Tag: Medicaid

Mitt Romney: Can You Help Us, Mr. Fix It? (Part 2)

Posted by – February 10, 2012

Continuing my comments on Mitt Romney’s “very ample safety net” statement on CNN; see the first half of my post: Mitt Romney: Can You Help Us, Mr. Fix It? (Part 1)

So, as I said in Part 1, it’s very important to assess presidential candidates in a just and fair manner, and too often the news media is blaring the one sentence “not concerned about the very poor” sans context. But, to be honest, Romney’s answer is even worse when examined in its full context and nuance. Gail Collins over at the NYT wrote an excellent line-by-line breakdown of Mitt’s full statement. I won’t reprint her words here but I highly recommend you take a look.

Romney’s statement (read it here in full) singles out the 95% of Americans in the middle as his main concern. He’s not concerned about the top 1% and that leaves the bottom 4% he isn’t concerned about. Basic arithmetic shows the bottom 4% are those earning under $5,000 annually, a group politicians barely notice exist, much less spend time helping. This category would probably encompass mostly the elderly and disabled, and the homeless, including a lot of homeless veterans.

The most intelligent and spot-on post I’ve seen on this so far in the sprawling blogosphere is from the Columbia Journalism Review’s Campaign Desk: Three Thoughts on Mitt Romney’s ‘Very Poor’ Day : CJR
What makes it great is it actually does what journalism should, dig beneath the noise and the claims and try and unearth the facts. It points out that when Romney says the bottom 4% have a “very ample safety net” and it’s the middle class that needs help, it reveals a deep misunderstanding about the safety net in his brain. The article points out that social programs, for example Medicaid, spend more on long-term care for the elderly and disabled than on any other line item, and plenty of those folks qualify under medical assistance and Medicaid keeps them perched barely on the edge of a middle class quality of life. The article also cites data showing that many beneficiaries of Medicaid are actually middle-class families—certainly families in that broad “90-95 percent of Americans” that Romney says he wants to help—who “would otherwise be stuck with the full tab for care for their elderly and disabled relatives.” Medicaid is life support for the middle class as much as it’s a “safety net” for “the very poor.” More people should be cognizant of this data. Paul Ryan is: he hates that Medicaid is benefiting the middle class.

When pressed by CNN’s Soledad O’Brien after his initial “very poor” remark, Romney went on to say “We will hear from the Democrat Party about the plight of the poor.”
Essentially, he’s saying that’s their job, not Republicans’ role.

This references a political balance that may have existed 30 years ago, when Tip O’Neill and outspoken liberals controlled the House of Representatives and made sure the concerns of the poor were heard sometimes, but most certainly doesn’t exist now. No Democratic party leader that would remotely try to balance the scales toward the poor has existed since the era Tip O’Neill clinked high ball glasses in the Oval Office with Ronnie after 6 o’clock, and spent all his working hours before 6pm standing up to President Reagan, fighting for his blue-collar, poor base. He was by the unions, for the unions, and that doesn’t exist anymore. That is over; Tip O’Neill died in 1994 and no one remotely like him has succeeded him. Nancy Pelosi, the longest-serving Democratic Speaker of the House since O’Neill (she served four years) spends more time cozying up to corporate interests than unions. Instead of O’Neill, a hardscrabble Catholic boy from a poor Irish district, fighting the good fight for every day blue-collar people, we have Pelosi, an aloof elite holding a net worth of approximately $58 million in real estate, stock, and businesses she and her husband own, and is now facing an insider trading scandal. Sadly, Chris Hedges is right about the death of the liberal class.

When was the last time you heard Pelosi or Obama, or even the Clintons talk about the very poor? About the impoverished elderly? About people with disabilities? About the marginalized and excluded bottom 4% of Americans who have no apparent “trampoline out of poverty”? If I had a nickel for every time I’ve heard “from the Democrat party [sic] about the plight of the poor” over the past 20 years, I doubt I’d have enough nickels to make a phone call. Democrats frequently speechify about “working families,” when the problem is American families aren’t working, they can’t find enough work to make ends meet; too much of our economic base has been off-shored, and there hasn’t been enough innovation to replace what’s been lost. Obama and Pelosi talk about the middle class, campaigning for that big demographic same as Mitt Romney is, minus mentioning the “very poor” at all.

So given the Democrats abdicating their past role as fighters for the poor, we have to ask the Republicans as well, Romney included, for assistance for those trapped at the bottom, for help fixing the safety net and the upward ladder.

Unfortunately, the video footage is coming out, showing that “the people who need the help most are not the poor” is a recurring theme in Romney’s stump speeches. This is really troubling stuff, particularly after all the data has again and again shown the U.S. to lead the developed world in poverty [Source]. Also, as Romney says “if [the safety net] has holes in it, I will repair them,” he’s simultaneously pushing forth a tax plan that would blow a hole in social programs’ funding like we’ve never seen: Romney Tax Plan Would Require Slashing Social Safety Net … Says Romney Economic Adviser. It is disturbing that Romney says we have a “very ample safety net” while the next minute pushing a tax plan that—based on the analysis of his own economic adviser—would require slashing the very social programs he’s saying he’ll “repair.” Yet another contradiction from Willard “Mitt” Romney, the human mystery wrapped in an enigma. I want to reform the system to revolutionize how it sees us and respects our individual freedom, we need a very big change, I like the possibilities in some of Senator Wyden’s ideas for replacing Medicaid—which he calls a “caste system”—with something better and more equitable; what we don’t need is to destroy the program, death from a thousand cuts.

Still, I hope for some kind of educational moment can come out of this. That’s why I’ve written Romney HQ a letter. I have nothing against Governor Romney as a person, I’m sure he’s a great, affable guy, and I’d love to meet him to work on bringing individualized funding, choice and competition to Medicaid/Medicare instead of “one size fits all.” We don’t really know what kind of Republican Willard is deep down or how he’ll really govern—is he a lefty Rockefeller Republican like his dad, a moderate pragmatist like George H. W. Bush, a hard-right Reagan-and-Ayn-Rand type?—we don’t know. So why not assume he can be very reform-minded like his dad; why can’t Mitt be the one to lead the way in revolutionizing Medicaid and Medicare to be completely different? Choice, competition, individualized budgeting, cash and counseling—let’s go!

After all, Romney supporters like to refer to Mitt Romney as “Mr. Fix-it.” I’ve seen dudes holding “Romney: Mr. Fix-it” signs prior to the debates on cable news. I found this image on mittromneycentral.com:

Mr. Fix- It, America needs a proven leader with a strong conservative message.
Fan art by MittFan12 (Steve Thomas)
In a bizarre interlude, me finding this “Romney Mr. Fix it” image led to me stumbling into the mittromneycentral.com chat room by accident. Most of the supporters in the chat were polite and cordial in answering my questions, and I left there with more respect for Team Romney than I came in with…

Mitt Romney, please fix the safety net.

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Mitt Romney: Can You Help Us, Mr. Fix It? (Part 1)

Posted by – February 10, 2012

Editorial cartoon: Richie Rich, the Monopoly Man, the Simpsons' Mr. Burns and Scrooge McDuck tell Mitt Romney he's embarrassing the rich 'you're making us look bad'

 

So, there’s been a dust up over Mitt Romney’s “I’m not concerned about the very poor” comments on CNN.  A lot of the blogosphere is mindlessly blasting this quote sans context, and the TV news even worse, so Team Romney isn’t wrong to protest how this has been “taken out of context.”  Cable news has been bad.  So bad: stopping short of breaking it down into a few syllables and grunts between prescription drug advertisements.

But, to be honest, Romney’s answer is even worse when examined in its full context and nuance.

Here’s Mitt Romney’s “I’m not concerned about the very poor, I’m not concerned about the very rich, I’m campaigning for Americans in the middle” the relevant part of his interview with Soledad O’Brien, with all the context and nuance he gave CNN:

ROMNEY: You know, just let people get to know you better. The nice thing about what happened here in Florida is I got a chance to go across the state, meet with people. They heard what I am concerned about. They understand how I will be able to make things better.

I think people want someone who not just throws an incendiary bomb from time to time but someone who actually knows how it takes to improve their life, get home values rising again, to get jobs again in this country, and to make sure when soldiers come home they have a job waiting for them. And make sure people who are retired don’t have to worry about what’s going to happen at the end of the week.

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.

I’m not concerned about the very rich, they’re doing just fine. I’m concerned about the very heart of the America, the 90, 95 percent of Americans who right now are struggling and I’ll continue to take that message across the nation.

O’BRIEN: All right. So I know I said last question, but I’ve got to ask you. You just said I’m not concerned about the very poor because they have a safety net. And I think there are lots of very poor Americans who are struggling who would say that sounds odd. Can you explain that?

ROMNEY: Well, you had to finish the sentence, Soledad. I said I’m not concerned about the very poor that have the safety net, but if it has holes in it, I will repair them.

On CNN February 1st, Mitt Romney included a tangent about

O’BRIEN: Got it. OK.

ROMNEY: The – the challenge right now – we will hear from the Democrat Party the plight of the poor, and – and there’s no question, it’s not good being poor and we have a safety net to help those that are very poor.

But my campaign is focused on middle income Americans. My campaign – you

can choose where to focus. You can focus on the rich. That’s not my focus. You can focus on the very poor. That’s not my focus.

My focus is on middle income Americans, retirees living on social security, people who cannot find work, folks who have kids that are getting ready to go to college. That – these are the people who’ve been most badly hurt during the Obama years.

We have a very ample safety net, and we can talk about whether it needs to be strengthened or whether there are holes in it. But we have food stamps, we have

Medicaid, we have housing vouchers, we have programs to help the poor. But the middle income Americans, they’re the folks that are really struggling right now, and they need someone that can help get this economy going for them.

O’BRIEN: All right. Mitt Romney, congratulations to you on your big victory last night. Thanks for talking with us. appreciate it.

CNN, Transcript of Soledad O’Brien interview with Mitt Romney, Feb. 1, 2012

For me, the “not concerned about the very poor” comment is one of the least disturbing parts of his answer here.

First, it’s what he said immediately following that: “We have a safety net there. If it needs repair, I’ll fix it.” That anyone who has been a leader in government can still essentially wonder aloud IF the safety net needs repair astonishes me. After all the tragic deaths (like the 12-year-old boy who died for lack of a dentist to simply pull a tooth) and horrible suffering that’s been well-documented and displayed, how can anyone not know our safety net needs a major shoring up if not—my position—a total rethinking and restructuring?

To quote from a 2007 blog post I wrote:

For those with severe disabilities dependent on Medicaid, the Republican cuts from 1995-2007 have had horrible consequences. I’ve had to fight like hell to survive. In 1996 in Alabama, Medicaid started gutting EPSDT (the federally-mandated program providing nursing care for those in need) and sending out termination notices to families in the mail. Then in 1999-2001 we had more aggressive cuts. They changed the rules so it’s only a temporary program to train caregivers to stay with their child 24/7, and they keep repeating that it is not the government’s role to “babysit” your child at all (even if your child is on life support and routinely coding). And now it is 2007 and Alabama barely funds it at all. We’ve almost been rolled back into the 1970s level.
I’ve had friends die. I’m sick of tolerating this evil like it is a valid policy position. It is in no way valid nor deserving of our deference and patience. It is nothing but immoral…

I have seen too much suffering and death because of inadequate supports and invisible safety nets and I am frakking traumatized that people are still pushing this destructive right-wing mythology that if we chip away at government funding even further, that this will magically increase services. It has been tried for years and has failed every time.

Excerpted from my post Vigorously Insisting On A More Perfect Union: Fighting Cuts, Demanding Universal Health Care | Nick’s Crusade
This “Demanding Universal Health Care” post was published by the Greenhaven Press imprint of Gale Publishing in the 2008 edition of Opposing Viewpoints: Health Care, if anyone is interested.

I think Romney needs to hear these stories, hear the details of how our lives are effected by the swiss cheese safety net.

Some of my other blog posts may prove instructive:
Feds Fiddling While State Medicaid Programs BURN | Nick’s Crusade (a critique of how ObamaCare will impact Medicaid, amid a report of budget cuts in the South leaving people with disabilities in their own waste)
Government-Sponsored Ablism and Segregation Tears Families Apart | Nick’s Crusade (an essay against state-sponsored institutionalization, segregation, and oppression)
Medicaid: Why It’s Broken and How To Fix It | Nick’s Crusade (highlights the broken parts of Medicaid, including funding disparities, poverty mandates and the ultra-expensive and antiquated practice of unnecessarily institutionalizing people, and lays out some solutions)

I plan to drop Willard “Mitt” Romney a note, you could do the same. Let him know what problems in “safety net” programs need his help, concisely and politely. Appeal to his “Mr. Fix-it” rhetoric. I don’t know if anyone will be able to connect and begin a constructive dialogue with Team Romney, but if even one person did, it would have a wonderful impact.

info@mittromney.com

Mitt Romney for President
P.O. Box 149756
Boston, MA 02114-9756

More thoughts on Mitt Romney’s “very ample safety net” comments in Mitt Romney: Can You Help Us, Mr. Fix It? (Part 2)

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Best Of Nick’s Crusade Blog, So Far

Posted by – April 10, 2011

I’m happy that some of my blog posts have become particularly well-trafficked resources on the interweb. I’ve often written about historical topics that interest me, and, oddly enough, those posts get more hits than posts about disability, politics and injustice, the main subjects of my Nick’s Crusade Blog.

This is a survey of the most viewed posts ever on this site…

China’s Age of Discovery: The Voyages of Zheng He

This post, about the explorer Zheng He and the voyages of his grand treasure ships, is usually the most viewed post for any given week. Not only does the post shed light on the way-ahead-of-their-time ways that the Yongle Emperor projected power and influence with technology like the printing press and an enormous Navy (techniques that would seldom be used with such sophistication until the 19th century) but it also remains very relevant because it details a Chinese period of prolonged international engagement, trade and wealth only rivaled by the high water mark of Chinese power today. The end of the treasure ships, with hardliners burning them as an isolationist backlash swept the empire, illuminates a pattern you see over and over again in Chinese history: after the inevitable bust comes following an economic boom, Conservative Confucians take over and crackdown on trade after a harsh isolationist reaction. Today, China-watchers and investors, and indeed the PRC regime, worry about another cycle of isolationist backlash cropping up if Chinese people in the underdeveloped heartland don’t feel enough improvement in their lives from foreign trade and become angry.

The Griffin Was Based On A Real Creature!

Rivaling “Zheng He” for the Top Search term leading people to my blog is “griffin” or related key words. This post is shockingly well-visited, and it’s one of the quickest ones I’ve written. I saw a program on the History channel about mythical creatures that suggested the Griffin came from ancient Scythian warriors who came upon dinosaur skulls and spread stories about Griffins to intimidate enemies, and decided to blast a quick blog post. I guess people really like Griffins.

Donald Duck As A Nazi. Really.

This post, coming in a distant third in views, generates hits from the sheer bizarreness of the video it highlights, a war propaganda-era Disney short with Donald Duck dreaming he is a Nazi. Even though the film is clearly meant to mock and underline the failures of the Nazi system, seeing Donald in a Nazi uniform is still WEIRD!

Special mention: Vigorously Insisting On A More Perfect Union: Fighting Cuts, Demanding Universal Health Care

This blog post of mine was published by the Greenhaven Press imprint of Gale Publishing in their Opposing Viewpoints Series, which is heavily used both in libraries and high school and college courses, to introduce differing views of the issues. it’s in the 2008 edition of Opposing Viewpoints: Health Care, if anyone is interested.

Also check out my comic art, Theodore Roosevelt and the Rough Riders vs. Zombies over at Superdude.org — it’s can’t miss!

Nick

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The Social vs. Medical Model of Disability, Communities Will Be Forced To Choose

Posted by – April 7, 2011

You may or may not know about the medical model and the social model of disability.

Many disabled people have rejected this model. From the Taxi Driver Training -- Democracy, Disability and Society Group, UK

The social model of disability sees disabilities as normal aspects of life, not medical problems requiring "treatment," with the real problems coming from inaccessibility and ignorance of disabled people. From the Taxi Driver Training -- Democracy, Disability and Society Group, UK

I wanted to talk about the social model of services and supports for people with disabilities, and barriers to implementing it.

When you think about disability internationally, most disabled people in countries around the world are taken care of by their own families and their own communities. In Alabama, where I’m from, and in many of the poorer states, they didn’t get the medical model at all until federal funding in the 1960s. Prior to that, all you had was a kind of quasi-social model, with families and neighbors taking care of their disabled children, the same way they did in the 19th century and from time immemorial. A new social model of services and supports would essentially work like an enhanced version of that, with disabilities normal phenomena that communities live with and provide for.

In the first world countries, as families are working almost entirely outside of the home, they have no recourse but to use government services to help take care of their disabled children and adults. In Alabama, the attitude is that the most harsh, spartan medical model is all they can afford, and that they can’t afford to innovate. They have missed an opportunity to save money by re-imagining a social model that would put the power back in the hands of families and people with disabilities, instead of forcing them to spend on treatments that the medical model wants for them.

Across the country, budget cuts are removing the medical model more and more from our lives, because the states can no longer afford the kind of medical services that they’ve been paying for. The medical model won’t be the force it has been without enough public funding. So there’s more need than ever to implement a new social model of services and supports. In one of the conferences that I attended (TASH Boston ‘02) there was a session on what drives people to put their loved ones into nursing homes. And the number one reason found in studies was that when someone becomes incontinent of bladder and bowel, the family doesn’t want to deal with it, and puts them in a facility. There was one story where a mother wanted to put her autistic son in a facility just because he couldn’t figure out how to zipper his pants, though he could otherwise engage in self-care. This is the institutional bias, up close and personal, and it is ridiculous. We can no longer afford to put people with disabilities in segregated, medical model institutions. The funds saved by turning the institutional bias on its head and closing more of these terrible, outdated, freedom-killing institutions is great. We can’t afford these awful dinosaurs financially, and we can’t afford it in the human toll, in the human potential and spirits that are locked up.

To escape that fate of being put away forever in a nursing home, I had to fight Alabama Medicaid policies that would cut off home care services at age 21. My campaign, Nick’s Crusade, led to the Dupree v. Alabama Medicaid lawsuit, which used the Olmstead decision to end the practice of Alabama cutting off ventilator dependent people from in-home services once they turned 21. It was a victory that helped half a dozen people stay in their homes, but it didn’t solve the underlying problem, that even in the home, the medical model of home nursing care tends to segregate, restrict and limit the liberty and potential of people with disabilities.

I ended up having to leave college because of problems with home nursing care, and eventually I began to outlive my family’s ability to take care of me, and ended up relocating to New York City in August, 2008. Because of difficulties getting home care approved and started, home nursing agencies that are dysfunctional and cruel, and relentless ablism faced by me and my partner Alejandra, my first 378 days in New York were spent in a city rehab hospital. It was my first stent in a facility, and I learned a lot about the system that keeps unnecessary institutionalization going and told the world in The First Video Blog Series From Inside An Institution In History. Make especially sure to watch my videos What Life In An Institution Is Really Like, And Why This Entire Model Should Be Replaced and Too Many Setbacks To Count (about the barriers and delays to getting home, with music).

Because Alejandra and I love each other, we made the decision to spend our lives together, as many people with and without disabilities do. However, most people with disabilities living in the U.S. run into the so-called “marriage penalty” if they receive federal Social Security benefits, which are reduced by one-third if two recipients marry. Choosing to declare our commitment to each other despite this policy, we held a commitment ceremony in Central Park on June 6, 2010. It was also an opportunity for others in the community to learn about and share their experiences with this injustice.

Getting the supports needed to maintain my health and safety, attain freedom to access the community and resume college remain problematic. I write and draw webcomics, such as Theodore Roosevelt and the Rough Riders vs. Zombies. I was going to show my work from a table at the MoCCA Festival, and ended up canceling because we didn’t have the help for getting me up in the chair and out to the festival. For me as a disabled man, “freedom,” means that I have good caregivers around me that can help me do stuff. Without those people, I’m stuck in my room at best, and, at worst, dead.

Nurses, personal care attendants, and other home caregivers will always remain enormously important in any model because in first world countries the cost of living is high, and thus the people doing the bulk of the care will be the ones who can do it without losing their apartment. Paid supports should be budgeted by the disabled person (see individualized budgets and the Cash & Counseling program) so that both the caregivers and the patient aren’t constantly battling middlemen–agencies and Medicaid, and so the patient can give their best staff higher pay and bonuses. This essay isn’t meant diminish the importance of nurses and PCAs but to re-imagine them as part of a support community that form around people with disabilities; with families and communities that refuse to shelve their people in prison-like nursing facilities, that refuse to use a strict, heartless medical model inside the home, that say NO to materialism and profiteering, and instead focus on care and caring. Personal care is incredibly intimate and sensitive, caregivers see and touch and care for wounds, deformities and vulnerabilities that no one else sees, this is soulful and special work; it should never be callously commodified or turned into a cold assembly line in a nursing facility. The people who are good at going into someone’s home and making them clean, comfortable, giving them care and freedom, are very special people. In a new social model, friends and neighbors of the disabled person partner with and lend their support to these special caregivers, helping them and assisting them to assist their patient. The caregivers in turn helping the friends to help their patient. They care about each other and collaborate to help the disabled person. The community loves and supports each other.

Relying on Medicaid to give me ALL the assistance needed to live a real life in the community will always be difficult as long as Medicaid is locked-in to the medical model. It’s near impossible without friends and volunteers in your community lending some support. What is needed is the social model: normalization of disability: for society at large to start seeing people with disabilities as equal members of families and communities, instead of undue burdens. If someone in the community had cared about the kid who couldn’t manage the zipper on his pants, he wouldn’t have been at risk of institutionalization at great cost to his community. If the community would give their time and love more, we’d need Medicaid, the increasingly dark, Kafkaesque bureaucracy that pays for services for disabled people, less.

There are plenty of ways for the community to support people with disabilities. When I was hospitalized for several months in early 1992, Bettie Hudgens, the founder of the Communications department at Spring Hill College, where my mom taught, created a sign up sheet so that volunteers would visit me every day, so I would have someone checking in on me during the hours mom was teaching. The signup sheet allowed the community to organize around me so that every day was covered. We need that kind of community building now more than ever.

Communities will eventually be forced to choose, will they pay more and more for Medicaid as its red tape continues to render it hilariously dysfunctional like a Soviet department, or will friends and neighbors pitch in to help the elderly get in and out of bed, and change soiled clothes so they wouldn’t have to be segregated in institutions, so their people with disabilities will have less involvement with the heartless Medicaid bureaucracy and be less exposed to the whims of the politicians that fund them. It’s up to us to implement a new social model, as the old models begin to collapse.

Nick

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The Cost of Denial For People with Disabilities

Posted by – September 25, 2010

To respond to the comments made during WBAI radio’s roundtable discussion about my latest blog essay “Why It’s Time For Survival Politics For People with Disabilities…”

The last statement in the radio segment about my blog was Josie Byzek saying that (my paraphrasing) the Tea Party may win big in the midterm elections, but then there could be a backlash at the ballots in two years (in the 2012 elections).
I don’t think the problem of inadequate services for people with disabilities will just go away with a political pendulum swing in two years. The dramatic changes that have already happened and will keep happening will ensure that these monkeys stay on our backs; because we squandered the budget for so many years on tax cuts and wars, budgetary realities will force severe benefit cuts, even if you had a 100% Dem Congress. No Congress will be able to govern in the way we’d all like, because of these very severe budgetary and political realities. Yes, part of the political reality is the Tea Party; those Tea Party activists and candidates who embrace an extreme form of Randism are more comfortable with disabled people’s blood on their hands than any political group has been in my lifetime; they’re completely comfortable demonizing people on public benefits as “robbers,” “leeches” and “parasites” and (I would argue) they’re completely irreconcilable with Judeo-Christian morality. Tea Party candidates and their Rand philosophy will be shaping the debate and helping define what is achievable legislatively like never before, and people with disabilities need to know about this, educate themselves, because this is a force that will affect our lives. But overlaying that is the larger problem of “we outta money.”

In this Dave Granlund cartoon, poor jobless people with a HELP sign reach out to Uncle Sam, but he just pulls out his empty pockets and says "I was going to ask you the same."

We’ll be paying the price for decades for the decision to try and pay for two simultaneous wars with tax cuts and “just go shopping!” and paying for it in numerous ways, some very painful. We gotta pay the piper, and we’ve run up a huuuuuuge tab. If history tells us anything, it’s that the tab is always borne by the poor and disabled, the most vulnerable and least able to pour money into campaigns to fight back.

Josie Byzek herself touched on the budgetary realities when mentioning sales tax revenue that helps fund state Medicaid isn’t the same anymore, the bottom fell out. We’ve got *apocalyptic* job loss, the last of the manufacturing sector exiting en masse, etc. Those hardhat-type 9-5 jobs won’t be coming back and you’d have to visit China to see them. The information tech world will be the source of jobs, but it hasn’t adapted and kept up enough to provide that yet, and it may be another lifetime before that happens. This will be a really ugly transition.

This Concord Coalition graph shows how Medicare, Medicaid and Social Security, in addition to interest on our enormous debt, continue to bloat the budget by % of GDP. In order to sustain benefit spending, we would need to HUGELY grow the economy, but currently, it's shrinking. Terrible choices are coming soon.

I’m arguing that technology, the economy, and politics are drastically shifting, and Medicare and Medicaid will soon change BIG TIME, so disability community leaders need to get in front of this and negotiate hard for the services we want to preserve most, because a lot of them ARE going away, and we have to get out of denial and start coping and adapting NOW! Catastrophic institutionalization, re-segregation, will happen unless we acknowledge that economic and budgetary realities mean that a lot of services are inevitably going away and negotiate hard for keeping select services we can’t go without (i.e. HCBS, Home and Community Based Services) using a cost-effectiveness argument. Congress won’t give a damn about us, but will care about cost if we make the case.

and y’know how Obama’s health reform bill increases Medicaid eligibility? It gives subsidies to help pay for the increased enrollment, but that enhanced FMAP is temporary. Then what? Then FAIL!! I’ve written about this in detail here; the eligibility mandates will hit the poorest states the hardest and they are already slashing programs to the bone to the extent they’re leaving us in our own waste. Once the eligibility mandates fully take effect in 2014, will the poorest states have to drop most care for people with disabilities? They could have to dump the people most in need, in favor of reshaping their programs to bring them in line with the new requirements, i.e. providing major medical coverage to low-income (able-bodied) adults. This is one of the worst parts of health “reform,” so very disconnected from the needs on the ground and the harsh realities we face.

This is a map of the worst and best Medicaid agencies in the U.S., with the reddest being the worst, and the lightest being the best. What I'm telling you is, this map will soon get much, much redder across the country.

In light of the situation, we need to be having conversations like “yes, we know that Medicaid dentistry and ophthalmology and free eyeglasses and prosthetics and leg braces and numerous things we’re accustomed to are going away, but we have to protect HCBS or the nursing facilities will cost the states EVEN MORE.”

We can’t afford the COST OF DENIAL. We can’t stay in denial that benefits will be changing; we can’t stay complacent! I’m saying WAKE UP, the societal, technological, economic and political changes are so great that benefits will be changing dramatically, and we aren’t prepared and we aren’t identifying priority areas to protect because there is an unwillingness to sacrifice ANYTHING, so Congress will likely cut EVERYTHING. Failure to get in front of this thing, staying in denial, will mean Congress will just impose 20% or 30% austerity across the board on all departments without understanding the issues involved.

Nick

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Nick’s Crusade Blog Featured On Local Radio WBAI!

Posted by – September 23, 2010

My blog posts are making waves! My new blog essay about the affect of the Tea Party and the related drastic benefit changes on people with disabilities was the subject of a roundtable discussion this morning on local WBAI radio’s disability chat show “The Largest Minority.”

You can listen to the radio discussion here.


Sept. 23 “The Largest Minority” on WBAI radio, featuring a reading of my blog essay “Why It’s Time For Survival Politics For People with Disabilities” and a roundtable discussion with cohosts T.K. Small & Lawrence Carter-Long, and guest Josie Byzek, New Mobility magazine

Listen to the discussion. I don’t agree that the shift in social services spending is a temporary problem that will be “all better” after the political pendulum swings back away from the Tea Party agenda.

I’m arguing that society, technology, the economy, and politics are drastically shifting, and Medicare and Medicaid will soon change BIG TIME, so disability community leaders need to get in front of this and negotiate hard for the services we want to preserve most, because a lot of them ARE going away, and we have to get out of denial and start coping and adapting NOW!

More on the important argument I’m making here: The Cost of Denial For People with Disabilities

Nick

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Why It’s Time For Survival Politics For People with Disabilities

Posted by – September 22, 2010

To listen to WBAI radio’s roundtable discussion about the below essay, go here.

This isn’t “The Great Recession,” it’s “The Great Change.” The recession–that is just a symptom of these enormous tectonic shifts going on (societally, technologically, economically, politically) and our inability to keep up has caused disruptions and economic downturn. That economic downturn is not the disorder, it’s just a symptom of the rapid changes spinning around us and our inability to cope. The change has come and will keep coming. Obama promised political change to help us adapt to all the other changes, but failed because of immediate backlash. Now, the backlash (led by the Tea Party) is bringing political change, and we’re headed for an upheaval that will radically shift ideas about the publicly-funded services and supports that keep people with disabilities alive and participating.

The Tea Party agenda is incredibly important for people with disabilities to learn about and understand because those ideas are here and will soon be back in the halls of power, BIG TIME.
Understand; the Tea Party movement is just the newest part of a self-described revolutionary movement that began in the ’60s with Ronald Reagan and first gained broad federal legislative power with the “Republican Revolution” brought by the 1994 midterm elections. The Republican Revolution brought us Newt Gingrich, Dick Armey, Tom DeLay, the leaders of the Revolution, and dozens and dozens of loyal soldiers under them. Those foot soldiers, Senators and Congressmen first empowered by the ’94 revolution, the “Revolutionary guard” if you will, make up the bulk of the Congressional GOP today. And they’re worried now because the Tea Party is leading a second revolution, and they want their seats. Rick Lazio is a good example. Lazio was yet another foot soldier for the Republican Revolution and its policy platform, the Contract with America (which demanded lower taxes, eliminating welfare, tougher anti-crime laws and a balanced budget amendment making deficits unconstitutional). That was no longer right-wing enough for conservative voters; Lazio got crushed by Tea Partier Carl Paladino in the GOP gubernatorial primary. You have to hate much more to be a real conservative. This is like one of Robespierre’s purges of earlier revolutionaries; it’s not enough to support the revolution and oppose the enemy, you have to show a frenzied enthusiasm for every facet of the revolution and consistently revile the enemy publicly, or face the guillotine. Paladino painted Lazio as a “liberal Republican” throughout the primary, an INSANE claim, and won because a huge plurality of Republicans actually believes this. Rick Lazio must feel like his head’s rolling down the palace rug right now, poor bastard. Republican Revolution of ’94 wasn’t enough; now, foaming ultra-conservatives demand Republican Revolution II!

Republican Revolution II has already started; they even use the language of revolution, openly. Example: from Carl Paladino’s victory speech: “The ruling class knows — they’ve seen it now — there’s a people’s revolution.”


Watch CBS News Videos Online
This video is a great primer on the Tea Party and what they’re all about.

This survey of the Tea Party shows that Tea Partiers are 89% white. Taken from the above CBS News video.

This survey of the Tea Party reveals that 58% of Tea Partiers keep guns in the home, and 63% (an overwhelming majority) get their political news from FOX News Channel. Taken from the above CBS News video.

Even if the GOP doesn’t take over the Senate and the House, the populist groundswell it has generated (and incumbents’ fear of losing their jobs) will severely limit what Congress can do.

What ideas are the Tea Party/Republican Revolution II based on?

Reaction. The primary idea/emotion of this movement is that Obama’s presidency and the Democratic Congress are threatening their way of life and they have to “take our country back.” Conservapedia, which often seems like a Colbert-penned parody but actually is a serious project founded by Andrew Schlafly (youngest son of early segregationist and anti-feminist leader Phyllis Schlafly), has a good article on the Tea Party movement and its founding motives, all of which are a reaction to Democrats and their policies. It really is akin to Italy’s Blackshirts; it’s an authoritarian mass movement (and is being studied as such by authoritarian psychology scholars). It fits the authoritarian blueprint to a tee, right down to the outcry of an oppressed “majority” against what they see as “radicals,” scapegoating (and fear-baiting) of minorities, fear of redistribution of wealth to the “lesser,” and rallying cries to return to a heralded, idealized past. They believe that if only Republicans (especially Tea Party-endorsed Republicans) controlled the government, the rapid changes affecting their lives and the economic anxieties and fear of losing privileges they cause would be reduced. Fear and rage animate this movement.

92% of Tea Partiers think Obama is turning America into a socialist state, according to this recent poll. Image taken from the above CBS News video.

Commentators online, including Michelle Malkin and Christopher Hitchens, have turned this AP Photo into the "Islamic Rage Boy" political meme that still floats around the blogosphere today.

It’s almost analogous to the infamous “Islamic Rage Boy” from Kashmir, in furious reaction to the Indian government that the protestors feel will eradicate their way of life. The Tea Party also sets up a battle for their way of life, absolute good vs. absolute, unadulterated evil, with no shades of gray in between.

The followers are reacting to economic anxieties, but the leaders are of an Ayn Randist-bent. If you’ve been an internet activist for over a decade, you could find them saying the same things they are now (staunch anti-federalism, strict constructionist view of the Constitution that damns all federal social programs as unconstitutional, blaming FDR and the New Deal for federal overreach and all subsequent economic problems, near-deification of Ronald Reagan, fundamentalist belief in Voodoo Economics to the point that they know that tax cuts can create enough new revenue to fund anything, white supremacy, extreme persecution complex, paranoid conspiracy theories about an all-controlling liberal elite) back in the Clinton and Bush years on web forums like FreeRepublic.com. Those wingnut views are now heard much more often as we allow the fringe to creep into the mainstream, but the hard-right ideas are not new. Online communities like FreeRepublic and their ilk would disgust most people in the first 20 minutes browsing threads; these are hard-right echo-chambers that have an incredibly radicalizing affect on their followers, environments where reviling “the other” is essential for being in the “in-crowd” and cross-pollination with known far-right extremist groups is vibrant and unconcealed. These guys have a hardcore agenda, and always sought to build a grassroots movement to primary out GOP incumbents and push the party to the fringe, but were never able to until the recession and widespread economic fear gave them a vehicle.

A neon green paper sign at the Tax Day Tea Party in Boston reads

What does the Tea Party mean for people with disabilities?

The Tea Party leaders’ Rand philosophy label us who use social services “robbers,” “leeches” and “parasites” because we suck up the wealth rightfully earned by the labors of others. Judging by this video of hate activists yelling abuse like “If you’re looking for a handout, you’re in the wrong part of town! Nothing for free here, you have to work for everything you get!” at a disabled man at a Tea Party rally, and throwing money at him in revulsion, this movement embraces Social Darwinism, and they really do intend hatred for us people with disabilities and cutting off our services. Though I too would like an end to UNNECESSARY government interventions (especially in the area of civil liberties, which conservatives seem to have abandoned en masse) what counts as necessary government intervention is where Rand-bots and I differ, because they see nearly every intervention as unwarranted tyrannical intrusion into private matters. For them, even saving people from dying of decubitus ulcers from lack of personal care is unwanted government overreach.

There are opponents of this extreme agenda within the conservative leadership, for example, the New York Conservative Party said: “If Carl Paladino wins this thing, it will cause severe damage — it could be for decades — to the Republican Party of New York State.” Many (correctly) predict an internal struggle over policy once the GOP wins Congress. If Tea Party candidates run the table, expect radical change in the services provided to us people with disabilities. More likely, incoming freshmen Congressmen will be unable to oust Leader John Boehner (R – Oompa Loompa) and compromises on policy goals are expected.

How should we adapt to survive drastic changes in social spending?

I call on disability community leaders to seek a meeting with future Speaker Boehner, as well as likely GOP budget planners Paul Ryan, Eric Cantor and Kevin McCarthy (who, during their book tour rolling out the 2010 Roadmap for America’s Future legislation, have been asking voters and fellow Congressmen for an adult conversation about how best to handle the coming scaledown in social services) and meet with them to discuss PRESERVING the most cost-effective services for people with disabilities: home and community based services (HCBS). If we people with disabilities have the needed home and community based services, we stay in our homes with our loved ones, producing value in our communities, paying sales taxes, property taxes, etc. But if those services are yanked out from under us, we end up in insanely expensive nursing facilities, or worse, dead. Conservatives are usually penny smart and pound foolish on this issue, slashing “optional” HCBS funding while leaving nursing home costs to continually balloon. That “institutional bias” has to change, or the affect on people with disabilities will be just devastating as political winds keep changing and funding streams dry up. The budget arithmetic just doesn’t work, so benefits have to scale down; stop thinking this won’t change, it IS changing!

Unless the disability community wakes up to the realities that Medicaid and Medicare will soon be drastically changing and we get IN FRONT OF the issue and begin educating and negotiating hard for our top 5 most essential services to preserve, our quality of life will go down the drain. Those of us in New York will be living with services like they have under Alabama Medicaid, and Alabamians with disabilities will fall to the level of Dominican Republic or Colombia or India. We have to prevent that. It’s time for hardcore SURVIVAL POLITICS!!

In Alabama, Medicaid policies really took a vicious turn after the first Republican Revolution took over Congress after the ’94 elections. Ideas about social services changed drastically overnight. In ’96-’97 I was fighting Alabama’s stated plan to end home nursing completely and ship every last one of us to institutions out-of-state. I won, but not before several people I knew died. After George W. Bush took over the presidency in 2001, Alabama Medicaid, began saying openly that they can’t afford home care and that it should be the responsibility of families and communities, not the state. Spending on home care dropped dramatically, to unprecedented lows. I had to lobby the state legislature, and eventually sue, to keep my care from being dropped when I turned 21. I won, and saved my younger brother, but my friend Chris died because no caregiver was at home to hear his disconnect alarm. Now with unprecedented yawning budget gaps, home and community based services are scant to non-existent in the red states. I escaped to New York just in the nick of time.

Please realize that the change is here already in most of the country, even California now–thanks to the Governator and a weak legislature. Too many in the NY disability community are happy, comfortable and complacent; ya’ll don’t see the tectonic shifts coming. It’s coming because of the growing consensus that we no longer want to pay for/can’t afford Medicaid and Medicare as it is now, the growing consensus for insane, rugged individualism. People with disabilities, WAKE UP! The time for soul-searching and tough negotiating with conservatives is NOW.

Listen to Paul Ryan talking about his “Roadmap.” Understand that soon we’ll have no choice but deep sacrifices and tough compromises, so the best approach is to negotiate hard for our biggest priorities, and start NOW!

Nick

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Republican Revolution II: Electric Bugaloo

Posted by – September 16, 2010

Terrifyingly far-right candidate Carl Paladino crushed state GOP-endorsed Rick Lazio Tuesday night and won the Republican nomination for Governor, meaning he will go head-to-head against Democratic nominee Andrew Cuomo for Governor of New York in the November 2nd election.

Photo of Republican Gubernatorial candidate Carl Paladino at a podium

Paladino is known for his ”controversial” bigoted comments and extremist stances on the issues.

Here’s a snippet of what CBS News’ Political Hotsheet had to say about Paladino’s primary victory:

Paladino’s victory over Rick Lazio doesn’t much change Republican prospects in the gubernatorial race, with Democrat Andrew Cuomo expected to cruise to an easy win. But it could prove a drag on Republicans in downballot races in the state and also embarrass the GOP establishment.

In April, Paladino acknowledged forwarding emails including images of bestiality and derogatory characterizations of President Obama, including one offering a video clip of African tribesmen dancing that characterized the video as “Obama Inauguration Rehearsal.”

The Tea-Party backed candidate reportedly sent an e-mail depicting a horse having sex with a woman and another that included a pornographic video and the headline “Miss France 2008 F[***]ing.” He also reportedly sent out an e-mail depicting President Obama and First Lady Michelle Obama as a pimp and prostitute and one showing an airplane landing near black men with the caption “Holy Sh*t. run ni**ers, run!”

Paladino also made headlines for saying last month, as the Associated Press reported, that “he would transform some New York prisons into dormitories for welfare recipients, where they could work in state-sponsored jobs, get employment training and take lessons in ‘personal hygiene.’” The program, he said, would be voluntary.

He waded into the debate over the proposed Islamic cultural center two blocks from Ground Zero, going even further than many other Republicans by suggesting he would invoke eminent domain laws to block what he calls a symbol of “conquest.” He believes global warming is a “farce.” He has what one New York tabloid called a “10-year-old love child.” If the state budget is late, he promises to shut down the government. He defended a friend who called New York Assembly speaker Sheldon Silver, an Orthodox Jew, “an Antichrist or a Hitler.”

In endorsing Lazio before the vote, the New York Times said that by nominating him the GOP “could avoid the national embarrassment of a Paladino candidacy.”

The state GOP tried to keep Paladino off the state ballot, but he got enough signatures to force his way on; he was then able to capitalize on voter anger against the Albany establishment to overtake Lazio, a mainstream figure who had been widely-expected to easily win the nomination (and then lose to Cuomo). Paladino’s victory looks like more bad news for a weakening Republican party in New York – and good news for Democrats who now have a potent symbol to feed their preferred narrative that Republicans are too far out of the mainstream for most Americans.
Excerpt from Carl Paladino’s Controversial Statements Could Embarrass Republicans – Political Hotsheet | CBS News

These email forwards are real; thanks to WNYmedia, a muckraking upstate blog, you can see all of the emails here, if you can stomach hardcore pornography (including one with bestiality), vile racism and the N-word.

These profane emails have garnered LOTS OF attention; you don’t want the governor of New York, who would be responsible for one of the most diverse, dynamic immigrant populations in the world, to be neck-deep in casual racism like this! Even Murdoch’s right-leaning NY Post came out against Paladino after WNYmedia exposed the emails, and Paladino’s extramarital affairs and 10 year-old love child surfaced (while Paladino attacked Governor Paterson‘s affairs as part of “Albany’s corruption”). Given conservatives’ penchant to angrily legislate publicly against the very behavior they continually engage in privately, you can expect Paladino to crackdown on pornography and other things if elected governor.

Unfortunately, the scandalous headlines have obscured even scarier facts about Paladino: his plans for New York. He wants the state budget slashed by 20% overall, even if he has to shut down the government to do it, he wants to axe the New York Power Authority, which would presumably transfer the NYPA‘s 4.2 million kilowatts of clean hydroelectricity to profit-hungry businesses, and he wants to put poor people into “voluntary” labor camps in converted prisons. Most disturbing is his proposed $20 billion cut to New York Medicaid, which would shrink state Medicaid/DOH by 30%, and would be inconceivably devastating for those of us with severe disabilities who rely on in-home care to stay alive and in the home.

Via the Adirondack Daily Enterprise:

Aside from consolidating government, Paladino said he would drive down Medicaid costs by $20 billion, which would reduce expenses for counties. The entire cost of the program is $52 billion, of which half is paid by the federal government and the rest divided between the state and the counties. Paladino said he would “slash” Medicaid and social welfare benefits, and require applicants to produce identification and be fingerprinted and drug-tested.

If we have the needed services and supports, we stay in our homes with our loved ones, producing value in our communities, paying sales taxes, property taxes, etc. But if those services are yanked out from under us, we end up in insanely expensive nursing facilities, or worse, dead. Conservatives are typically penny smart and pound foolish on this issue, and merely two years ago it was unimaginable that the hard-right agenda would have this level of prominence and influence.

Republican Revolution (1994), which Rick Lazio was a foot soldier for in Congress, and wanted budget cuts, elimination of welfare, law and order and anti-union laws, is no longer conservative enough for Republican voters. You have to hate much more to be a real conservative. This is like one of Robespierre’s purges of earlier revolutionaries; it’s not enough to support the revolution and oppose the enemy, you have to show a frenzied enthusiasm for every facet of the revolution and consistently revile the enemy publicly, or face the guillotine. Paladino painted Lazio as a “liberal Republican” throughout the primary, an INSANE claim, and won because a huge plurality actually believes this. Rick Lazio must feel like his head’s rolling down the palace rug right now, poor bastard. Republican Revolution of ’94 wasn’t enough; now, foaming ultra-conservatives demand Republican Revolution II!

It seems the entire country has lurched to the right; America is being driven insane by economic anxieties and the drastic changes in so many things (the economy, technology, politics and society). All the changes have triggered a huge reactionary push-back, but, even more, a tectonic shift that makes the nuttiest elements in politics more powerful than even four years ago under the Bush Administration. For such an extremist candidate to win the GOP nod, even in New York, with its proud tradition of moderate/liberal Republican governors and senators, for the right-wing nuts to conquer the home of the old Rockefeller Republicans, you know that politics has shifted DRAMATICALLY.

The right-wing nuts are more powerful now than four years ago, even though with Obama (hope and change!) the exact inverse was supposed to be the case. Support for the First Amendment is shockingly low, and support for discrimination is shockingly high–just look at the support for a nationwide ban on mosques, espoused by former Speaker Gingrich. Why has politics slid so easily to the far-right?? WHY IS THIS? what happened?!

My theory for what happened is basically: it’s Democrats’ fault! Even amidst soaring, Bobby Kennedy-esque optimistic rhetoric, Democrats delivered the same crappy, tepid leadership and status quo, making lies out of “yes we can.”
Obama isn’t up for election on November 2nd, and that makes it BAD for Democrats’ chances, because none of the people running have Obama’s rhetorical gifts, and most of what’s left for voters is the Democrats with long records being corrupt and craven and ineffectual and impotent, the Democrats suck at campaigning and suck even more at governing, Like Charlie Rangel, along with the rest of the leadership (Pelosi, Reid, etc.) who are deeply corrupt. They gave up 3/4 of progressive aims on the health care bill, in exchange for campaign bribetributions. We ended up with a love letter to the health insurance industry, one of the most evil industries in the world (I believe that one day there will be a memorial for all the victims of this industry). The vast majority of the health care bill’s crazy $1 TTTTTTrillion price tag is subsidies to the health insurance industry, a sector that is already bloated, inefficient, and unethical. When you subsidize something, you’ll inevitably get more of it; in this case we’re subsidizing EVIL. If there were any justice, the health insurance cartels would be broken up via antitrust actions (like what happened to Ma Bell), rather than maintaining stable monopolies in each state. But wait, the health insurance industry is specifically exempted from antitrust law, and the Democrats chose to leave it that way!
Those who were suspicious of the health reform effort had their suspicions confirmed, and then some; the health reform bill truly does increase the power of health insurance companies over our lives. Democrats could have done health care reform the right way, guided by their better angels, and be heralded as heroes in this election; instead, they used Massachusetts’ fascist RomneyCare as their model and refused to adopt and build on proposals from a more classical liberal view, like Sen. Ron Wyden’s plan. Democrats were on their worst possible behavior, showing the whole world how craven and corrupt they can be. That means Democrats’ credibility is shot. Thus we have no real counter to the unAmerican monsters dominating the Right (when internment camps for Muslims and nationwide bans on mosque construction become mainstream in your party because no one will “refudiate” such extremism, you are officially monstrous). The Democratic party doesn’t have the testicular fortitude to fight back; hell, they cowered instead of force a vote on health care for 9/11 rescue workers!

We liberals now have no choice but to abandon the binary, up/down, Democrat/Republican, black/white, thinking that leads us to act as if we only elect more Democrats, everything would be peachy. We know that a progressive agenda is desperately needed in this country, but go wrong in assuming that the Democratic party will always pursue those goals. We need to primary the hell out of a lot of seats until we can purge the corruption and get some actually good candidates elected.

Meanwhile, we’re boned. We’re going to see a repeat of what happened to the Democrats in the ’94 elections, that ushered in the “Republican Revolution” (Newt Gingrich, Dick Armey, Tom DeLay & company). At that time, the Democrats had caved to their corporate masters as well, and liberal voters were dispirited, while conservative voters were in a frenzy. The same thing is coming to you live on Nov. 2nd. But, of course, Republican Revolution II: Electric Bugaloo is looking much scarier–they’ve gone all Jacobin; it’s dogmatic purity or the electoral guillotine.

some of the players in Republican Revolution II: Congressman John Boehner, media wanker Tucker Carlson, and dark queen Sarah Palin

Once Republican Revolution II starts, John Boehner will likely win Speaker of the House

Republican congressmen are already openly tweeting about what they want to do, an extended government shutdown (like Gingrich did). With the economy already tanking, a disruption in government services could trigger a disaster. But I’m even more concerned about fundamental shifts in American values, social services, and escalating confrontation with the Islamic world.

I don’t feel like I am living in “the age of Obama,” already I feel like I am living in the age of Glenn Beck.

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Feds Fiddling While State Medicaid Programs BURN

Posted by – May 21, 2010

Question: In light of Obama’s plan to expand Medicaid eligibility, is anyone in Congress noticing the MASSIVE state budget cuts to Medicaid across the country and ruminating about how that jives with this impending expansion? I fear that if states have to raise income eligibility and bring millions of uninsured onto the Medicaid rolls, that will mean even deeper cuts in “optional” home care programs to pay for the expansion, and even more people with disabilities’ dreams shattered.

I wish Congress would have put protecting the most disabled Americans ahead of uninsured able-bodied people, but they didn’t. For Congress, people like me are invisible.

The states slashing Medicaid the deepest (the Southern states) are the ones that will see the most new Medicaid eligibles thanks to “Health Care Reform.”

PERFECT
FISCAL
STORM

That means life for people with disabilities in the South is about to get even worse. Good thing I fled Alabama.

Medicaid, especially in the South, is increasingly in tatters. State Medicaid programs were slashed to the bone in the 90s thanks to “the Republican Revolution” and now there’s no fat left to trim, so they’re taking chainsaws to muscle and bone.

In the Wall Street Journal, it discusses a woman who’s had to sit in her own waste all day thanks to state budget cuts. I suppose the state hoped her bed sores and inevitable sepsis take her quickly, otherwise Medicaid will be on the hook for expensive hospital stays that would dwarf the cost of just leaving her f#$%ing home care uncut in the first place. I’ve seen this happen over and over again to people I fight for. It’s left me scarred to depths few of you could ever understand.

Here’s the Wall Street Journal piece, by Clare Ansberry.

FLORENCE, S.C—Tandem forces of shrinking state budgets and rising health-care costs have collided and struck a small brick ranch house in this rural town, home to Barbara Hickey.

Born with cerebral palsy, Ms. Hickey, now 67 years old, is confined to a motorized wheelchair. She lives alone and relies on certified nurse’s assistants to get her in and out of bed, bathed, clothed and fed.

In December, she received a letter from the South Carolina Department of Special Needs and Disabilities, saying her weekly 50 hours of personal-care help was being cut to 28 hours. That meant Ms. Hickey would get help for two hours in the morning and two hours at night. If she needed to use the bathroom in between, she would sit in a soiled diaper.

After several days of reduced care, the local office of the South Carolina Legal Services appealed the cuts on behalf of Ms. Hickey. Her hours have been restored pending the appeal.

Home health care—funded largely by Medicaid—generally costs less money than institutionalizing developmentally disabled people like Ms. Hickey. But the political reality is that it’s easier to cut back home services than to close a 24-hour facility, which can leave people with nowhere to go. Thus, some of the biggest cuts around the country are happening in the basic services that help the disabled cope at home.

South Carolina says it has little choice but to cut funding for Medicaid. It faced a $563 million deficit for the current fiscal year, and like other states must have a balanced budget. Medicaid, the joint federal-state health-insurance program for the poor and disabled, already consumes about 20% of its $5 billion budget and is one of its fastest growing costs.

The health-care program is on course to consume 40% of the budget of South Carolina in five years, and leaves little for anything else, says Gov. Mark Sanford. “It could force legislators to either cut further into bone in the areas of education, law enforcement and economic development, or raise taxes. Neither option is palatable.”

The state already is making painful cuts elsewhere. The state’s Department of Juvenile Justice has closed five group homes and cut 25 after-school programs. There are 1,000 fewer public-education teachers this school year than last.

Across the country, budget-strapped states are focusing on Medicaid. Created in 1965, it is now a $379 billion program, including state and federal funds. State spending grew an average 7.9% in fiscal 2009 as the economic crisis hit and more people signed up for Medicaid.

It was the highest growth rate since the last downturn six years ago. Spending is expected to keep growing at that pace for the next decade because of rising costs and growing enrollment.

But states don’t have much flexibility when it comes to what they can and can’t cut inside Medicaid. Although it is a state-managed system, the federal government pays a percentage of each state’s total costs and makes many of the Medicaid rules. Under federal Medicaid law, states must offer inpatient and outpatient hospital care, X-rays and lab services. They also have to cover nursing-home services and meet certain standards, such as staffing ratios.

There are further constraints this year. States can’t reduce Medicaid eligibility this year because of a condition attached to federal stimulus money, and under health-care reform, they can’t eliminate existing programs.

States also run up against other laws when they make deep cuts. Lawsuits have been filed in South Carolina, Florida, Connecticut, Virginia, Mississippi and New York, claiming Medicaid cuts make it impossible for those with disabilities to live at home and that it violates the Americans with Disabilities Act.
(I know the lawyers behind this class action. I say RIGHT ON!!!!)

Logically, states would cut the most expensive, least efficient services and keep the most cost-effective. But because of mandates and the need to save money quickly, that isn’t as easy as it sounds.

For example, home care—because relatives often provide some of the care—is generally cheaper than housing people with developmental disabilities in institutional facilities. In 1993, the average Medicaid cost for each person with disabilities was $48,500. At the end of 2008, the latest figures available, it cost an average $55,000. Adjusted for inflation, that actually represents a 23% decrease, largely as a result of more services being shifted away from costly institutions to the home, says Charlie Lakin, director of a University of Minnesota program that tracks services for the developmentally disabled.

But many in-home services, though critical to those receiving them, are optional. Furthermore, there aren’t many minimum standards set for in-home services, so it’s easier to cut them without violating funding requirements. There are fewer immediate consequences for the state when it cuts those services because families won’t generally abandon disabled relatives and leave states on the hook for housing.

Cutting home care could ultimately prove penny-wise and pound-foolish, however. It could push more people into institutions or large group homes because that is where services are guaranteed, even though institutional care is more expensive.

The department’s fiscal problems have been exacerbated by past spending decisions. A special state audit released in December 2008 showed that the department hadn’t provided many new services for which it had received funding and, as a result, it couldn’t recoup millions in federal matching Medicaid dollars. For example, the state spent less than $700,000 of $10 million allocated to serve autistic children, which resulted in the loss of $13.6 million in federal matching money. The state said it couldn’t ramp up the program fast enough because it couldn’t find qualified service providers. After the audit, the executive director of the department and four of the department’s seven commissioners resigned. The department has since implemented most of the recommendations made by the Legislative Audit Council.
(This same thing nearly happened with the NHTD –Nursing Home Transition & Diversion– waiver here in New York: the bureaucracy imposed on providers was SO ridiculous than very few participated, and the rules were so cumbersome for patients that, in the program’s first two years, only one patient downstate–me–transitioned home from a facility!)

Recent state cuts have targeted developmentally disabled people living at home. In December, families were told that some of their in-home support was being cut by as much as half.

Brian Phillips, a 37-year-old with cerebral palsy, was told that he was losing half of his personal-care hours. He can work a TV with a remote control but can’t dress or feed himself, or get in and out of his bed or wheelchair.

He lives alone with his father, James, 70. The elder Mr. Phillips, who has had open heart surgery and whose heart functions at only 26% of its capacity, cannot lift Brian on his own. He appealed the cuts and the hours were restored pending his appeal.

“These are cuts no one wants to make. They are very difficult for agencies to implement and they are very upsetting and very, very difficult for our families,” says Lois Park Mole, spokesperson for the state Department of Disabilities and Special Needs.

People will generally do what they must to keep their disabled family member at home regardless of the cuts. At some point, however, even the most dedicated may not be able to continue, especially as their own health deteriorates.

In Aiken County, Board of Disabilities Executive Director Ralph Courtney says waiting lists for services are growing. There are more than 5,000 on waiting lists for various services, from residential programs to in-home programs.

“We want to give families hope to keep their family unit together, but in reality there is very little we can put in place to assist them,” says Mr. Courtney.

In-home support is cheaper, he says, than the alternative: group homes and larger residential programs that need to be maintained and staffed 24 hours a day. “But you can’t put people out on the street,” he says. “You can cut in-home support.”

Even though Ms. Hickey lives alone and needs help with nearly every aspect of daily living, it cost less to have her live in a house with 50 hours of personal care help than in a nursing home. Institutional care in South Carolina costs about $100,000 per person a year, compared to $39,000 for home and community services, according to the University of Minnesota research.

Read the entire article here: Disabled Face Hard Choices as States Slash Medicaid

How does littering the entire country with families destroyed by Medicaid cuts, jive with HEALTH CARE REFORM?

Honestly, I have gotten so many hate messages over the years, I’m now convinced that the Americans will continue to react with cold indifference, or, worse, celebration–”good riddance! No one is gonna force me to pay for you useless leeches!”–as Medicaid policy continues to cull out people with disabilities like me, UNABATED.

And you wonder why I’m so angry that I’d consider reconstructing the U.S. entirely? It’s because my every day experience involves the above Kafkaesque Medicaid policies harming me or the people I care about!

Nick

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Fix The Broken Foundation Before Building A Skyscraper On Top Of It

Posted by – August 22, 2009

My biggest beef with Health Care Reform right now is that we’re building a new tower on top of a broken foundation. Medicare and Medicaid are badly broken, and we’re building more programs on top of that. Bad idea.

Insurance company bureaucracy is even worse, but federal programs have to be significantly better in the future for there to be meaningful competition. Right now, the government health care system is still far too fail. Medicaid is deeply corrupt, admitting people to nursing homes because institution owners and their lobbyists line the pockets of state legislators; people are even stripped of home care just for turning 21, and forced into institutions. As far as Medicare goes, its fee schedule encourages procedures over responsible diagnosis and management, causing the death of primary care and creating a costly and disastrous situation for patients. An old man will have no problem finding a cardiologist to do an angioplasty, but may find it near-impossible to find a primary care specialist who can manage him with meds instead.  A crude example, but it speaks to how costs can explode when so few primary care docs are around and it’s mostly proceduralists who have survived the extinction. Most new doctors the past few decades have stayed away from family practice because Medicare’s the AMA‘s drastic undervaluing of the E&M (evaluation and management) reimbursement codes make it difficult to survive financially as primary care physicians. You get what you pay for, and Medicare (and the private insurance industry that follows Medicare’s lead) pays for procedures, procedures, procedures, NOT talking to patients and thinking about what’s best for us. According to Medicare, taking a detailed history from a patient is worth nothing more than something like the first 27 seconds of a proctoscopy; I rarely see doctors taking detailed histories anymore, outside of residents in university hospitals who are ordered to do so. Do plenty of docs have to do more and more procedures just to stay afloat and keep their doors open? YES!!

Aside from a fee schedule that has buried primary care and incentivized unnecessary procedures, Medicare has also become such an unwieldy bureaucracy that even the most basic functions are drowning in red tape.

Read this personal experience from primary care specialist Dr. Toni Brayer:

Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to “cognitive, diagnosing, talking” physicians makes the idea of expansion untenable.

May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief…22 pages for a change of address. It is now mid-August and I still do not have the “approval” for my address change.

I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.

I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information “overnight, registered” because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my “bank officer” and a utility bill from the office. Mr President, I don’t have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients…but I certainly did comply.

I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.

I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.

Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.

A loyal American,
Internal Medicine (aka: primary care) physician

Source: EverythingHealth: Fix Medicare

It seems like the government doesn’t want doctors participating in Medicare, and makes the reimbursements so low and the hassles so high (they can’t even manage a simple change of address without a half-year bureaucratic nightmare) that more and more providers just give up. Yes, this is yet another case of the government’s unfortunate cranial-rectal inversion.

Dr. IcedLatte lists more aspects of modern medicine that desperately need to change here.

The Tower of Babel

The Tower of Babel

I support a public option in the new health care reform package, but (unlike some conservatives) I realize we already have several widely-used public options, Medicare and Medicaid, that the government runs, and should fix as a core part of health reform. If a new government program just continues the failures of Medicare and Medicaid, that’s not reform. We have to include the CCA in the bill, include a wider adoption of the PROMETHEUS bundled payment system (PROMETHEUS stands for Provider payment Reforms, Outcomes, Margins, Evidence, Transparency, Hassle-reduction, Excellence, Understandability, Sustainability) so that the government’s skewed, guaranteed-to-fail fee for service billing system doesn’t bankrupt Medicare. Don’t build a tower of babel that’s just going to fall. Listen to all the experts, doctors and patient advocates, and FIX MEDICARE AND MEDICAID. I agree (mostly) with this article by David Ignatius, focus on health system reform, not just “health insurance.” We have to fix the foundation or the new skyscraper is going to collapse.

Nick

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