PerryCare to replace Medicaid in Texas

Or perhaps we should call it RepubliCare. "Cheaper, better, and without so many of those nasty poor sick people".

Medicaid is the health lifeline for more than 3 million of the most vulnerable Texans, but some Republicans, including Gov. Rick Perry, are talking about opting out of the program as a massive state budget shortfall looms.

The prospect, described by some as far-fetched, raises fears about the toll on poor children, people with disabilities, pregnant women and the elderly. Medicaid covers at least part of the cost for more than 60 percent of nursing home residents.

Speaker-in-waiting Warren Chisum is here to ally concerns.

Those looking to shake things up said they are not proposing to put existing Medicaid patients out in the cold. They said they want to find a way to deliver health care in a better, more cost-effective way as Texas bends under the burden of more needs than money. 

"It's not a warning that we're going to throw momma out of the retirement home, it's just saying we've got to do something different, because this is not working for us," said state Rep. Warren Chisum, R-Pampa, who cited the Medicaid opt-out idea as he runs for House speaker.

Rest assured, the Republicans say there will be no death panels deciding who gets treated and who gets rolled on a gurney out in the street.

With their ability to touch Medicaid hampered by federal requirements and the federal health care law aiming to add to the Medicaid rolls in the future, some fear the impact on areas such as education and public safety.

"It sends a strong message to the federal government that what you've asked the states to do, even with the (funding) matches that you're proposing, is going to cause the states to go bankrupt — or certainly it's going to compromise our ability to deliver on education, public safety and infrastructure," said state Rep. John Zerwas, R-Richmond, an anesthesiologist.

The Texas Health and Human Services Commission is looking at what the effect would be if Medicaid were abolished in Texas or federal matching funds were slashed. Zerwas, who carried the legislation that called for the study, is saying not that he supports an opt-out but that the idea needs to be thoroughly studied, including the human and economic effects.

Details are unclear on what would replace Medicaid if Texas opted out. Groups, including the limited-government Texas Public Policy Foundation, are working on proposals with the idea that the state still would be able to pull down federal funds in addition to its state health care money, or the federal government would otherwise continue coverage options. 

"It's not just opting out of Medicaid. It is replacing the Medicaid program with something that is affordable by the states and the federal government and can deliver better care," said the foundation's Arlene Wohlgemuth, a former state lawmaker. 

Perry told Fox News that he thinks Texas could find a "private insurance solution" that would save the state and federal government $40 billion each over six years while covering more people. He did not give specifics.

There it is: PerryCare. Which of the governor's richest friends wants to start the company to take Medicaid private? What private insurance company wants to take over coverage of the elderly, the poor, and the infirm? I forget; which ones are now?

Who said elections don't have consequences?

Update: STC has more, including a "superbad" quote from Speaker-to-be Chisum.

Sunday Funnies, Derision Points edition

"George W. Bush says he is glad to be out of the Oval Office because he doesn't have to think all the time. And I'm thinking: wait a minute, that was him thinking all the time. Really?" — David Letterman

"George W. Bush was interviewed by Matt Lauer, who asked him if he would still invade Iraq if he knew then what he knows now. It's an unfair question. For one thing I don't know if Bush does know what he knows now." — Jimmy Kimmel

"'Decision Points' by George W. Bush has dropped, and it's like 'War & Peace' without the peace. Here's the very first page: 'In the last year of my presidency I began to seriously consider writing my memoirs.' Right away he's got you hooked. Did he write them or didn't he? You won't know until you read the book. Maybe the rest of the pages are blank. If there's one thing we've learned it's that we can't believe something is there just because Bush says it is." — Stephen Colbert

"In his new book, George W. Bush says he’s happy to be out of Washington. Well, it’s unanimous." - David Letterman

"President Bush told Matt Lauer the most embarrassing thing he ever did drunk was ask a friend of his parents what sex was like after 50. That's nothing. John McCain asked Sarah Palin to be his running mate when he was sober." – Jay Leno

"No sir, I'm not going to read it until he reads it." – David Letterman

In the clearing stands a boxer ... somewhere

Willaim Greider (whom I have enjoyed reading since he wrote in the '80's for Rolling Stone) nails it again here.

Given the election results, the question Barack Obama has to decide for himself is whether he really wants to be president in the fullest sense. Not a moderator for earnest policy discussions. Not the national cheerleader for hope. Not the worthy visionary describing a distant future. Those qualities are elements in any successful presidency, and Obama applies them with admirable skill and seriousness.

What's missing with this president is power — a strong grasp of the powers he possesses and the willingness to govern the country with them. During the past two years, this missing quality has been consistently obvious in his rhetoric and substantive policy positions. There is a cloying Boy Scout quality in his style of leadership — the troop leader urging boys to work together on their merit badges — and none of the pigheaded stubbornness of his "I am the decider" predecessor, nor the hard steel of Lyndon Johnson or the guile of Richard Nixon.

I have never seen this fighter. I have never seen Obama respond to a challenge with a battler's mentality. During his debates with John McCain, I bemoaned to all those watching around me that he would not punch back.

Republicans, who are masters of deceptive marketing, seized on Obama's most appealing qualities and turned them upside down. Their propaganda cast him not as soft but as a power-mad (black) leftist, destroying democracy with socialist schemes. The portrait was so ludicrous and mendacious, the president's party hardly bothered to respond. Egged on by the Republican Party and Fox News, right-wing frothers conjured sicko fantasies and extreme accusations: the president is not only a black man (bad enough for the party of the white South); he is not even American. The vindictive GOP strategy is racial McCarthyism, demonizing this honorable man as an alien threat, just as cold war Republicans depicted left-liberal Democrats as commie sympathizers.

Even Obama supporters began to ask, Where is the fight in the man? Some critics blame a lack of courage, but that neglects the extraordinary nerve Obama displayed in his rise to the White House — a young black man with an unusual name and limited experience who triumphed through his audacity. Obama's governing style is a function of his biography — a man who grew up always in the middle, both black and white. He succeeded by learning rare skills, the ability to bridge different worlds comfortably and draw people together across racial, political and intellectual divides. He learned to charm and disarm, not to smash and conquer.

For the first time in his life, those qualities seem to have failed him. Indeed, he may have been misled by his high regard for his own talents. This is really his first encounter with devastating political defeat. The question now is, What will he learn from his "shellacking"? Possibly not much, since it is always very hard to rethink and adjust in midstream. But remember, this man is an unusually observant politician with a great thirst for self-reflection. One can reasonably hope that as he absorbs the hard knocks, he will make calculated changes in how he governs.

But those around him continue to kowtow and cave in, crawfish and backpedal. Does this reflect their own weakness or just their counsel to him, or the president's own view? Or is this just more of the confusion coming out of the White House right now?

Bluntly put, Obama needs to learn hardball. People saw this in him when he fired Gen. Stanley McChrystal, and many of us yearn to see more. If he absorbs the lesson of power, he will accept that sometimes in politics you can't split the difference or round off sharp edges. He has to push back aggressively and stand his ground, more like those ruthless opponents trying to bury him. If Congress won't act, the president will. But first he has to switch from cheerleading to honest talk. Tell people what the nation really needs, what Republicans intend to sabotage. In a political street fight, you've got to hit back.

Only Obama can decide this about himself, but others can influence the outcome by surrounding him with tough love and new circumstances created by their own direct actions. It does not help Obama to keep telling him he did great but the people misunderstood him. He did lousy, not great, and in many governing dimensions people understood his failures clearly enough. They knew he gave tons of money to bankers and demanded nothing in return. They knew he thought the economy was in recovery. They couldn't believe this intelligent man was that clueless.

Popular forces can blow away the fuzziness. They can mobilize to demonstrate visible support for the president's loftier goals and to warn him off the temptation to pursue a Clintonesque appeasement of the right. Given the fragile status of his presidency, Obama needs to know that caving in is sure to encourage enemies and drive off disheartened supporters. People should, likewise, call out the president's enemies and attack them with the harshness that's out of character for him. The racial McCarthyism of the GOP establishment is a good place to start.

People who still have great hope for Obama can help revive his presidency, but only if they toughen up themselves. Stop holding his hand (he's an adult) and start building a people's agenda that compels the president to change his. Obama won't like this at first—his own supporters talking back—but he can learn to draw strength from their courage. If people fail to step up with their own message, the president will likely fail with his.

2012 is literally going to be won or lost by Obama, entirely through his own action or lack thereof, in the next few weeks. Will he fight against renewing the Bush tax cuts for millionaires with a lame-duck Congress and Speaker? Will he pick up the gauntlet thrown at his feet by Mitch McConnell?

How badly does he want to be re-elected in 2012, and help Democrats down the ballot get elected as well? We'll find out soon enough.

Sunday Funnies