disconnect between Versailles and the rest of the country finally became obvious to at least some of them, but I would bet that in the coffee shops and the bars and the VA posts, raising the Medicare eligibility age was the breaking point. The debt debacle and the proposal to toss elders onto the ice floes all happened at the same time, so causality is hard to determine, but really, the only one who responds "I'm thinking" to "Your money or your life" is Jack Benny.... Medicare, as part of the social contract, is far more important to people than ZOMG!!!! Teh debt!!!! even if, under the careful direction of their bankster owners, the well-insured Versailles courtiers are obsessed with the latter, and regard the human Medicare beneficiaries as mere counters in their games.

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twig's picture
Submitted by twig on

Exactly! In fact, they're already doing it! [emphasis added]

Heart failure patients covered by Medicare or Medicaid or who have no insurance at all received fewer evidence-based therapies than those with private insurance, researchers found.
(snip)

Patients in the Medicaid and no insurance groups with left ventricular systolic dysfunction (LVSD) had the highest adjusted rates of inhospital mortality.

Patients with LVSD who were covered by Medicare or Medicaid, or who had no insurance also had longer hospital stays, and those with Medicare or Medicaid had lower use of ACE inhibitors or ARBs and beta-blockers [all standard methods of treating heart failure].

So people who don't have private (i.e., $$$$) insurance are already being shoved onto the metaphorical ice floe and left to die, even with Medicare/Medicaid. Of course, the number of deaths will just increase if they cut provider payments. So there you go -- another win-win for the hurry-up-and-die crowd!!

Submitted by hipparchia on

Turns out that in "evidence-based" medicine, the only evidence that really matters is what's in your wallet. Shocker.

that's a great line, demonstrably true, and i may steal it from you someday.

meanwhile, the 'evidence-based guidelines' appear to have been developed by, or at least paid for by, pharmaceutical and medical device manufacturers:

The Get With the Guidelines Heart Failure (GWTG-HF) program is provided by the American Heart Association (AHA). The GWTG-HF program is currently supported in part by Medtronic, Ortho-McNeil, and the AHA Pharmaceutical Roundtable. GWTG-HF has been funded in the past through support from GlaxoSmithKline.

and none of the authors of that 'study' has ever taken a dime from any pharmaceutical or medical device manufacturer, have they?

Hernandez has received research support from Johnson & Johnson, Proventys, and Amylin Pharmaceuticals. Heidenreich has received grant support from Medtronic. Fonarow has received research support from the National Heart, Lung, and Blood Institute (significant), is a consultant for Novartis (significant) and Scios (modest), and has received an honorarium from Medtronic (modest).

[...]

Shah is supported by grants from the American Heart Association Pharmaceutical Round Table and the Stanford National Institutes of Health (NIH)/National Center for Research Resources Clinical and Translational Science Awards. Klein is supported by an NIH grant. Phillips has received grants from Novo Nordisk, Merck, Amylin, Diasome, Eli Lilly, Roche, and sanofi-aventis; and in the past has been a speaker and served on scientific advisory boards for Merck, Novartis, Boehringer Mannheim, Takeda, and other pharmaceutical companies making diabetes-related products.

gee, medtronic doesn't make ICDs [medical device mentioned in the article] by any chance, do they?

but still, their conclusions must be valid, after all, the study covered 99,508 patients! right?

Kapoor and colleagues said their study was limited by not having the patients' socioeconomic status available, which could influence whether patients accept or refuse certain evidence-based therapies.

Also, they noted, reliance on chart data has inherent limitations, and they did not follow up patients after discharge for long-term consequences.

private insurance is generally provided by employers, which means that people covered by private insurance generally have jobs, which means that they probably also have at least some money and can afford the copays, deductibles, etc.

and last but not least, these 'private insurance is better than govt insurance' articles are generally written with an eye toward discrediting medicare and medicaid, even if they kinda sort have to fudge the facts a little. if you look at the abstract of the original article [the full article is behind a paywall], you see a long list of things that private insurance patients got more often than those on medicare or medicaid, but it's mostly a list of medications. from the review article, medicare patients actually got the highest number of implanted medical devices:

Of particular concern, they said, is that just 31% of those with no insurance and 38% of those on Medicaid received an indicated ICD. That compared with 42% of those on Medicare and 41% with private or HMO coverage

still, gotta diss the govt! partly because there are some ideologues who want 'free markets' in everything and partly because private insurance generally pays more than govt insurance.

so even though medtronic is more likely to sell MORE ICDs to medicare patients, medicare, being the big buyer they are, will probably pay less per device, and medtronic would ideally prefer that we all be on private insurance [pays more!] with the premium payments backed by generous govt subsidies [because it's obvious to everyone that the completely uninsured can't afford this stuff].

twig's picture
Submitted by twig on

the story, because I didn't think of it from that perspective. Makes sense, though -- very interesting that this is really about making private insurance look good. The propaganda machine sucked me in once again! Thanks for the correction, Hipp!

Submitted by hipparchia on

the propaganda machine is just doing its job. ;)

also, since it's patently obvious that the uninsured and the poor [ie those most likely to be on medicaid] really are getting worse [and less] care, these kinds of articles are being very sneaky in piggybacking on that truth.

twig's picture
Submitted by twig on

My niece is on -- actually was on -- Medicaid and lost it, for reasons no one understands, so she had some care (much needed!) for a few months and now it's over -- even though she's still in need.

She works part time, 20 hours a week, minimum wage (whatever that is in Michigan). A few months ago, she got a letter saying she was eligible for Medicaid coverage, so she went to the doc for sleep apnea and got the CPAP deal, which Medicaid agreed to pay for in installments.

Then she got another letter saying she was no longer eligible for Medicaid and they would not continue to pay for the CPAP. So the machine is gone and she's back to square one. No new job or increase in hours, so no one knows why she was eligible a few months ago but isn't now. And unfortunately, no one there is willing to do the work or ask questions to figure this out. All they know is you get evaluated every six months or so (?) and told whether or not you qualify.

So it sounds like Medicaid patients who start treatment for whatever may get a few months of help and then mysteriously "unqualify," thereby losing any progress or improvements that may have been made. Great system! Imagine people starting on medication and then being told Medicaid won't pay anymore -- yeesh!

Submitted by lambert on

Great discussion! Spoke too soon on the study; looks to me like bait and switch, where truth is the bait, and a solution that makes the situation worse is the switch.

Submitted by hipparchia on

a lot of evil can sure be perpetrated using the truth but only part of the truth.

Submitted by hipparchia on

the federal govt sets some minimum standards that the states have to meet in order to get federal matching funds. then for anything beyond that the states have lot of leeway in deciding what they'll pay for and who qualifies. these state guidelines can change yearly, and possibly more often.

and yes, many people drift in and out of medicaid, for years on end. usually it's because their incomes go up and down [seasonal employment] but it can also be because the states can vary their generosity frequently.

in your niece's case, did her eligibility change at the beginning of a new fiscal year [or possibly even fiscal quarter] for her state? that might account for it if her income [or possibly her total assets] stayed the same.

twig's picture
Submitted by twig on

good question -- I don't think so, but it would seem something changed, maybe on their (gov't) end.

The strange part is she apparently didn't ask for it. Her kid has been on it for years , and she just got a letter telling her she was eligible. And then after 6 mos (or so?) she got another letter saying she lost it.

Which made me wonder if this happens all the time -- b/c I'm thinking of all the bad outcomes for people who get a few months of medication or treatment and then go back to nothing at all -- that's a recipe for disaster.

Submitted by JuliaWilliams on

governor, and a sweep of the state house and senate by Rs. They passed a budget which included 1.7 bilion dollar tax breaks for business, and started slashing everything from education to healthcare, in addition to taxing old-age pensions, and other wonderful stuff. Just following the ALEC playbook.

Submitted by hipparchia on

but it would seem something changed, maybe on their (gov't) end.

that's what i meant to say :) i think julia's got it right. and yes there are health consequences.