First, there's Jonathan Chait's analysis of the current stonewalling strategy; namely, not one penny more of revenue from anywhere no matter what, but plenty of cut, cut, cut. And absolutely no deal. Here's the paragraph that caught my eye, though:
So, step one: Block any compromise to reduce the deficit. Step two: Blame Obama for failing to reduce the deficit. I actually think this plan can work.
This may sound like a cynical strategy. And it is. But it’s not a purely cynical strategy. It reflects an important intellectual development on the right. Capretta is advocating not just the classic no-taxes-ever approach that has defined the party for years, but also its newer (or newly fervent) belief in privatizing health-care services.
Aha, and that follows what I'm seeing on a state level.
Rick Scott's little song and dance was the first salvo. Scott, as you'll recall, decided he would turn down the Medicaid expansion dollars from the federal government because he's crazy. But after hospitals lobbied him hard, he went to Kathleen Sibelius looking for a deal that went like this: Let me privatize all Medicaid services and I'll take your Medicaid dollars.
What a guy. And that leads me to this article in the New York Times on Wednesday, addressing the differences in care between for-profit providers and not-for-profit providers.
Writing about his colleagues’ research in his 1988 book “The Nonprofit Economy,” the economist Burton Weisbrod provided a straightforward explanation: “differences in the pursuit of profit.” Sedatives are cheap, Mr. Weisbrod noted. “Less expensive than, say, giving special attention to more active patients who need to be kept busy.”
This behavior was hardly surprising. Hospitals run for profit are also less likely than nonprofit and government-run institutions to offer services like home health care and psychiatric emergency care, which are not as profitable as open-heart surgery.
A shareholder might even applaud the creativity with which profit-seeking institutions go about seeking profit. But the consequences of this pursuit might not be so great for other stakeholders in the system — patients, for instance. One study found that patients’ mortality rates spiked when nonprofit hospitals switched to become profit-making, and their staff levels declined.
These profit-maximizing tactics point to a troubling conflict of interest that goes beyond the private delivery of health care. They raise a broader, more important question: How much should we rely on the private sector to satisfy broad social needs?From health to pensions to education, the United States relies on private enterprise more than pretty much every other advanced, industrial nation to provide essential social services. The government pays Medicare Advantage plans to deliver health care to aging Americans. It provides a tax break to encourage employers to cover workers under 65.
It's a little amazing to think this even has to be said, but apparently it does. If you're chasing a bottom line, it's likely that services will suffer while profits are padded, and nowhere is that more evident than health care. A simple comparison of the administrative costs between Medicare and private insurance plans proves that. Medicare averages around 7 percent annually, while private insurers "struggle" to keep theirs below 20 percent.
So if I'm right, Republicans have decided that they will not participate in any budget negotiation that actually reduces the deficit because while they happen to agree that health costs will be the primary driver of future deficits, their answer is simply to privatize those costs, continue to drive up the deficit while loading up the pockets of their corporate for-profit cronies.
If this is, in fact, their strategy then we can expect bandaid solutions to deadlines. When this continuing resolution runs out Republicans will submit yet another budget privatizing Medicare, signed with a Paul Ryan flourish. The Senate will, of course, reject anything that looks like that, and the House will not approve any Senate amendments changing that, which means they'll just go on approving the continuing resolution for short periods of time.
Siege mentality with a privatized chaser. The only answer to this is to get ahead of the message now, to keep hammering home how disgusting and odious privatizing Medicare and giving Granny a voucher would be, and to make Republicans own it. They can't be allowed to hand this off to Democrats, which means pushing Democrats to quit thinking there is some bipartisan answer to this. There isn't.
Then in 2014, boot their asses out of office. Just like that.