This is very good news. Many have feared that, with the Paul Ryan plan to end Medicare getting so much attention, Congress would downshift to a safety valve, the Paul Ryan plan to cripple Medicaid, as part of a deficit reduction deal. Under the Ryan plan, Medicaid would be turned into a block grant, which means that state policymakers would be allowed to change the program as they see fit, and that the program would not get funding based on need, but a flat amount that would not rise in a recession, when more people become poor and qualify for Medicaid. Experts estimate that tens of millions of people would lose Medicaid coverage as a result, and considering that fully half of the coverage expansion from the Affordable Care Act comes from increases to Medicaid, the increase in the ranks of the uninsured would simply be magnified.
But rather than roll over for this, enough Senate Democrats to sustain a filibuster have said that they won’t allow it.
Forty-one Senate Democrats have signed on to several letters vowing to oppose House Republicans’ proposed Medicaid overhaul, ensuring the proposal won’t get enough votes to clear a filibuster hurdle.
One letter, to President Obama, spearheaded by longtime Medicaid defender Sen. Jay Rockefeller (D-W.Va.), garnered 37 signatures. It makes clear that the senators will oppose proposals to cap federal spending on Medicaid, a program whose spending currently fluctuates with need.
Four other senators — Dianne Feinstein (Calif.), Mark Udall (Col.), Michael Bennet (Col.), and Amy Klobuchar (Minn.) — wrote separate letters to the president.
This basically becomes a firewall against severe changes to Medicaid. And not one Democrat in either chamber signed on to the Ryan budget and its changes to Medicare.
There’s still one option to guard against; Congress could use the budget reconciliation process to pass a budget that messes with Medicaid while leaving these 41 Democrats behind, requiring only 50 votes. But the numbers for such a deal would be difficult to find, because there are probably at least a few Republicans – Rand Paul, Mike Lee, Jim DeMint – who wouldn’t sign on to any deal that doesn’t abolish government altogether.
Overall, it’s good at this stage for 41 Democrats to plant a flag and say they won’t support the block granting of Medicaid. This complicates the Biden negotiations; if Medicare, Medicaid and taxes are off the table, there’s just not that much left.
UPDATE: Jay Rock is leading this effort. Here’s his interview with Ezra Klein.




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Well, good on them. Do we ever need more surprises like this!
I’ll believe it when I see the actual filibuster in action. Remember, Oblather hasn’t set to work twisting arms yet. Until I’m proven wrong I’ll just file this under “Kabuki – Act One”.
Since there is no “progressive caucus” in the Senate, I find it somewhat difficult to connect the dots, from LBJ’s Great Society to what the Corporate Democrats are determined to accomplish, and at the expense and cost to the Middle Class.
Therefore, in this current election cycle, will Progressives be challenging Obama and Biden, on their behavior or lack thereof, for perpetuating and even expanding the Great Society?
Jaango
If Jay Rock does not turn out to be Jello Jay, this could be a Good Thing. (But the Rock has turned to Jello many, many times before.)
Jello Jay rears his head at the end of Ezra’s interview:
Incidentally, the so called “excess per capita growth rates” to which Jello Jay refers are notoriously inaccurate at predicting future growth. See CBO’s long-term budget outlook which is published annually to see how it fluctuates. Not that I disagree that Mediciad is a lean program. I don’t. I just want to show the Jello Jay doesn’t grasp the complexity of this problem just like he doesn’t understand the intertubes.
Oops, I misread the quote. It seems like it’s Ezra that doesn’t understand excess per capita growth rates.
So when are the Dems actualy going to present their own plan to cut the deficit, raise the debt limit in a responsible way, and maybe even a fiscal year budget?
I worry, too, that the WH will twist arms behind the scenes. Until BO says straight up, “I will veto any bill that cuts MediCare/cAid benefits, Social Security benefits, or extends the Bush tax cuts,” we can’t assume that he won’t sell them out.
And even that would only turn it into a maybe – he’s very big on ‘supporting’ progressive principles, but not standing up for them, let alone fighting.
Fucking asshole.
It doesn’t matter what BO says, it all comes down to what he does.
And the two things he does best are:
a) Lie.
b) Fuckover liberals, progressives, and supporters.
Asstute comment.
Buzz, waz up? It’s been a long day, okay-right?
There’s a reason I pretty much only comment at the crack o’ dawn and mostly lurk if I’m around later.
But, I do agree with your comment.
(((econbuzz)))
Obama can’t be happy about this. So sick of that clown.
We used to make comments when the Queen Bee has been on the tee bee.
Jane Hamsher has spoken on MSNBC, or elsewhere, but it doesn’t seem to happen that much anymore. Woe is me that I long for the good old days.
Jane was on Cenk’s show and did a great job.
It’s unfortunate that this was not split into two bills: one for the size (and growth) of Medicaid spending and one dealing with whether Medicaid should take the form of block grants.
Block grants for Medicaid prevent the “split the dinner check” moral hazard problem. Loosely speaking, so long as the Federal government agrees to foot part of the bill, States are incentivized to spend beyond economic efficiency – spending more than a dollar (comprised of up to the State’s $1 plus some from the Federal government) to get a dollar’s worth of utility. So I can understand the argument for this.
But the actual level of Federal contribution for Medicaid to reach that efficient level is potentially pretty broad. If a State’s efficient level of health care spending is $X, then Federal spending could range from as low as $0 (completely paid by the State) in some cases all the way up to an upper limit from the Federal government’s block grant of $X (at which point States won’t contribute anything and we look a lot like single payer for Medicaid). Anywhere in that range, you WANT to spend that money because you get more than its value in utility. I have no idea what that upper limit is (the total of all States’ $X-values), but before Medicaid gets cut it would be nice to hear the Republicans explain their side of this story.
Thanks, demi. Long day.
Just think of how inappropriate that statement by Klein is: C’mon, Senator, get real, there must be some way we can fuck over the poorest of the poor to get a “win.”
This complicates the Biden negotiations; if Medicare, Medicaid and taxes are off the table, there’s just not that much left.
Like I care about his made up problem, cuts to dod, hls, stop all the fucking wars, and stop bailing the clowns on ws then there’s plenty for Main Street. Yes I’m suprised they found some back bone but for how long, just enough to quite the masses then back to business as usual. Voting Green
i’ve never even seen Cenk’s show – but I read his stuff now and then.
can’t watch the cable news at all anymore. sometimes even yell at the BBC these days…
I worked at my volunteer job for 6 hours today, so I might have missed a sound bite.
I really, really need to focus on my life and not follow every tweet. But, I can catch up at the Lake, when I’m home. :)
x2
hey I commented on that just as she was coming on.. Just back a thread ago or so…
Hi Demi ☺ ☺
Amen. Fucking Corporatist asshole is all he really is and has ever been.
yup demi it was here
Can’t tell you how impressed I am with volunteer service. You should be proud.
That’s an important point. I think the best answer is to federalize Medicaid, but I’m not sure.
See my #18, the box was on when I walked through the door. And, I got a glimpse.
It’s really good For Me to go out and volunteer at a community outreach/Food Bank. It’s a wonderful opportunity to serve others and not get my blood pressure going.
But, you do what you need to do to thrive, too.
When Larry Wilkerson ( Colin Powell’s) 2nd in command says we live in Nat’l Security State not a Republic anymore and that the powers to be ONLY care about WAR and starting as many as possible you’d all better believe it. They’ll loot every other part of the State to fund they’re wars that’s for sure. Obama is doing there bidding, as will whomever gets selected next year. The REPUBLIC is DEAD folks game fucking over!!
Change we can believe in: cutting Medicaid in a depression.
Massive fail — or betrayal, take your pick.
I’m not proud. I’m am, however grateful for the opportunity to serve others. Funny, I saw the old (after 9/11) Power of Pride bumpersticker on a car at the grocery store. I always felt discomfort seeing that.
Pride goes before a fall, is what I’ve heard.
But thanks for the encouragement you meant.
Well, since my life depends on this program and I’ve watched it fall apart for the past 15 years, I’ll take any ray of sunshine that finds it’s way through the smog.
I have been subjected to enough humiliation as even my doctors say insensitive things like “taking care of the poor will collapse our society!” right to my face.
Or how about this one when the shots I receive for my disorder went up 100% after Mr Oilbomber’s deal with big PhRMA, for no apparent reason my neurologist tells me that medicine is just SO much more technological these days and previous to this particular drug, I would have been stuck with one much, much worse.
I refrained from arguing with him as he was in a terrible mood and hostile for some reason I don’t want to think about, but the drug I’m referring to is NOT “new technology” it’s been around for about 30 years and was probably developed at taxpayer’s expense in a university research lab somewhere anyway.
It’s really hard when doctors I’ve worked with for years are so callous.
I wish the gov would take a look instead at how much the hospitals, HMOs and insurance companies are taking as their slice to “manage” the thing. Privatization at it’s worst
Okay, okay. Sorry.
I am sure Obama and his minions will find a way to undermine this show of spine….give them credit for now but we will see!
If you make Medicaid completely Federal and still distribute via block grants, you are likely to lose the benefit of local knowledge – the idea that the individual States have a better idea how to estimate their needs than the Federal government. Is this a small price to pay or a huge deal-breaker? I don’t know.
If you make Medicaid completely Federal but don’t use block grants, then either the Federal government defines what’s covered (which won’t necessarily be efficient for every State) or the State defines what’s covered and instead of the “split the dinner check” problem you get the more severe “dinner’s on me” problem!
My guess is that with a little bit of effort, the Federal government can find a point where it’s block grant contributions are large enough that State governments can safely cover the gap between the Fed’s spending and the efficient level but not so large that it exceeds the State’s efficient level by itself. For example, if the Federal government made block grants equal to 50% of (total… State+Fed) Medicaid spending for the prior year, all of the States should be able to cover up to efficiency and total spending (State + Federal) would not exceed this efficient level. This isn’t a perfect scheme by any stretch, but it should quickly answer the question of just how much we should be spending on health care total and fairness (between the States) could be addressed along the way.
Oh yeah. He and Joe and Timmeh are sharpening their pencils as we speak.
I know what you mean, but THIS federal government can’t grab its ass with both hands.
Could this BE ?!?
Is this the first sign of Democrats actually having balls?
Small, I admit… but even the mightiest Oak starts as a small seed.
Fixed it for ya. (;>
Yes, better.
Betrayal. Obama’s specialty.
Traditionally, the feds set the minimum for services that will be reimbursed through Medicaid. States have the latitude to add other services, with fed approval (which gives the states the opportunity to show they understand their populations in need and can respond with effective and efficient services). Of course, in the current environment (i.e., recession/depression) and the on-going effort to destabilize state funding and destroy social programs) states can’t add benefits. They are struggling to maintain their basic minimum and some have given up on that.
Medicaid was almost an after-thought to Medicare. Nobody understood the magnitude of need for medical care among the poor in the US in 1965. So, flush with pride at having enacted Medicare, they added Medicaid, too. Medicare is a federal program and has been very successful. Medicaid, in addition to beginning with lack of understanding of the size and needs of the poor under-65 populations, was split up between the states and the feds. And we see the results, emphasized, highlighted and underscored by the current economic situation and the vicious adversarial attempts to destroy social programs. It’s a mess.
I suppose it depends upon how you define “successful”.
You are correct that the feds set the minimum and States can add but it is a system that is inherently inefficient. That’s the nature of the “split the dinner check” problem… if the feds pay 50% (will vary from state to state) of a State’s services, the State will rationally continue to add services until the utility gained is only slightly above $0.50 for every dollar spent. That is, the states have the opportunity to show they understand their populations needs and can find the best set of services that would otherwise cost twice the benefit received. A block grant (within the limits previously discussed) does away with this as each additional service would then have to independently justify itself (in terms of utility gained) dollar for dollar.
The 50/50% certainly does vary from state-to-state. In order to demonstrate that “states have the opportunity to show they understand their populations needs”, you’d have to go to a whole different set of variables–outcomes of care, appropriateness of services, etc. Not only that, but you need to demonstrate that states do indeed try and find the “best set of services” at best cost. We’re stuck now with a situation where the elderly poor, for example, are shunted into nursing homes, many of which we wouldn’t want our grandmas to be in. Among the reasons for this are a) the federal requirement for a nursing home care benefit without the necessary teeth to enforce quality standards that are worth a hoot, b) the states’ deteriorating ability to fund their share, let alone enhance this one benefit, and c) the increasing amount the feds have to fork over for Medicaid in a terrible economic and political climate.
“Rationality” doesn’t have much to do with all this, I’m afraid. Right now it’s desperation. And meanwhile, of course, the numbers of poor in need of medical care are increasing by leaps and bounds.
It seems like we’re talking past each other.
My posts have dealt exclusively with the economic theory behind block grants for Medicaid – because many people here seem to oppose them out of hand – and how to achieve efficient spending for health care services. Requirements like finding the “best set of services at best cost” would still lead to the lower efficiency levels previously discussed.
There are a thousand other important issues regarding healthcare, poverty, and the social contract (some of which you list) that I have not attempted to address in these posts. We can talk about these other issues if we want, but since they aren’t about the economic nature of block grants for Medicaid, I’d prefer if we just started a new chain.
OK. Please define “efficient spending for health care services.” Use the elderly poor and nursing homes, if you will.
Are those the chains that would be put around the necks of our seniors and the poor?? Same old shit as Ayn Rand would advocate… Hell I guess we should just put all those People out on thew ice flows in winter! Or maybe you are looking at the Solient Green solution?? Yeah convert all that bio-mass into food pellets for all….
As I defined before, efficient spending is when you get a dollar’s worth of utility (or more) for a dollar spent. This applies to anything money can be spent on (nursing homes for the elderly poor, better education facilities, renewable energy plants, fixing roads, etc.).
We may disagree as to what a dollar’s worth of utility represents, but assuming through honest and open dialog we can overcome that hurdle, the current model of Medicaid still fails because of the “split the dinner check” problem.
Please note: I am not saying what that level should be… I am only describing the phenomena. The appropriate level of Federal support may be more, less, or the same as current spending – I’m not commenting on that. I am only commenting on a problem inherent in the system.
In case you or others haven’t seen it, this is the “split the dinner check” problem:
Suppose I think a burger is worth $6 and a steak worth $13. If the price of the burger is $5 and the price of the steak is $20, I will buy the burger and feel good about my decision because I net $1 of value. If, however, you agree to match what I pay, I will put up $10 to get the $20 steak even though I think it is way over-priced – in this case I net $3 in value. Now suppose you and I go to dinner together and before we sit down we commit to splitting the bill. If we both act in our own self-interest and we have the same value for the menu items, we will BOTH end up buying the steak, paying $20 apiece, and getting negative value for our money. Restaurants LOVE IT when groups decide to split the bill. This is not a trick of the circumstances (though we can build artificial counter-examples, the law of diminishing return of utility means this appears in the real world all over the place); it is an economic artifact of the decision to split the bill.
As it applies to Medicaid:
The same economic principle applies when the Federal government offers to split the bill with the States on Medicaid. For a group of roughly identical people, there is some level of care where the value of the care matches the utility received. That value may be at $30,000 or $100,000 or $1M per person (we haven’t defined which group we mean so it could vary) but after that, the law of diminishing returns says, “we aren’t getting enough extra benefit to justify the extra money” – that is, an extra dollar of spending gets less than an extra dollar’s worth of utility. When the Federal government offers to split the bill on Medicaid, it pushes the State’s rational decision point out to where an extra dollar’s worth of spending only creates an extra $0.50 (assuming it is a 50/50 State) worth of utility. Since every State is in the same boat, every state buys more healthcare than they would otherwise. The Medical industry LOVES it when you split the bill.
You are going to have to start making some sense. I’ve suggested absolutely nothing of the kind.
That’s all well and good and intellectually titillating, but right now we are in a situation where too many states can’t even reach the 50/50 split. And I’m very curious as to how you define “the value of the care”. Are you defining “the value of the care” strictly in dollar amounts, in the ability of the care to reduce pain and suffering, or what?
Please tell me about your last 10 on-site Medicaid accepting nursing home visits this year, and what you observed.
I’ll tell you mine.
This split the dinner check thing is completely useless as regards the problems in situ. I am intimately familiar with this as we have checked far and wide into the difference between NM and CO to potentially place my partner’s mom in a Medicaid accepting nursing home facility. I have been in over 12 facilities in the last 3 weeks.
The difference is profound, and may I say, you have Zero Idea Of What You Are Talking About.
The present mechanism is the problem regardless of the relative percentages spent. For a particular State, the right decision may be an 80/20 Feds/State payment while for another it may be 10/90 the other way but in both cases, the Feds contribution should be a block grant rather than the current mechanism.
The “value” of something is essentially the price someone (could be a person, a company, or society) is willing to pay for a particular level of service. When we are talking about Federal spending for healthcare it is something society as a whole needs to determine. I have my own opinions, but this is not the VictorX dictatorship. But once those values are set – even if we just arbitrarily accept your values, ad arguendo, provided they are all finite – we get back to the necessity of block grants for health care.
Calm yourself down.
I have made NO STATEMENT as to the appropriate level of health care spending. For all you know, I could be all about quadrupling spending on health care – particularly for the poor – and prefer a single-payer option. For all you know, I may be going through the exact same thing looking for a home for my brother who is not going to survive chemo (or figuring out a way to support his kids).
But this is the problem with the health care debate in this country. You try to discuss an aspect of it reasonably and someone always jumps in without thinking. Nothing you wrote has anything to do with the nature of block grants verses cost splitting within the current Medicaid mechanism. As this is the ONLY thing I have commented on, how did you miss this so completely?
I’ve missed nothing. And I’m quite calm.
You see my sister is a JD and an MSW in New Mexico. They basically operate in “block grant” mode – the minimum. The Medicaid conditions there are DREADFUL.
When she came during this last 30 days to see if we need to place The Mom in a skilled nursing facility instead of a return to assisted care, we’ve toured these 12 facilities together, and there is a remarkable difference between how the States operate. 4 to a room possible in NM, 2 to a room in CO for starters. Not to mention other standards.
That is with how it works TODAY.
You didn’t answer my question; how many facilities you been in recently, and what did you observe?
Without such firsthand knowledge of even your own jurisdiction’s outcomes, I maintain you simply have No Idea Of What You Are Talking About.
New Mexico’s problem is NOT that it uses a block grant. It doesn’t use a block grant (you may want to look up what a block grant is). I don’t know who told you this is a block grant, but they were wrong and now you are wrong. New Mexico’s problem is that it is underfunded. Period.
Which is what their politicians, led by Gary Johnson did. It functions just like the block grant you are talking about, because THEY UNDERFUNDED IT.
Their current governor, Martinez, wants to cut even further and I can guarantee you what she would do if it was a true block grant, would be to cut it further and give another tax break. She’s as much as said so.
You care about a theory, not about outcomes. Otherwise, you would tell me about the Medicaid Long Term Nursing facilities that you’ve recently been to, instead of just arguing theoretical points about money.
Tell me, how did they smell when you walked into them?
Recall that YOU interjected yourself into an ongoing conversation. This conversation is about economics. It is by no means the only thing I care about but it is the only thing this topic is about. If you don’t want to talk about economics DON’T JUMP INTO A CONVERSATION ABOUT ECONOMICS. Everything you say in this thread that does not involve this economics issue is off topic.
A block grant could be $100T. If New Mexico received $100T, it would have no problem funding it’s health care needs. Your complaint is that New Mexico is underfunded (incidentally, I may agree but I’m not familiar with New Mexico’s situation and beyond that, it is OFF TOPIC), not that it is a block grant. If you understand nothing else, please understand these two things:
1. The conversation you invaded is about an economic mechanism
2. Your problem with New Mexico is about the level of funding – not about what mechanism provides that funding
Further, I am neither Gary Johnson nor Governor Martinez and I have no intention of speaking for, defending, or taking blame for their comments or actions.
I repeat: I have made NO COMMENT ABOUT THE APPROPRIATE LEVEL OF FUNDING.
Invaded? LOL! It is a blog you know.
Economic mechanisms have real policy outcomes that affect real people. That is a fact.
Who cares what you didn’t say about appropriate levels of funding; they’re already not appropriate, a fact which you aren’t picking up.
Policy and standards count; unaccountable grants are exactly that, and will be abused howsoever some Executive or Legislative body wishes to do so.
It is absolutely unconscionable to pay a Federal Tax for one purpose (Medicare/Medicaid) and then have it switched out in the form of unaccountable block grants to howsoever a State wants to use it, i.e. tax cuts vis-a-vis Martinez.
Your instance about FUNDING versus my pointed comments about outcomes, which are far more important at the human level than “funding”, speaks volumes.
Ok, I think we are going to have to end this exchange. There’s just no way that I’m going to be able to take you seriously at this point (at least in this conversation). I don’t want this to get insulting, so I’ll leave it at that and you can say whatever you feel like saying.
And I’ll take you seriously about Medicaid Block Grants when you’ve done a Medicaid Long Term Facility tour in your jurisdiction.
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