About Those Medicare Vouchers

Kaiser Family Foundation is a respected, non-partisan, nonpolitical think-tank focused on medical research. The Foundation has just released its analysis of Paul Ryan’s plan to “reform” Medicare; the high (or low) points of that analysis are instructive. According to Kaiser,

  • Nearly six in 10 Medicare beneficiaries nationally could face higher premiums for Medicare benefits, assuming current plan preferences, including more than half of beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage enrollees. Even if as many as one-quarter of all beneficiaries moved into a low-cost plan offered in their area, the new system would still result in more than a third of all beneficiaries facing higher premiums.
  • Premiums for traditional Medicare would vary widely based on geography under the proposed premium support system, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming and the District of Columbia, but an average increase of at least $100 per month in California, Florida, Michigan, New Jersey, Nevada and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California’s San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
  • At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums in their current plan. Many counties in those states have relatively high per-beneficiary Medicare spending, which would make it more costly to enroll in traditional Medicare rather than one of the low-bidding private plans in those counties. In contrast, in areas with relatively low Medicare per-capita spending, it could be more costly to enroll in a private plan.

Ryan insists his plan would save money. And it would. It would save the government money, by shifting the costs of medical care back to the people the program was supposed to help–the elderly, and especially the low-income elderly.

This is Ryan’s basic approach to fiscal responsibility. His central insight (big thinker that we keep being told he is): We can save the government lots of money by eliminating or greatly reducing programs like Medicare. We can privatize social security and send Medicaid back to the states where it would almost certainly die (approaches Ryan favored until the campaign ixnayed that talk), saving taxpayers–especially rich ones–billions. (Of course, we could also cut defense spending, but that’s sacred under the Romney/Ryan approach). Or we could take the approach favored by Grover Norquist, and just get rid of government altogether. Drown it in a bathtub.

What pisses me off isn’t that some people, including Ryan, reject the very notion of a government that provides a safety net. People are entitled to their political positions, just as I am entitled to mine. What pisses me off is that they lie about it.

Ryan knows his “remake” of Medicare would cost seniors more money. If it is such a great idea, he should be able to explain why we should embrace it. Instead of lying about it, Mr. Serious Thinker should have the balls to defend it.

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Urban Life and Political Strife

Every couple of weeks, I get an email from Citiwire.net, a brainchild (I think) of Neil Pierce, the longtime observer of urban life and policy. Each email has two columns, one from Pierce and a second that “rotates” among a variety of writers. (Those of you interested in–or passionate about–cities should sign up. It’s free.)

Last Friday’s edition included a piece from Curtis Johnson, identified as the President of Citistates Group, commenting on a very prominent article from the previous week’s New York Times headlined “Republicans to Cities: Drop Dead.”

Johnson–who noted that he had worked many years for a Republican governor–said he cringed “to see the way sensible economics has been chained up, locked out and hooted over by the reigning ideology of today’s Republicans. Not that the Democrats are much better. A dear colleague of mine says ruefully that the Democrats don’t have very good answers, but Republicans don’t even understand the questions (and he’s Republican).”

Johnson goes on to report what most people who follow urban policy already know: as baby-boomers age, a huge number of them are abandoning suburbia and moving back into the cities, while the “millennials” already prefer urban life. (He shares a ‘factoid’ of which I was unaware–millennials are the first modern generation showing a decline in automobile ownership.)

Despite the increasing move to the cities–a move amply documented by demographers–those cities are struggling. Infrastructure is crumbling. Mass transit is lagging (or, as in Indianapolis, virtually non-existent). “Things that metro regions used to be able to build in a decade now take 30 to 40 years.” Yet policymakers of both parties give short shrift to these problems.

Johnson ends by pointing out something I’ve known ever since I got married, because it is my husband’s most persistent gripe: We rely upon our cities to generate the profits that pay the nation’s bills. Here in Indiana, certainly,  tax revenues generated in Indianapolis don’t stay here–along with the other cities in Indiana–South Bend, Ft. Wayne, Evansville–we pay the lion’s share of the state’s bills. We fund the priorities of Indiana policymakers–priorities that rarely include us.

It behooves us to take better care of the goose that is laying that golden egg.

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In Defense of Apostasy

A good friend of mine, one of those thoughtful Republicans from a former era, has decided–after internal struggle–that he will cast his vote for Richard Mourdock–despite his obvious distaste for the man and his positions. His justification is that Mourdock will cast his first vote for leadership of the Senate. My friend, a long-time Republican who has held elective office, is a “team player.” He cites the old adage: “he may be a son-of-a-bitch, but he’s our son-of-a-bitch.”

I understand the reasoning. If you truly believe that your “team” has better ideas, will do better by the country, you can justify swallowing hard and supporting dubious team members.

But what if your whole team is playing dirty? What if the mean-spirited and intellectually limited guy you are holding your nose and voting for is more typical than you want to admit? What if your team has abandoned the ideas and positions that drew you to join in the first place? Where should your loyalties lie–to the team, or the sport? To your party, or the country?

People join political parties for many reasons. Mom and Dad were Democrats or Republicans. You want to get ahead, and you live in one of the increasingly common areas where one party dominates. You identify as union, or management, and that identification trumps other concerns. Or you develop a political philosophy and choose the party with the platform that is most consistent with that ideology. Whatever the reason for that original choice, political scientists tell us that few of us rethink it. Instead, we continue to root for our first “team,” much as sports fans do.

In my own case (being a teenager who read a lot and didn’t date much), I became a Republican because I had formed pretty firm political positions; I was a social liberal and a fiscal conservative (still am), and in the early 1960s, the Democrats were much farther to the left than I was (or than Democrats are today). I was drawn to the libertarian wing of the Republican party, which came closest to my own beliefs. In the years since, both the Democrats and GOP have moved further and further to the right, and I became less and less comfortable with my “team.” George W. Bush was the final straw, and I left the party. I became an apostate. Many of my former political friends understood; others became very chilly, and some very critical opinions of my apostasy have gotten back to me. Fair enough.

But here’s the thing. Politics isn’t football, where who wins and loses doesn’t ultimately make a difference in the lives of real people. Many of my Republican friends from the “old days” recognize how much the party has changed, but they can’t bring themselves to sever the bond. They tell themselves that the Mourdocks and the Pences and Akins and Wests and Bachmanns and Brouns and so many others are just outliers, that the Democrats also have whack jobs (true enough, just not nearly as many and not currently in control of the party). So they justify continuing to support the very people who are destroying the once-respectable Republican brand.

No intellectually honest person will agree with any political party 100% of the time–or even 90%. We all fit imperfectly into those political boxes. But when the party you vote for holds positions you know to be deeply damaging to the body politic, when too many of the people you are nominating are uninformed bloviators and  worse, it’s time to consider apostasy.

If we all became “swing voters,” willing to abandon either party when it loses its way–if neither party could depend upon a base of knee-jerk support from people who are cheering for a team rather than voting their policy preferences–I think we’d get better parties.

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Coming Out

Coming Out Day is today, October 11th.

These days—four states are preparing to vote on same-sex marriage, with victory likely in at least one, Don’t Ask Don’t Tell headed for the dustbin of history, and progress being made on a wide variety of civil rights issues affecting lesbians and gay men—the incredible importance of coming out to the struggle for gay civil rights sometimes escapes notice.

I thought about this last weekend, when I spoke at a conference sponsored by the Northeast Ohio Center for Inquiry. The Center for Inquiry is a national secularist organization, promoting (gasp!) science and reason over supernaturalism. There were four speakers at the all-day conference, and we all took different topics. Not surprisingly, my own presentation focused upon the lack of understanding of the religion clauses of the First Amendment, and the ways in which Americans’ abysmal lack of civic literacy fostered misconceptions, and enabled revisionists determined to rewrite the country’s history.

The last speaker of the day was a lawyer from Los Angeles named Edward Tabash, and it was his talk that made me sit up and take notice.

Tabash’s talk was titled “Taking Atheism to the General Public,” and his message was simple: “We need to emulate the gay community. We need to Come Out.” As he noted, atheists and gays are two communities targeted primarily by religion. Not all religions, certainly—to suggest otherwise would be to engage in the same sort of stereotyping that we decry—but a fundamentalist, literalist “brand” of belief. Tabash urged secularists to emulate the political activism tactics of GLBT folks; as he pointed out, those tactics have resulted in impressive gains, and those gains all began with the deceptively simple act of coming out.

Last Tuesday, I had the honor of emceeing (is that a word?) IUPUI’s third annual Harvey Milk dinner. The dinner draws the campus GLBT faculty and staff and allies, and it has grown steadily since the first dinner. Two hundred and twenty people attended this year’s event; they filled a sizeable space in the Campus Center. An event like that—with that sort of attendance in that sort of venue—would have been inconceivable even ten years ago. It was possible because people took deep breaths, risked families and friendships and livlihoods, and demanded social recognition. They came out.

They took those risks in order to honor their deepest natures, in order to live honestly.

It took guts.

The local CFI has lots of members, but a significant number of them are “lurkers,” on the organization’s website, but unwilling to be identified. Many of them live in small Indiana communities, and rightly fear the reaction of their employers and neighbors. Still, as Tabash noted, the prejudice against secularists won’t change until more of us come out.

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