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Credit: Center for American Progress

One day after branding President Obama "really out of touch with what's happening in America," Mitt Romney marked his Florida primary victory by declaring, "I'm not concerned about the very poor." Of course, back in December Romney announced that "I'm concerned about the poor in this country," adding, "We have to make sure the safety net is strong and able to help those who can't help themselves."

If Mitt Romney's latest statement seems like a contradiction, at least it's a more honest one. After all, his proposal to slash $700 billion in Medicaid spending and send what's left as block grants to the states would devastate the program serving nearly 60 million poor and elderly Americans. But as it turns out, his 59 point, 162 page economic plan isn't very concerned with the middle class, either. Over the next decade, that budget-busting blueprint would drain $6.6 trillion from the U.S. Treasury and divert most of it into the pockets of the richest Americans.

On Wednesday, Romney explained his devil-may-care attitude towards the 46.2 million Americans now living in poverty and the 51 million more with incomes less than 50 percent above the poverty line:

"I'm not concerned about the very poor. We have a safety net there," Romney told CNN. "If it needs repair, I'll fix it. I'm not concerned about the very rich, they're doing just fine. I'm concerned about the very heart of America, the 90 percent, 95 percent of Americans who right now are struggling."

That's an odd statement for Mitt Romney to make, and not merely because he previously declared himself part of "the 80 to 90 percent of us" who are middle class. Romney's own economic plan says otherwise. Romney's isn't worried about fixing the safety net; he wants to shred it. And in December, Chris Wallace of Fox News called him on it.

WALLACE: But you don't think if you cut $700 billion dollars in aid to the states that some people are going to get hurt?

ROMNEY: In the same way that by cutting welfare spending dramatically, I don't think we hurt the poor. In the same way I think cutting Medicaid spending by having it go to the states run more efficiently with less fraud, I don't think will hurt the people that depend on that program for their healthcare.

It's not just that Romney's block grant program would lead governors to begin "capping enrollment, thinning benefits, increasing co-payments, and so on" in the future. As Ezra Klein explained, they are already doing that now:

Twenty states implemented benefit restrictions in the past year. In fiscal year 2010, 39 states implemented Medicaid provider rate cuts or freezes (up from 33 in fiscal year 2009), and 37 states have provider rate restrictions planned for the next fiscal year.

And as the Kaiser Family Foundation determined last year, the Ryan plan championed by Mitt Romney and virtually every Republican in Washington to repeal the Affordable Care Act would certainly hurt working Americans as well:

"By 2021, between 31 million and 44 million fewer people nationally would have Medicaid coverage under the House Budget Plan relative to expected enrollment under current law."

Then there's Mitt Romney's tax plan.

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He just can't help it. This is what a guy who is concerned with bottom lines thinks. Mitt Romney has no empathy for the very poor because in his mind the scaled-back food stamp, Medicaid and welfare programs will take care of them. No, no. He's concerned with the middle class. Of course he's concerned about the middle class! They're the biggest block of potential voters.

This is how Romney rolls. He is always looking for the bottom line, the way to get from point A to point B, whether or not he steamrolls people along the way. Since the 'very poor' are unlikely to be Romney voters, he's not concerned about them.

It's a classic gaffe on his part, nearly as bad as John McCain's remark that the "fundamentals of the economy are sound" in 2008, made at a time when the fundamentals were very, very badly broken.

Here's what he said:

This is a time people are worried. They're frightened. They want someone who they have confidence in. And I believe I will be able to instill that confidence in the American people. And, by the way, I'm in this race because I care about Americans. I'm not concerned about the very poor. We have a safety net there. If it needs repair, I'll fix it.

If I were to stop there, it would make a wonderful ad. But Soledad O'Brien gave him a chance to fix what he just said. Here's the rest:

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Ron Paul does a great job in these debates painting himself as the kindly old country doctor who remembers better times, when health care was available to all and didn't cost very much. Maybe costs were less because leeches were cheaper back then.

This particular spin suggests that Medicare and Medicaid were somehow birthed out of an idea and nothing more, that there was no reality at the time where people died, or couldn't get treated, where the elderly were always cared for in their old age and never had to rely on their family, or even bankrupt them, or where people simply died because there was no doctor to care for them or treat them.

It's an image that might be painted through the artists' eye, but it isn't realistic or reflective of what people endured. Neither is his answer to this woman's question, which is simple enough:

QUESTION: My name is Lynn Frazier and I live here in Jacksonville. And for the Republican presidential candidates, my question is, I'm currently unemployed and I found myself unemployed for the first time in 10 years and unable to afford health care benefits.

What type of hope can you promise me and others in my position?

(APPLAUSE)

BLITZER: Let's ask Congressman Paul.

Yes, let's ask Congressman Paul to give this woman a very real answer to a very real problem happening today, in this time, in this place. Look at what he says:

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Credit: CBO

He called for rationing Medicare, replacing it with an underfunded voucher system that would dramatically shift costs to elderly Americans. He proposed repealing the Affordable Care Act, slashing Medicaid by $1.4 trillion over the next decade and turning what's left over to the states as block grants. By 2021, his budget would leave up to 44 million more Americans without health insurance. His budget, one which garnered the votes of 235 House Republicans and 40 GOP Senators, would in turn use the savings to deliver $4.2 trillion in tax cuts, most of them to the richest Americans who need them least.

He is Wisconsin Representative Paul Ryan. And he is Politico's Health Care Policymaker of the Year.

As Politico revealed Tuesday, decimating the U.S. health care system and gutting the American social safety net apparently deserves praise, not scorn. For Politico, the catastrophic impact of Paul Ryan's draconian and dishonest budget matters far less than the fact that people are talking about it:

When House Budget Committee Chairman Paul Ryan released his budget plan in April, the Wisconsin Republican instantly changed the conversation about health care in America. It wasn't always a polite conversation. And it gave way to new Democratic charges that Republicans want to "end Medicare."

But Ryan got everyone talking about ways to get health care entitlements under control -- and he gave Republicans the most detailed illustration to date of how market forces could be used to do that. He has influenced how Republican presidential candidates such as Mitt Romney talk about health care, as they use variations of his Medicare plan in their campaigns. And if Republicans gain power after the 2012 elections, his blueprint is sure to be the starting point for their future health care policies.

As it turns out, Ryan didn't "instantly" change the conversation. Most Republicans, including his party's leadership, refused to endorse his 2010 Roadmap for America's Future until after the November mid-terms were safely won. And Ryan's goal to "end Medicare" is only the beginning of the unraveling of the safety net he would undertake.

To be sure, Ryan's voucher scheme would end Medicare as we know it. As Ezra Klein, Matthew Yglesias and TPM (among others) noted, Ryan's Republican deficit reduction gambit would inevitably lead to the rationing of Medicare.

Because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage. The Washington Post's Klein described the inexorable Republican rationing of Medicare which would then ensue:

The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.

It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.

Last year, Ryan acknowledged as much.

"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

Of course, Ryan left out the real culprit - the private insurance market. But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60 percent of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today."

As Paul Krugman explained using the chart above:

Medicare actually does a better job of controlling costs than private insurers -- not remotely good enough, but better...

If Medicare costs had risen as fast as private insurance premiums, it would cost around 40 percent more than it does. If private insurers had done as well as Medicare at controlling costs, insurance would be a lot cheaper.

But you don't have to take Paul Krugman's or Ezra Klein's word for it that "the GOP outsources Medicare to private insurers and gives senior citizens checks that cover less and less of the cost of insurance every year." In words and pictures, the nonpartisan Congressional Budget Office issued the same dire warning (see chart at top).

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This is so sad. Ever since the Reagan era, mental health services have been inaccessible to a large segment of the population, particularly the poor and disadvantaged. And especially now the embrace of austerity by our Republican overlords is taking a toll. A deep one.

Via Yahoo! News:

Suicide is on the increase in rural America--nowhere so much as in western mountain states like Idaho, Wyoming and New Mexico. Mental health professionals attribute it in part to cutbacks in Medicaid funding, to the recession and to the culture of the rural West.

In Idaho, somebody kills himself every 35 hours, according to a 2009 report to Idaho's governor by the state's Council on Suicide Prevention. Their report calls suicide "a major public health issue" having a "devastating effect" on Idaho's families, churches, businesses and even schools: 65 students aged 10 and 18 killed themselves in a recent five-year period.

Recently, a county sheriff in Bonneville told the Idaho Falls Post Register that his department was getting more suicide calls than in 2010—a year in which 290 Idahoans took their own lives. "We're in a spike right now," he says.

Historically the suicide rate in rural states has been higher than in urban ones. According to the most recent national data available, Alaska has the highest rate, at 24.6 suicides per 100,000 people. Next comes Wyoming (23.3), followed by New Mexico (21.1), Montana (21.0) and Nevada (20.2). Idaho ranks 6th, at 16.5. Suicide is the second-leading cause of death for Idahoans aged 15-34. Only accidents rank higher.

Kathie Garrett, co-chairman of the Idaho Council on Suicide Prevention, says the problem has gotten only worse since the recession. "The poor economy and unemployment—those put a lot of stress on people's lives," she explains. To save money, people skip doctor visits and cut back on taking prescribed medications. Cuts in Medicaid have reduced the services available to the mentally ill.

Assuming the Affordable Care Act withstands a Supreme Court challenge, Medicaid funding from the federal government will increase substantially, but for these people, it's too late. Between the economy and lack of access to mental health services, some feel overwhelmed and miserable, particularly at this time of year.

If you know someone suffering, please encourage them to call a suicide hotline or reach out to someone for help. The national suicide hotline number is 1-800-273-8255.

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This holiday season, let's spare a kind thought for the decent people who toil inside Washington's legislative machinery. These good folk must live and work inside the dreamlike bubble that is today's policy and media world. Each day they strain to see reality through the reflected light of the false but colorful narratives projected against the bubble's surface.

Or would it be a better metaphor to say they're prisoners in some cold underground cell? No matter how many polls are conducted, no matter how many economic analyses are performed, no matter how many bitter lessons are taught and re-taught, there are those who hope to deny them even a glimpse of reality.

Instead these good people are forced to stare into the harsh glare of synthetic reality, hour after hour, as if were a naked lightbulb in windowless room. Only a few precious slivers of genuine sunlight penetrate the dank basement of illusion that imprisons them.

Well-intentioned staffers in Washington need good information to do their jobs well. Instead they're being inundated with confusing pseudo-facts and empty fear-mongering. This week's case in point? The Congressional "Super Committee." Did you know that unless they come up with their cuts there will be no Christmas this year? You didn't? Then you haven't been reading the Wall Street Journal.

Unfortunately, that kind of distortion isn't the exception. It's the rule.

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For social conservatives, it is often said, life begins at conception and ends at birth. If so, nowhere is that more true than in Mississippi. After all, the Magnolia State seems poised to pass Amendment 26, the so-called "personhood" initiative which by defining a fertilized egg as a human being would ban virtually all abortions and inevitably outlaw many forms of birth control and in vitro fertilization.

But while Mississippi is focused inside the womb, there seems to be little concern about what happens to its residents outside of it. As the dismal rankings in out-of-wedlock births, poverty, family income, education, health care and almost every other indicator of social dysfunction show, personhood is a painful struggle for the actual persons of Mississippi.

With some of the most draconian abortion restrictions in the nation, Mississippi is now home to only one clinic providing the procedure. But as it turns out, Mississippi is also home to the most depressing statistics for out-of wedlock births in the entire nation. As the numbers from the U.S. Census Bureau show, Mississippi has the highest percentage of total births to teen mothers (17.1 percent, compared to the national average of 10.5 percent) and unmarried women overall (53.7 percent, compared to 39.7 percent nationally).

Mississippi may not be a Hobbesian dystopia where life is nasty, brutish and short. But as a quick glance at the poverty and income data show, life there isn't easy. The Census Bureau's 2011 Statistical Abstract (which is based on 2008 data), shows poverty and median household income is worst where GOP's laissez-faire crowd finds its strongest support. Financially speaking at least, life is no heaven on earth in America's most religious state.

Of course, Mississippi is one of the poorest states in the Union and has been for some time. According to the 2011 data compiled by the U.S. Census Bureau, Mississippi ranks first in the number of people living below the poverty line. Unsurprisingly, its 50th ranking median household income of $37,790 is the lowest in America, and over $14,000 below the national figure. Per capita income is similarly dismal. It's with good reason that in 2007, Mississippi ranked fourth in per capital federal aid.

That need for federal funding is especially acute when it comes to one of the Magnolia State's greatest failures: education.

The education of its children provides just one of many heart-breaking stories of failure for the people of Mississippi. At $7,890 per student per year, Mississippi ranks 45th in school funding. (And even that meager figure is only made possible by substantial funding from the federal government.) According to the National Assessment of Educational Progress tests administered by the U.S. Department Education, only 22% of Magnolia State fourth graders read at or above grade level. By eighth grade, the figure falls to 19%. (Only the District of Columbia does worse.) It's no surprise that Mississippi has the lowest mean score on the ACT college admissions test taken by 96% of the state's high school graduates. And as it turns out, only 63% of its children even graduate, less than the national average of 69% (and much lower than the 81% in, for example, that target of right-wing retrograde reform, Wisconsin.)

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AFL-CIO President Richard Trumka came out strongly Friday in opposition to reports that Democrats are offering significant concessions in hopes to make a deal on the congressional "Super Committee" whose job it is to cut the deficit. He said the union opposes any cuts to Social Security and Medicare or to the federal contribution to Medicaid. Trumka made it clear that he thinks draconian cuts to the social safety net are a bad solution for what he called a fabricated crisis.

He called on those who agree to show their support by texting DEBT to 225668.

The text of the full press release:

People around the country are raising their voices in protest because they’re fed up with a system that is stacked in favor of the richest one percent of Americans -- at the expense of the other 99 percent of us. Unfortunately, what reportedly happened this week in the so-called “Super Committee” just proves their point.

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Now remember, Medicaid is the default option for the Affordable Care Act. So if more and more states privatize it, those who are enrolled in those states will get significantly less money allotted to their care:

There have long been moves to privatize the management of Medicaid, but with shock-doctrine austerity hawks making as much mileage from their budget crises as possible, this year has seen an especially strong push to privatize the heath care of low-income and disabled Medicaid users at a state level. All across the country in states like Texas, New York, Louisiana, Florida, Illinois, South Carolina and Kentucky, state governments are stealthily privatizing Medicaid by handing over the money they get from the federal government to private contractors -- sometimes with minimal savings to the states themselves. It’s all part of a broader trend called “managed care” or “co-ordinated care” -- deceptively bureaucratic terms for a turn with sometimes deadly consequences for Medicaid patients.

Figures recently published by the Commonwealth Fund, show that the percentage of people receiving Medicaid who are signed up through publicly traded HMOs has increased nationally from 19.6 percent in 2009 to 27.1 percent in June this year. This is set to increase this year by at least 1.7 million new people, bringing Medicaid patients in privatized health plans to a record 29.8 percent.

In June, California began moving 380,000 older and disabled patients into private plans, while New York will begin moving 1.5 million patients into managed care in October. Further south, Florida is looking to move most of its 3 million Medicaid enrollees into private plans. And with the Affordable Care Act (the recent health care reform law) expected to raise Medicaid enrollment by 16 million by 2019, the Commonwealth Fund concluded that "given recent patterns in state contract awards to managed care plans, it is reasonable to anticipate that plans operated by publicly traded companies will enroll the majority of the expanded Medicaid population." As a result, the Washington Post reports that insurers expect $60 billion in new annual revenue from this market after 2014.

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Talking Points Memo reports that Nancy Pelosi is drawing a line in the sand on what cuts the upcoming debt ceiling commission can make:

At a pre-recess press conference Tuesday afternoon, TPM asked House Minority Leader Nancy Pelosi (D-CA) whether the people she appoints to the committee will make the same stand she made during the debt limit fight -- that entitlement benefits -- as opposed to provider payments, waste and other Medicare spending -- should be off limits.

In short, yes.

"That is a priority for us," Pelosi said. "But let me say it is more than a priority - it is a value... it's an ethic for the American people. It is one that all of the members of our caucus share. So that I know that whoever's at that table will be someone who will fight to protect those benefits."

The question now becomes, "Will Harry Reid follow suit"? If he does then Social Security, Medicare and Medicaid will be protected. If even one of his selections, as TPM author Brian Beutler points out, doesn't hold firm to the same standard as Pelosi, then cuts are almost certain to come.