In your Facebook exchanges with my wife/your sister, you made it clear you have made a fairly full transition to conservatism in your politics. As you know, I am liberal. But I hope over the years I have impressed upon you that I am knowledgeable, have the ability to understand the way policies and programs work and effect people, and would not bullshit you.
My intent in writing is not to argue about the merits of one political philosophy or another, or one set of politicians. My intent is to inform you about the real world consequences of following one set of policies, without the distortions of politicians and pundits spinning the facts to fit their viewpoint.
Specifically, I want to tell you about the impacts the Paul Ryan Budget would have on those close to you if it were implemented. I realize his budget plans won’t all become law, and that there may be some differences between his and Romney’s plans. But with the Republicans nearly unanimously voting for and supporting most of what is in his plan, I think it’s indicative of what Romney, Ryan, and the Republicans hope to accomplish.
Your nephew
Since Romney selected Ryan, the sexy issue has been Medicare. But those changes don’t take effect for a decade or more. One policy he does have in mind for an immediate set of cuts is Medicaid. Most people think of Medicaid as the program that provides free or low cost health care to poor people. It does provide a minimum level of health care to certain groups of poor people. But it does so much more, especially for people with disabilities.
If your nephew chooses to live in a group home or a supported living arrangement out in the community, Medicaid is what would pay for it. After he graduates high school, Medicaid will pay for the day programs he would attend, instead of spending day after day playing Xbox. If he wants to work in the community, Medicaid will pay for a job coach to ensure his work is safe and fulfilling. Medicaid will help us pay for devices that would help him communicate. It will help pay for transportation so he doesn’t need to rely on your sister or I running him to his job or program. It will pay for speech and occupational therapy. It will pay for respite care so your sister and I could get away once in a while without relying on one of our moms to care for him. And yes, when he gets older, it will be his primary source of health care as well.
Clearly Medicaid will be a tremendous asset in allowing your nephew to have a better, more fulfilling life. Now I wish my career turned out better and we were able to contribute more out of pocket to these expenses, but some of the things Medicaid can do to improve your nephew’s life are not affordable to any but the wealthiest among us.
Paul Ryan’s Budget plan begins cutting Medicaid almost immediately. It slashes Medicaid by 1/3 over the next decade, and by the time your nephew is 57 years old, its federal funding will be cut in half. These cuts will impact your nephew even more because the first programs states slash are those for the mentally, physically, and intellectually disabled
http://www.bloomberg.com/...
There’s no provision in the Ryan Budget to make up for the shortfall. If states don’t make up for it, these programs will be gutted. Your nephew will lead a less fulfilling, less healthy, and less happy life if these cuts take effect. It will mean fewer resources for your sister and me to contribute to your niece’s dreams and will impact her life when your sister and your mom and you and your wife and I are dead or not able to take care of your nephew any more. This goes for your cousin’s little girl, too, as well as the vast majority of families with special needs kids.
Your mom (and aunt, grandma, and in-laws)
Paul Ryan was careful to point out on 60 Minutes that people over 55 won’t be affected by his plan’s changes to Medicare. Well you also need to consider how his changes to Medicaid will affect your mom.
As I hope you just read, another part of Medicaid is the support it provides to the 2/3 of elderly who need to be in nursing homes. We’ll all do all we can to make sure your mom can stay out of such a place. But if there ever comes a time when her ailments require a residence situation, the Ryan cuts to Medicaid could be the difference between a facility where your mom has help getting to the bathroom before falling asleep, or a place where your mom lies in her crap all night.
Even if your mom doesn’t have to go into a residence situation, when your mom can’t work anymore, all she will have for income is Social Security and whatever small IRA she might have built up. She will be poor. She will need other resources. More than likely, she will qualify for Medicaid, which will help her pay deductibles and co-payments for her Medicare Part B coverage (more on Medicare below).
There’s also the matter of Medicare Part D, which is the part of Medicare that pays for prescription drug coverage. The way it works is the program pays about $2000 of the first $3000 in drugs needed for the year. After that, all drug costs come out of pocket until the beneficiary has spent $4700 out of pocket. Then the program kicks back in and pays the rest with a 5% co-pay. This area between the first $1000 out of pocket and $4700 out of pocket is what is called the “donut hole.”
The result is people with cancer or other catastrophic illnesses/diseases that need lots of drugs need to find a way to come up with $4700 to pay their out of pocket share. Again, your mom will have very limited resources. Heaven forbid, but if she gets sick, the choice will be food or medicine or most of that $4700 coming out of your pocket.
But Obamacare closes the donut hole. Slowly at first, but not long after your mom retires and needs Medicare, it will be completely closed and provide much more comprehensive coverage for the medicines she’ll need. But one of the central focuses of the Paul Ryan budget is to repeal nearly every provision of Obamacare. Doing so reinstitutes the donut hole, and again forces seniors into the choice of food or medicine or the children paying thousands of dollars.
Your little sister
I understand you may be able to get your sister on your health coverage. That’s fantastic. As you know, one of the aspects of Obamacare is that she will get to stay on your insurance until she’s 26 (the same goes for your nephew with us). One thing you may not have considered however is how Obamacare’s pre-existing condition provisions would impact her coverage.
If your sister has a lapse in coverage between your stepmom’s insurance and yours, without Obamacare, your insurance company could restrict any treatment related to the injuries from her accident. More than likely your health plan would deny coverage for an extended period of time because it’s a pre-existing condition. If she has related injuries, the health insurance company would probably try to deny that coverage as well.
Obamacare also makes your insurance company cover the cost of birth control. Without, that expense probably comes out of your pocket. Furthermore, if you combine the effects of cutting both Medicaid and Obamacare, what happens if, again heaven forbid, your sister gets pregnant after booted off your coverage at 19? Or what if your company decides not to cover her, or you decide to quit your job (as I understand you want to do to start a landscape business)?
Medicaid is the program that provides prenatal care and other health services to poor women who become pregnant. How about your other cousin’s girlfriend? They’ve already talked about getting pregnant. Who would pay for that? Medicaid. It sucks to ‘encourage’ that kind of stupid decision, but you don’t want to punish their child with poor/no healthcare during and after her pregnancy. Otherwise you just cross your fingers and hope that a fifth year senior doesn’t screw around for the next ten years before he figures out how to be a man.
We all hope that your little sister will further her education. Neither my wife/your sister nor I could have gotten through school without Federal Financial Aid. One program that helped us both was the Pell Grant program. Even working full time throughout college and law school, I would have starved without it. Another program is student loans. Unfortunately I went to school when student loan interest rates were at an all time high, so my student loan payments hang like an anchor around our family’s neck.
Paul Ryan’s plan slashes the Pell Grant program. A lot of the analysis as to exactly who would lose how much is muddled. However, two things are not in dispute, the Ryan plan calls for freezing the program at a maximum of $5500 (or less) per year, and cutting off eligibility for students that come from families that are not dirt poor.
This means your sister’s Pell Grant gets cut. Even if you and your wife were considered a source of income for your sister’s schooling, she’d probably get something from the Pell program. With your stepmom as her source of family income it would be more. With the Ryan Budget, estimates are that $45,000 in family income means NO Pell Grant.
http://edmoney.newamerica.net/...
The other thing to consider is the interest rate on student loans. Back in 2007, the rate was cut in half. That reduction was due to expire a few months ago. Obama and the Democrats tried to get a one year extension of the low interest rate. Republicans said ‘ok, but only if we pay for it with cuts to Medicaid.’ Obama and the Dems said ‘no.’ The Senate got around the impasse by making deals regarding cuts the Republicans wanted to the highway funding bill. If the Ryan Budget were in place, no more extensions. Interest rates on Stafford Loans would be 6.8%.
http://www.politifact.com/...
http://firstread.nbcnews.com/...
A quick hypothetical. Let’s say your sister needs $20,000 in financial aid to get through four years of school. Let’s also assume the interest rate reduction gets extended throughout her college career, and she gets a small Pell Grant, $2000 per year.
Need: $20k
Grants: $8k
Loans: $12k
Payment w/ 3.4% over 10 years = $118
Now under Ryan’s policies
Need: $20k
Grants: $0
Loans: $20k
Payment w/ 6.8% over ten years = $230
That’s about $13,400 more for the exact same education. And it’s not like the university gets the money. The government does, at least now. Used to be the banks got most of it. Now the government does because of legislation passed with Obamacare. I’m not sure whether the Ryan plan turns it all back over to the banks.
http://en.wikipedia.org/...
The thing getting all the attention right now is the current Ryan Budget, so I’m trying to stick with that, but a quick word about Ryan’s history of Social Security policy. In 2004 and again in 2010 Ryan proposed not only a scheme to partially ‘privatize’ social security (giving our retirement money to the banks and Wall Street….what could go wrong?), but also large cuts to Social Security.
These cuts include survivor benefits, even though Ryan himself benefited from them when his father died when he was a teenager. This is how Paul Ryan paid for college. If he got his way in 2004 or 2010, this would have meant fewer resources for your stepmom to raise your sister with, and while Ryan’s plan for Social Security might not ever have an effect on her survivor benefits, there will be many other girls just like her who have to deal with their dad dying when they are young and need those resources to have a shot in life.
http://www.usnews.com/...
http://www.epi.org/...
You
Perhaps you (or someone you know) received a check from your health insurance company recently. This is because Obamacare made it so health insurance companies have to spend at least 80% (85% in some cases) of the premiums they collect on health care services, as opposed to operations, executive compensation, and profit. So instead of an insurance company’s CEO deciding ‘let’s hike rates and stuff the extra money in our pockets’ they have to give that money back to the policy holders.
http://www.tampabay.com/...
http://www.commonwealthfund.org/...
http://www.martindale.com/...
http://www.statesman.com/...
As you can see, your state law administrators tried to get a waiver of this requirement for the insurance companies. (Editors note: Above is a partial list of links to stories regarding various states that sough waivers. There are many others. Most states were denied. NC received a waiver.) To me, that’s putting insurance companies over people. Fortunately, the waiver was denied for your state. So perhaps you and some people you know get a nice little check to pump back into your town’s economy. Perhaps some of those people might use their check for lawn care or landscaping services.
I understand that your current insurance is fantastic. But if you do want to move on from Manufonics, you’ll more than likely have the policy offered through your wife’s work, which is probably less generous. But that’s not as big of a deal as it was a couple years ago, since many of the preventative health services families need are now covered at 100% due to Obamacare. Colonoscopies, pap smears and mammograms, physicals and immunizations, smoking cessation, weight loss counseling, and many other services are completely paid by your insurance company without any out of pocket expense.
Paul Ryan wants to eliminate that. So as the son of a man that died of colon cancer, when you inevitably need another colonoscopy, the co-pays and deductibles will come out of your pocket. The same goes for yearly physicals and immunizations for your kids to go to school, and all the health screening your wife (and maybe your sister) will need to make sure their lady parts are healthy. If you decide to chart a healthier future for yourself, the professional help you would need will come out of your pocket, instead of the insurance company’s pocket.
And going back to the pre-existing condition issue, if something should happen that causes your family to have an insurance lapse of 63 days, your new insurance could deny treatment. More issues with your back? Coverage denied. Complications due to your wife’s surgeries? Coverage denied. Treatment for your son’s ear problems? Coverage denied.
But the big issue for you and all people our age is Paul Ryan’s plan for Medicare. Again, he promises to not change anything for people over 55. Great. What about you? Well he plans significant changes for you.
First off, he plans to increase the age you need to be to start receiving it by two years. I understand you are quite fatalistic, but maybe your wife isn’t. The second big issue is the “voucher” issue. The media, and the Democrats for that matter, do a terrible job of explaining what this means, so let me explain.
Medicare is a health insurance policy (source: Wiki). Just like your policy, there are provisions for in-patient care (which is called Medicare Part A) and out-patient care (which is called Medicare Part B). Like your health insurance at work, there is a system of deductibles, co-pays, and limits.
In general, people who have Medicare absolutely love it. The key is, this level of coverage is guaranteed, and the cost blows away anything provided by private insurers for most seniors. Unlike private health insurance, they can’t go jerking around with deductibles and limits and coverage because the CEO wants another gold house.
In a voucher program, all those guarantees are gone. That entire system ends. There are some guarantees of coverage and costs, but they are far fewer. Instead, as a 67 year old who always got insurance through an employer, you get to go insurance shopping and try to figure out what is the best policy based on what you think your health condition will be.
The government then sends payment to the insurance company to pay your premium. Hopefully your voucher is enough to buy the level of coverage you think you need from a private insurance company. I guess you are magically supposed to get a better policy even while the insurance company is taking a cut. And nobody really disputes that the out of pocket difference between traditional Medicare and Ryan’s plan will skyrocket.
http://www.politifact.com/...
It’s a corporatized system where your healthcare is at the whims of a handful of CEOs. But don’t worry. If out of pocket insurance costs drain your or your wife’s resources, you can fall back on Medicaid once you get poor. Oh shit. Nope, no you can’t. Ryan repealed Obamacare and cut Medicaid 20 years ago. I hope someone comes to help your wife to the bathroom so she doesn’t lay in her own crap until morning, and I hope the person that does it doesn’t have to be your daughter.
One quick aside. You will hear a lot about Obamacare ‘cutting $716 billion from Medicare to pay for Obamacare.’ It’s a load of disingenuous horseshit. What’s more, it’s a hypocritical load of disingenuous horseshit. What’s more, it’s a hypocritical load of disingenuous horseshit that has been debunked time and again, but the Republicans keep telling the lie.
Obamacare doesn’t cut benefits. It cuts wasteful spending by stopping the amount of money hospitals and insurance companies soak the government for when they submit bills for the procedures they provide. What’s more, one third of savings goes to pay for wasteful spending in a previous scheme of coropratized Medicare called Medicare Advantage (Medicare Part C).
http://www.politifact.com/...
http://www.politifact.com/...
http://www.politifact.com/...
One final aside on the future of health care is that the Ryan-Wyden plan is a potential compromise that has both programs, old Medicare with the voucher program. The problem most foreseen with this plan is the private insurance companies will raise premiums for the sickest forcing them into old Medicare where the fund won’t be able to handle the expense of having only the sickest people in the program.
http://www.cbpp.org/...
And then there’s the issue of taxes under the Ryan Plan. It’s difficult to put an exact dollar amount on the effects of Ryan’s plan because the plan is incomplete. So let’s look at what is in the plan and what is missing and how it all plays out.
First, the plan calls for eliminating the capital gains tax. The capital gains tax is what you pay on the money you make for buying and selling a piece of property. For instance, if you buy a car for $500 and sell it for $1000, you are supposed to pay tax of 15% on the profit. Securities (stocks, bonds, etc) and entire companies are also ‘property’ for this purpose.
Perhaps you heard that Mitt Romney would pay less than 1% of his income on taxes in the one year of tax returns he’s released under the Ryan plan. This is because all his money is made through buying and selling ‘property.’ So if all his money is made by exchanging pieces of paper on stock exchanges, it doesn’t matter how much he makes, it’s not taxed in Ryan’s plan.
If some vulture capitalist came along and bought Manufonics-Your Town where you work, fired the employees, sold off the machinery and land, and made $10 million in the process, he would not pay one dime in federal income taxes. If some vulture capitalist bought all of Manufonics International, moved all its operations to China thus raising the stock price, then sold off all the stock and property for a $10 billion profit, he and his investors would not pay one red cent in taxes under Ryan’s plan. $10 billion tax free for them, no job for you.
Next, the plan proposes a two tier tax rate scheme of 10% and 25%. At first glance this looks like a tax cut for everybody. But the problem is Paul Ryan claims his plan wouldn’t explode the deficit. He claims he will do this by ‘simplifying the tax code, cutting out tax breaks.’
On 60 Minutes he said he would close some of the tax schemes Romney uses to avoid taxes, which is great. The problem is the wealthiest people in this country make big chunks of their money through capital gains. They won’t need those tax shelters to avoid paying taxes anymore. They just won’t be obligated to pay taxes on big chunks of their income in the first place.
Economists that have looked at this proposal have reasoned that the only way these cuts can take place and not explode the budget deficit is by eliminating tax breaks used by middle class people. The same conclusions have been reached by people who looked at Romney’s tax plan.
http://www.rollcall.com/...
http://abcnews.go.com/...
http://www.cbsnews.com/...
http://www.businessweek.com/...
http://taxvox.taxpolicycenter.org/...
The only way to give these big tax breaks out to the wealthy is to either explode the budget or raise taxes on the poor and middle class, including you. As someone who has followed politics for far longer than the ‘socialist fascist terrorist-loving Muslim from Kenya’ has been in politics, much less the President, three things the Republicans have been after for a long time is taking away the tax free IRS contributions, the mortgage interest tax deduction, and taxing you on the part of your health insurance premium paid by your employer. Eliminating these and other tax breaks for the middle class quickly gobbles up any savings you might have had with a 10% tax rate.
Many other people you know
Ryan’s plan has tons of other cuts too. He plans cuts to agriculture support (know anyone around your town who needs these programs this summer?) environmental protection (know any hunters/fisherman or asthma sufferers?), science including cancer research, veterans benefits (your uncle, your other uncle, your third uncle and his wife), roads (know anyone with cars?), alternative energy (know anyone who uses alternative energy?) and schools (know anyone who attends or works for public schools?).
But he won’t cut oils subsidies. And he massively increases defense spending. And he denies climate change. And he opposes abortion even if the woman was raped.
http://www.thedailybeast.com/...
http://www.realclearpolitics.com/...
http://thinkprogress.org/...
http://www.cnn.com/...
I’m not trying to change your philosophy. And I’m not hiding any facts or trying to spin this on you. These are the types of changes that Romney, Ryan, and the Republicans all have in mind. This is what they really believe will turn this country around. I wanted to be sure you knew about it.
Update: Obligatory thanks for the recs. I'm deliberately staying away from comments to avoid giving out any indication of who my in-laws are.
There is a lot of sentiment in the comments that tends toward these types of efforts being pointless. I think that's a mistake that is based on stereotyping a large swath of the American people. Suffice it to say, I wouldn't have written this if I didn't think persuasion was possible.