> The United States has a lot of hospital outpatient departments (HOPDs) or ambulatory surgical centers (ASCs) that perform procedures that don’t require overnight stays in a hospital bed. Many of the procedures that can be done at a HOPD or an ASC can also be done in a regular doctor’s office. There may be reasons to think the HOPD or ASC model is superior to a basic doctor’s visit in some cases, but right now, Medicare arbitrarily reimburses HOPDs and ASCs at a higher rate. That costs the government money and also generates perverse incentives.
> I’m hoping that the reason this didn’t make the list is just a question of committee jurisdiction and that it’ll be included by Ways and Means in the end. Alternatively, Republicans decided they didn’t want to piss off the hospital lobby, so they left it out.
Can we get a follow-up on this point? If the hospital lobby got Republicans to turn away from site-neutral payments…that could make for a good article on how lobbying is actually working right now. (And: to what extent is the AMA part of the "hospital lobby"?)
How does loaning money to students cost the government money? Banks loan money to make money, not lose it. I’m paying 7 % interest on my loan. Who’s making the money? Thanks.
We’re going to need an update related to Trump’s orders suspending grants, whatever that means. Lawyers are obnoxious so they like to say things like, “Trump can’t do that” when they mean, “he can but he’ll get sued so some judge and ultimately the Supreme Court will decide whether to approve.” But these orders sound important?
“The Right: a hundred year war for American conservatism” really explains a lot of the history behind this movement. The goal is to roll back the New Deal protections. Democrats need to be arguing for larger federal responses but really starting to be smart about deficits, immigration and making sure it’s as efficient as possible. A project 2029 if you will.
I don't know, maybe it's a political mistake to protect the other team's voters. Maybe it's better to let them reap what they sow and campaign on fixing it next time.
Republicans are so bullied they will vote "yes" for anything Trump puts forward. A few weak democrats will probably join them after a phone call from "the Donald". An inordinate amount of benefits go to MAGA states and you will see that the voters there will cheer every time their benefits are cut, "yeah, that's owning the libs!" It reminds me of the hazing scene in Animal House. Whack! Thank you sir, can I have another? Whack, thank you sir can I have another.....
As a Wisconsin resident, I wonder how potential cuts to Medicaid will impact foster families and children adopted out of foster care. In Wisconsin, children in foster care are covered by Medicaid. We started fostering my now son in January of 2020 and we adopted him in 2022. Even post-adoption he is on Medicaid. We could certainly afford to have him on our insurance but lots of other people that provide foster care and adopt foster kids probably don't have the means to afford health care for another kid.
Knowing that Medicaid is there is important for people considering foster care. There is a critical shortage of people willing to provide foster care, or even adopt foster kids and I worry that cuts to Medicaid could target foster kids.
Again, my family will be fine (assuming we don't lose our jobs or something like that!) but lots of foster families aren't as lucky as us.
I just hope the Dems will be in lock step on this. I kind of fear the WelcomePAC types (whom I typically support but don't always trust) will want to seem bipartisan and they are working to cut taxes for "American families in districts like mine."
"Democrats are on much firmer ground politically contesting GOP priorities on core fiscal issues than almost anything else ..."
Not only is this clearly true, but Dems have a reasonably good chance of heading off the most draconian welfare-state cuts thanks to the narrow margins in Congress. We won't prevent tax cuts for the rich - the Almighty Herself could not prevent the GOP from cutting taxes for the rich - but people's health coverage and SNAP being taken away should not be treated as a foregone conclusion.
Some key things to remember:
- The GOP barely got their ACA repeal bill through the House last time with a much bigger majority. There are 6 Republicans *still in the House* who voted against it in 2017, some of whom subsequently campaigned on this vote.
- There are quite a few more House GOP moderates - around 10-20 by my count - who weren't around in 2017 but for whom draconian cuts would go against their public positions (and their political interests). And recent reporting has confirmed that a dozen or so House moderates have been warning leadership against taking away people's health care.
- In 2017, the two big substantive bills that included big cuts to the funding of the ACA - the BCRA and ORRA - both came to the Senate floor and neither got more than 45 votes. So the GOP was farther away from actually passing big cuts to financial aid and Medicaid than is commonly realized. By voting down the narrow final package, Collins, Murkowski, and McCain just put out of its misery a legislative process that was going nowhere.
- If I had to guess who the pivotal Senate votes would be I would say the two somewhat moderate members from WV (a state that would be devastated by cutting Medicaid). Capito played a key role in opposing Medicaid cuts in the 2017 Senate debates and Justice (who was governor at the time) was a vocal *opponent* of ACA repeal.
Bottom line - let's take on this fight and protect the most vulnerable Americans!
Jim Justice is a uniquely interesting case. I was looking into his political history recently, and I find notable about him the fact that when he switched parties from Democrat to Republican a few years ago, he did not seem to change his ideology much – he seems to have always been kind of conservative on social issues and moderate (or even slighly left of center) on economic issues. In fact, in some of his relatively recent tweets (after he had already become a Republican) he basically bragged about various expansions of social programs he managed to get passed as governor. At one point, when the West Virginia legislature tried to cut some (relatively small) amount of money from the state's Medicaid budget, he was strongly opposed to it. There were even times when he put some political pressure on Joe Manchin to get more generous bills passed early on during Biden's presidency.
At the same time, much more so than Capito, Jim Justice has recently been extremely obsequious toward Trump. So he is definitely not a moderate on the "obsequiousness toward Trump" parameter. I could easily imagine him voting against reductions in Medicaid funding, while claiming that he is doing so because reducing Medicaid is not "what Trump would have wanted", while Trump himself remains silent on the issue.
Overall, Jim Justice reminds me of many Eastern European style conservatives – obsequious toward strongman leaders and socially conservative, but in favor of social programs and "big government".
Off-topic, but related to yesterday's post on "Democrats must reject DEI" - I just read on The Bulwark that the Air Force removed a video honoring the Tuskegee Airmen from their training materials, because a video honoring Black service members is too DEI-ish, and we can't have that.
I said it yesterday and I'll say it again: DEI wokery was excessive, harmful and stupid. But Agent Orange and his minions aren't like "let's repudiate the woke extremism by returning to the ideal of we are all Americans, we are all equal, we are all judged as individuals." No, they are going to do dumb, mean-spirited things like tossing the video honoring the Tuskegee Airmen just because they can, and Matt Y and his allies are gonna be all "we can't make any noise about this, because then we'll just make The Median American Voter angry."
I'll say the same thing here that I say in the National Review comments (different screen name). As someone who supports free markets and limited government, I say that big spending cuts are needed to slash the budget deficit, the single biggest threat to our economic health. This has to go beyond symbolic cuts to "waste, fraud and abuse", or cuts that solely target the poor, foolishly reinforcing the GOP caricature painted by the left. If the supposed party of fiscal responsibility is unwilling to sleigh the sacred cows that include entitlements and defense spending, then all the posturing over DEI and "woke" is just entertainment for the mouth breathers watching Fox News .
I have many thoughts. None of them are fit to print in, say, the NYT, but "f**k those f**king sh*theads, great job screwing over some of the world's most desperate people, I hope you're really proud of yourselves" about covers it and is within bounds for a Substack comment section, so.
I swear to God, there have been many really bad US Presidents - W screwed the pooch royally on Iraq - but Dump is off the chart in terms of sheer spite/wanting to make his enemies cry.
> The United States has a lot of hospital outpatient departments (HOPDs) or ambulatory surgical centers (ASCs) that perform procedures that don’t require overnight stays in a hospital bed. Many of the procedures that can be done at a HOPD or an ASC can also be done in a regular doctor’s office. There may be reasons to think the HOPD or ASC model is superior to a basic doctor’s visit in some cases, but right now, Medicare arbitrarily reimburses HOPDs and ASCs at a higher rate. That costs the government money and also generates perverse incentives.
> I’m hoping that the reason this didn’t make the list is just a question of committee jurisdiction and that it’ll be included by Ways and Means in the end. Alternatively, Republicans decided they didn’t want to piss off the hospital lobby, so they left it out.
Can we get a follow-up on this point? If the hospital lobby got Republicans to turn away from site-neutral payments…that could make for a good article on how lobbying is actually working right now. (And: to what extent is the AMA part of the "hospital lobby"?)
How does loaning money to students cost the government money? Banks loan money to make money, not lose it. I’m paying 7 % interest on my loan. Who’s making the money? Thanks.
Amazing incompetence. Matt's not aware that inflation is a war on the poor! That's the Donk's tax of choice.
We’re going to need an update related to Trump’s orders suspending grants, whatever that means. Lawyers are obnoxious so they like to say things like, “Trump can’t do that” when they mean, “he can but he’ll get sued so some judge and ultimately the Supreme Court will decide whether to approve.” But these orders sound important?
“The Right: a hundred year war for American conservatism” really explains a lot of the history behind this movement. The goal is to roll back the New Deal protections. Democrats need to be arguing for larger federal responses but really starting to be smart about deficits, immigration and making sure it’s as efficient as possible. A project 2029 if you will.
I don't know, maybe it's a political mistake to protect the other team's voters. Maybe it's better to let them reap what they sow and campaign on fixing it next time.
If you’re in it just for winning, that makes sense. But if you’re in it to prevent human suffering, then you’re missing the point.
I'm a utilitarian. Over the long term will more people suffer if the GOP wins or if Democrats do?
Cutting the mortgage interest tax deduction saves 1 trillion according to the menu. Stop the wealth transfer to the suburbs and you can keep TCJA.
Republicans are so bullied they will vote "yes" for anything Trump puts forward. A few weak democrats will probably join them after a phone call from "the Donald". An inordinate amount of benefits go to MAGA states and you will see that the voters there will cheer every time their benefits are cut, "yeah, that's owning the libs!" It reminds me of the hazing scene in Animal House. Whack! Thank you sir, can I have another? Whack, thank you sir can I have another.....
As a Wisconsin resident, I wonder how potential cuts to Medicaid will impact foster families and children adopted out of foster care. In Wisconsin, children in foster care are covered by Medicaid. We started fostering my now son in January of 2020 and we adopted him in 2022. Even post-adoption he is on Medicaid. We could certainly afford to have him on our insurance but lots of other people that provide foster care and adopt foster kids probably don't have the means to afford health care for another kid.
Knowing that Medicaid is there is important for people considering foster care. There is a critical shortage of people willing to provide foster care, or even adopt foster kids and I worry that cuts to Medicaid could target foster kids.
Again, my family will be fine (assuming we don't lose our jobs or something like that!) but lots of foster families aren't as lucky as us.
I just hope the Dems will be in lock step on this. I kind of fear the WelcomePAC types (whom I typically support but don't always trust) will want to seem bipartisan and they are working to cut taxes for "American families in districts like mine."
GOP out here literally taking food out of kids' mouths. Gross.
"Democrats are on much firmer ground politically contesting GOP priorities on core fiscal issues than almost anything else ..."
Not only is this clearly true, but Dems have a reasonably good chance of heading off the most draconian welfare-state cuts thanks to the narrow margins in Congress. We won't prevent tax cuts for the rich - the Almighty Herself could not prevent the GOP from cutting taxes for the rich - but people's health coverage and SNAP being taken away should not be treated as a foregone conclusion.
Some key things to remember:
- The GOP barely got their ACA repeal bill through the House last time with a much bigger majority. There are 6 Republicans *still in the House* who voted against it in 2017, some of whom subsequently campaigned on this vote.
- There are quite a few more House GOP moderates - around 10-20 by my count - who weren't around in 2017 but for whom draconian cuts would go against their public positions (and their political interests). And recent reporting has confirmed that a dozen or so House moderates have been warning leadership against taking away people's health care.
- In 2017, the two big substantive bills that included big cuts to the funding of the ACA - the BCRA and ORRA - both came to the Senate floor and neither got more than 45 votes. So the GOP was farther away from actually passing big cuts to financial aid and Medicaid than is commonly realized. By voting down the narrow final package, Collins, Murkowski, and McCain just put out of its misery a legislative process that was going nowhere.
- If I had to guess who the pivotal Senate votes would be I would say the two somewhat moderate members from WV (a state that would be devastated by cutting Medicaid). Capito played a key role in opposing Medicaid cuts in the 2017 Senate debates and Justice (who was governor at the time) was a vocal *opponent* of ACA repeal.
Bottom line - let's take on this fight and protect the most vulnerable Americans!
Jim Justice is a uniquely interesting case. I was looking into his political history recently, and I find notable about him the fact that when he switched parties from Democrat to Republican a few years ago, he did not seem to change his ideology much – he seems to have always been kind of conservative on social issues and moderate (or even slighly left of center) on economic issues. In fact, in some of his relatively recent tweets (after he had already become a Republican) he basically bragged about various expansions of social programs he managed to get passed as governor. At one point, when the West Virginia legislature tried to cut some (relatively small) amount of money from the state's Medicaid budget, he was strongly opposed to it. There were even times when he put some political pressure on Joe Manchin to get more generous bills passed early on during Biden's presidency.
At the same time, much more so than Capito, Jim Justice has recently been extremely obsequious toward Trump. So he is definitely not a moderate on the "obsequiousness toward Trump" parameter. I could easily imagine him voting against reductions in Medicaid funding, while claiming that he is doing so because reducing Medicaid is not "what Trump would have wanted", while Trump himself remains silent on the issue.
Overall, Jim Justice reminds me of many Eastern European style conservatives – obsequious toward strongman leaders and socially conservative, but in favor of social programs and "big government".
Off-topic, but related to yesterday's post on "Democrats must reject DEI" - I just read on The Bulwark that the Air Force removed a video honoring the Tuskegee Airmen from their training materials, because a video honoring Black service members is too DEI-ish, and we can't have that.
I said it yesterday and I'll say it again: DEI wokery was excessive, harmful and stupid. But Agent Orange and his minions aren't like "let's repudiate the woke extremism by returning to the ideal of we are all Americans, we are all equal, we are all judged as individuals." No, they are going to do dumb, mean-spirited things like tossing the video honoring the Tuskegee Airmen just because they can, and Matt Y and his allies are gonna be all "we can't make any noise about this, because then we'll just make The Median American Voter angry."
I don't like this one bit.
They reinstated the Tuskegee Airmen thing, FWIW.
Thanks, that's good to know!
One consequence of Medicaid cuts: Medicaid pays for a lot of substance abuse treatment. Cutting Medicaid would likely put addicts back on the street.
The big question is how to reach the people who will be most effected by the cuts. They believe the MAGA propaganda.
I'll say the same thing here that I say in the National Review comments (different screen name). As someone who supports free markets and limited government, I say that big spending cuts are needed to slash the budget deficit, the single biggest threat to our economic health. This has to go beyond symbolic cuts to "waste, fraud and abuse", or cuts that solely target the poor, foolishly reinforcing the GOP caricature painted by the left. If the supposed party of fiscal responsibility is unwilling to sleigh the sacred cows that include entitlements and defense spending, then all the posturing over DEI and "woke" is just entertainment for the mouth breathers watching Fox News .
Do you have any thoughts that are fit to print about the sudden death of PEPFAR?
I have many thoughts. None of them are fit to print in, say, the NYT, but "f**k those f**king sh*theads, great job screwing over some of the world's most desperate people, I hope you're really proud of yourselves" about covers it and is within bounds for a Substack comment section, so.
I swear to God, there have been many really bad US Presidents - W screwed the pooch royally on Iraq - but Dump is off the chart in terms of sheer spite/wanting to make his enemies cry.
Cosign.