This NY Times article on the
government's plans for Medicare, Medicaid, and
Social Security talks about privatization, the end of entitlements and
substituting defined contributions for defined benefits .
Instead of
guaranteeing each of us minimal income and health benefits, the feds will
give the states a constant amount of money and tell them to decide who gets
what benefits in the face of peoples' growing needs and the worst budget
deficits since World War II. This system of block grants was
started with
"welfare reform" in the 1990s under Gingrich, and Clinton, who vowed
to "end
welfare as we know it."
For the last two decades, the poor have paid for the redistribution of
wealth to the rich, and military expansion, but as this article suggests,
the next strategic target will be the old and the disabled.
Also see NY Times, Feb 1, 2003, "Medicaid Proposal Would Give States More
Say on Costs," that starts out saying "The Bush administration
proposed
fundamental changes in Medicaid today that would give states vast new power
to reduce, eliminate or increase benefits for millions of low-income people,
including many who are elderly or disabled. The proposal, coming at a time
when states face huge deficits, would do away with federal rules that now
apply to one-third of all Medicaid recipients and two-thirds of all Medicaid
spending."
New York Times, February 24, 2003
Bush Proposes Major Changes in Medicare and Medicaid
By ROBIN TONER and ROBERT PEAR
WASHINGTON, Feb. 23 - President Bush has begun one of the most ambitious
efforts to reinvent Medicare and Medicaid since the programs were created 38
years ago. Combined with his earlier plan for Social Security, the proposals
offer a fundamentally different vision of social welfare policy, many
experts say.
Mr. Bush's proposals for Medicare and Medicaid, taking shape in recent
weeks, would transform these pillars of the Great Society and their
guarantee of health benefits to the elderly, disabled and poor.
States would have far more power to determine who receives what benefits in
the Medicaid program, which covers 45 million low-income Americans. The
elderly would rely more on private health plans, and less on the government,
for their health benefits under Medicare, which covers 40 million elderly
and disabled people.
The administration's vision for Medicare and Social Security moves away from
the notion that everyone should be in the same government-managed system
with the same benefits. It promises individuals more choices, including the
option of picking a private health plan or investing some of their Social
Security taxes in the stock market.
But critics say these proposals would also mean less
security, fewer
guaranteed benefits and more financial risk for beneficiaries.
The magnitude of the Bush proposals is only gradually dawning on members of
Congress. Unlike President Bill Clinton and former Speaker Newt Gingrich,
Mr. Bush has not boasted about the boldness of his vision for these
programs, perhaps because he is mindful of the voters' anxiety about major
changes in health care.
Indeed, a senior administration official dismissed the idea that Mr. Bush
was attempting fundamental change in Medicare and Medicaid.
"We're looking at two programs that have worked, that have provided
health
coverage to people who need it, and we want to help them work better," the
official said. "The idea is to strengthen and improve the programs."
A test for the administration will come in the next few days, as officials
seek an endorsement of the Medicaid plan from the nation's governors,
meeting here. The initial reaction at the governors' meeting today was
mixed.
Administration officials and their allies in Congress, including some
centrist Democrats, said such changes were essential to modernize creaky
government programs and to stem the growth in entitlement spending.
"I think the administration, like all of us, is looking for an answer to
the
question of how we can afford all of this," said Representative Jim
McCrery,
Republican of Louisiana and an influential member of the Ways and Means
Committee. "How can we structure the system of health care for the elderly,
in the case of Medicare, so that our society can afford the cost?"
Medicare, Medicaid and Social Security accounted for 42 percent of all
federal spending last year, and that share is expected
to grow.
But several architects of those programs argue that
the Bush administration
is retreating from the goals of the Great Society and the New Deal, and the
promises the government made across the generations. The Bush plans, they
say, are essentially an effort to limit the federal government's financial
responsibilities and to cap what is now an open-ended guarantee of specific
benefits - an effort to move from a defined benefit to a defined
contribution.
Robert M. Ball, who worked at the Social Security Administration for three
decades and was commissioner from 1962 to 1973, said, "These proposals are
a
major departure from the principles that have governed the social insurance
programs from the beginning."
Senator Edward M. Kennedy, Democrat of Massachusetts and one of three
remaining senators who were in Congress when it created Medicare, said,
"Medicare and Medicaid are two of the most successful social programs ever
enacted."
Mr. Kennedy added, "Medicare is a firm commitment to every elderly
American,
not a profit center for H.M.O.'s and other private insurance plans."
Mr. Bush's Medicare proposal, being revised after an earlier draft drew fire
on Capitol Hill, would encourage many beneficiaries to leave traditional
Medicare and get their benefits through private health plans associated with
the program.
Administration officials assert such plans can manage care, tailor benefits
and control costs better than traditional Medicare,
one of the last bastions
of fee-for-service medicine. The officials also argue that Medicare must be
overhauled before Congress adds prescription drug benefits, a priority for
each party.
"When it comes to cars, and when it comes to health care, 1965 is not the
state of the art," Mr. Bush has said.
Democrats, as expected, are fiercely resisting the administration's plans,
although there is widespread agreement on Capitol Hill that the program
needs to be updated with a prescription drug benefit.
More troubling for the administration is the criticism that has come from
influential Congressional Republicans, alarmed at the possibility that the
administration might be overreaching. They have been particularly scathing
about the possibility that the Bush plan would require the elderly to leave
traditional Medicare and join a private plan to get drug benefits, discussed
in the earlier draft.
Both sides in this debate have a strong sense that the nation is at a
crossroads - politically, philosophically and demographically - as the
entitlement programs are strained by an aging society.
The architects of Medicare said the program was created
with some
fundamental precepts that the Bush proposal would undermine: that all
working Americans pay into the same Medicare system; that the healthy and
the sick, the rich and the poor, end up in the same program; and that all
have the same core benefits when they retire.
The idea that the elderly would be better served by a
private, for-profit
insurance market is anathema to these veterans of the Great Society. Before
Medicare, they say, the private health insurance market was a failure for
the elderly, nearly half of whom had no hospital coverage. They fear that
private health plans would be tempted to recruit the healthiest of the
elderly, leaving sicker, more costly patients to the original
fee-for-service Medicare program.
Critics also argue that "choice," a favorite theme of the Bush
administration, is not necessarily what the elderly
want or need.
Dr. Philip R. Lee, recruited by the Department of
Health, Education and
Welfare in 1965, said of the Bush administration: "They talk about giving
people choice; Medicare gives people the choice of their individual
practitioner. That's what most people think about when they think about
choice."
The issues raised in the Medicaid debate revolve largely around the role of
the federal government. Citing the model of the 1996 welfare law, Health and
Human Services Secretary Tommy G. Thompson says states can be trusted with
far more authority to decide who receives what benefits.
The administration's proposal would offer states vast new power to reduce,
eliminate or expand health benefits for low-income people, including many
who are elderly or disabled. In return for the flexibility, and a temporary
increase in federal assistance, states would eventually have to accept a
limit on the federal contribution to the program's cost. The choice would be
up to the states; they could stay with the existing program.
Administration officials say the plan would allow states to stretch scarce
resources during fiscal crises. Critics assert it would replace the poor's
entitlement to health care with a block grant to the states, just when the
number of uninsured is rising.
Gov. Bill Richardson of
proposal was "extremely risky in an uncertain economy."
There were other critics today among the governors. Janet Napolitano, the
new governor of
administration's Medicaid proposal because, she said, the federal money
would not keep pace with the rapid growth of the state's Medicaid program.
Noting that
reflected in the state's Medicaid rolls, Ms. Napolitano added,
"Fast-growing
states in the West should be very, very concerned about this."
But Gov. John G. Rowland of
about the plan. "It's a great deal," Mr. Rowland said. "I'm very
pleased
with the prospect of greater state flexibility."
Mr. Thompson argued that the administration proposal would preserve
comprehensive insurance for most of the poorest beneficiaries. But states
would have "carte blanche," he said, to
alter Medicaid coverage for about 15
million recipients."
States are not required to cover these people, but once they are on the
Medicaid rolls, they have legally enforceable rights to benefits.
Mr. Bush's proposal for Social Security, first offered in the 2000 campaign,
would also break sharply with the past by allowing workers to divert some of
their payroll taxes to individual accounts that would be invested in stocks.
While its political prospects have been dampened by
the declining stock
market, Mr. Bush reiterated his support for the idea last month in his State
of the Union address.
Both sides agree that the coming debate over these proposals will be a
fundamental clash of political philosophies - over the obligations of
government, the rights of the individual and the role of the private sector.
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Another way to view these cuts is in the context of the SF Chronicle article
yesterday (
Colonialism," which said, in part:
"This will not just be our first pre-emptive war, but it will be followed
by
a massive, indefinite occupation. . This will not just be our first
pre-emptive war, but it will be followed by a massive,
indefinite
occupation. American military forces will unleash a "democratic
tsunami,"
they believe, that will transform all Arab governments and fortify the
region for American interests for decades to come."
".. The
for the long-distance deployment of
deployments will require huge increases in defense spending, with the
president's new budget projecting rises over the next few years to $500
billion annually from the current $350 billion. This does not include the
estimated $40 billion per year that will be needed to maintain 150,000
American troops in
For the entire SF Chronicle article," Reshaping the
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/02/23/IN200988.DTL