Sunday, December 23, 2012

Callousness on parade in Republican health care politics – Bobby Jindal's Christmas spirit

Unfortunately, it's all too easy to multiply examples of that callousness.  But for one especially striking illustration, I commend to your attention this piece by Rod Dreher in The American Conservative ... as well as some relevant highlights from a piece by Josh Barro, which follow it below.

The American Conservative
December 22, 2012
Dying Poor People & Jindal’s Priorities
By Rod Dreher

Not sure how this is going to sound to the rest of America when Louisiana Gov. Bobby Jindal runs for president:
Cuts to hospice care announced by state officials last week are deeper than originally portrayed, eliminating hospice treatment for all Medicaid recipients starting in February, the Louisiana Department of Health and Hospitals said Wednesday. In announcing the reductions to hospice care, which aims to make dying people more comfortable in the last six months of their lives, Jindal administration officials said the cutbacks would force people on Medicaid to seek the service in a nursing home. But the change actually means the state is eliminating all hospice care – both at home and in nursing facilities — to people covered by Medicaid.
Merry Christmas, Poors! More:
Legislators at a Friday hearing to discuss the $165.5 million in reductions and other budget fixes were especially alarmed by the hospice cuts. The cuts are needed because a revenue shortfall has thrown the the state’s budget out of whack. The budget must be balanced by the time the fiscal year ends on June 30.
If the state doesn’t have the money, it doesn’t have the money — and we in Louisiana are constitutionally required to balance our state budget. But not enough money to pay for hospice care for the poor? Really? What kind of state are we?

We are the kind of state that provides at least $1.79 billion annually in tax breaks and incentives to business.

We are the kind of state that won’t cut or scale back those, even a little bit, but will cut $1.1 million annually to provide minimal end-of-life care for 5,800 poor Louisianians.

Such are the priorities of our presidential hopeful Republican governor and our GOP-run state government, it appears. I believe that our governor is sincere when he openly and enthusiastically talks about his Christian faith, which makes it all the more frustrating to see that business and industry are the Chosen People in this state. more important to take even more away from the poorest of the poor than to compel the well-off to give up the least tax break. Gov. Jindal said in a 2011 Christianity Today interview:
I think that it’s absolutely critical to get the economy growing without raising taxes or increasing the deficit. I’m also proud to belong to a party that stands for the sanctity of human life and traditional marriage. Those values remain important during good and bad economic times.
“Sanctity of life”? With Medicaid-funded hospice, we’re talking about helping terminally ill poor people die with dignity. What kind of “sanctity of life” ethic values maintaining state tax breaks for wealthy corporations over hospice care for the poor?

Jindal supporters, what am I missing here? Help me out.

[Via The Mighty Favog.]

=> These actions by Jindal's administration that Dreher finds so morally dumbfounding are part of a larger story that also happens to be a moral scandal—the equally callous political posturing by many Republican governors who are refusing to implement the Medicaid expansion included in the Affordable Care Act (aka Obamacare). Back in July another dissident conservative writer, Josh Barro, spelled out what's involved here:
[G]overnors can’t repeal the Patient Protection and Affordable Care Act. Their option is to take federal funds that will pay for 90-plus percent of a Medicaid expansion to cover the working poor, or not. Republican governors who decline these funds will be attacked for blocking coverage expansion to help the poor and the sick that is nearly free to state taxpayers because that is exactly what they will be doing.

Second, any governors who believe that undermining Obamacare is part of a long game to get a better health reform are mistaken. If there is Republican enthusiasm for "a health system reform that seeks to contain cost growth through progressive cost-sharing, deregulation designed to facilitate business-model innovation, and other market-oriented measures," [JW: Barro is quoting from a piece by  Reihan Salam that tried to concoct a speculative pseudo-sophisticated defense of what the Republican governors were doing] then where was that reform (or even serious legislative action toward such a reform) when Republicans ran the federal government between 2001 and 2007?

The alternative to PPACA is nothing. Mitch McConnell’s comments last weekend were instructive -- Republicans in Congress have no meaningful plan to replace Obamacare and think that 30 million uninsured Americans is “not the issue.”

Conservative health wonks will object to my characterization. They will say they have many plans to use markets to drive down costs so that affordability is less of an issue. They may even advance plans that spend money to subsidize some sort of coverage for some expanded group of Americans. But Republicans have not taken them up on those plans when they have had the chance. That’s partly because expanding coverage costs money, and Republicans aren’t willing to spend money on it. And it’s partly because achieving significant cost control, even though market mechanisms, goes against the interests of groups that support Republicans, such as doctors and seniors.

There’s a reason Representative Paul Ryan’s plan to cut Medicare costs doesn’t even start affecting anyone for 10 years. The Republicans’ best electoral strategy on health care is to talk a good game but not implement reform with meaningful effects. If Republican governors refuse expanded Medicaid, those federal incentives won’t change.

This is a shame, because Reihan is right about one thing: There's a lot that’s undesirable about the PPACA model. [....]

Those are all things Republicans could have gotten if they had been willing to play ball on reform. But instead, they hunkered down and decided to throw everything they could at the law. [....] Turning down the Medicaid expansion would be just another component of the obstruct-everywhere strategy.

Republicans might succeed in throwing enough wrenches in the law to prevent it from working, though that looks less and less likely following last week’s court decision. But nobody should fool himself into thinking the endgame is a sleeker, better reform that expands coverage and controls costs. If Republican lawmakers in the states decide to turn down Medicaid funds, the main effect will be many of their constituents going without health insurance.
Happy Holidays,
Jeff Weintraub