Tag Archives: South Carolina

Subverting Democracy by Corrupting Truth

States Not Expanding Medicaid

Source: WhiteHouse.gov

“None of my friends can afford Obamacare, either,” Meghan said indignantly, “it should be repealed.”

We were in the South Carolina Lowcountry. Meghan is a mid-to-late-thirties single mother who is balancing raising her child, her relationship and job while still working on her degree.

She was telling us about the hospital where she works. Like so many rural hospitals across the South, her hospital has a significant number of uninsured patients coming through the emergency room for treatment. Federal law (EMTALA) requires all hospitals with an emergency department that receive Medicare to screen, treat, stabilize or transfer anyone requesting treatment regardless of ability to pay.

Meghan told us that her hospital had to cut back staff, which backed up her ER waiting room even more. She told us that the hospital could not afford to treat really sick uninsured patients and mostly their doctors patched up the uninsured sick the best they could, gave the patients some medicine and sent them on their way with a prescription knowing the prescriptions were unaffordable and the patients would be back. Meghan blamed Obamacare for all of it.

That is when I chimed in and told her that things at her hospital were going to get worse. The Affordable Care Act (ACA, aka: Obamacare) is complicated and when passed, assumed every state would expand Medicaid. With almost everyone having insurance, there would be fewer uninsured at the ER and hospital costs would go down. With lower costs, federal Medicare reimbursements are being reduced each year.

That’s when Meghan said that Obamacare was too expensive and should be repealed. And that is when I told her that she had been lied to. That for people earning up to 138% of the poverty level, Obamacare was should have been free and is in free in 28 states. But that her state government decided that the fate of 340,000 South Carolinians was to bankrupt, go to the ER or die.

I wasn’t sure which one of us was going to scream or cry first. Meghan seemed bewildered and said, “It isn’t Obama’s fault that I don’t have health insurance, but it is the states? The state did this? None of my friends know that. All we hear is that it has to be repealed. This is terrible. Why would they do that to us?”

Then I told her about the money. The more than $15.8 billion that her state would have gotten from Washington that was to pay for 100% of Medicaid expansion. Money they will never get. Money that would have created many tens of thousands of good permanent jobs, saved countless bankruptcies, saved lives and made lives better. Money that South Carolina taxpayers are sending to other states.

It gets even worse as the states have to make up the difference for indigent care and the decrease in Medicare reimbursements – money needed to keep hospitals like Meghan’s open. The Robert Wood Johnson Foundation and the Urban Institute put that number at $167.8 billion for all the states not expanding Medicaid from 2013-2022 – for instance, Georgia will lose $1.2 billion in Medicare reimbursements in 2016– more than twice the cost of expanding Medicaid. Stupid and mean.

Despite this, there is good news even in the states which haven’t expanded Medicaid. The online marketplace makes it easier to enroll and determine eligibility. South Carolina, for example, had about 300,000 people who already qualified, but had never enrolled in Medicaid. Using HealthCare.gov, South Carolina has already added over 150,000 of them.

In fairness, there is a cost to the states to accept the expanded Medicaid money. States must provide basic benefits and offer it to all of their citizens below the poverty level, not just women with children. According to the Urban Institute and McClatchyDC.com, South Carolina’s 10-year cost to expand would have been about $1.2 billion – a lot of money, but not much to get $15.8 billion in return. For Georgia to get $33.7 billion, would cost $2.5 billion over 10-years (which could be funded by the governor’s discretionary budget) – one other note on Georgia – five rural hospitals closed since 2012 and more and six more are at risk (USA Today). Here’s a chart for other states.

Suggested reading: What Is the Result of States Not Expanding Medicaid?

Note: this story also published at LikeTheDew.com

Debate Du Jour

cbs-debate-screenshotAfter a long day of college football and poignant play-by-play announcer comments on the rape of children and the effect on Joe Paterno, an estimated 612 channel changes between games – each accompanied by a “where are my glasses moment,” an unrehearsed comedy segment using picture-in-picture mode on our not-wide-enough-screen-TV, and a frustrating trip to NetFlix “New Arrivals” which all pre-date the birth of the parents of our grand-children, we decided on a survivor show: the “CBS News/National Journal South Carolina Republican Debate.”

Eight candidates. Each seeking to find the heart of the Republican voter and ride their hate toward final victory in November to overthrow four long years under the iron-will of the Democrat (insert your preferred insult here) who has spent his entire time in office trying to undo the problems created by the last Republican vice-president and his henchman, George Bush.

Can Cain harass Bachmann saying “9-9-9” or by “Ubeki-beki-beki-beki-stan-stan”? Can Perry remember what he’d forgotten? Can Huntsman get a question from the moderator? Can Santorum get past audience snickers? Can Newt be more sanctimonious? Can Bachmann think of anything new to say? Can Paul continue to sound sensible? Can Romney again calm the debate with the black hole of his personal charisma? And will they, one-by-one, convincingly kiss the “ring” of Jim DeMint? These were the questions we wanted answered.

The subject: national security and foreign policy. The entire debate, including commercials, was an hour and a half. You can watch it at CBS.com, read the transcript, their fact check or winners and losers. Here’s what I heard.

  • Bachmann, Huntsman and Santorum recognize that foreign policy is complicated and that it is dangerous to give simple answers to complicated questions.
  • Romney and Cain recognize that it is best not to answer questions, simple or otherwise, with specifics and that it is dangerous in politics to give answers, simple or otherwise.
  • Newt prefers to agree in general with other candidates so he’s not really on the record, while speaking as if he knows the inside jargon the others don’t.
  • Perry worked very hard this week and delivered a few carefully rehearsed lines reinforced by the extensive experience that he gained as governor of a state where he can see Mexico.
  • Paul spoke his mind clearly and saw no reason to give long answers to questions that were, inherently, absurd.

For specifics on issues, I carefully charted the candidates’ answers below. Enjoy:

Chart: How would you prevent Iran from building nuclear weapons?

Chart: Your appraisal of the combat situation in Afghanistan and how would you change it?

Chart: Sending troops into Pakistan?

Chart: Foreign Aid?

Chart: Thinking outside the box?

Chart: Listening to the right people before making a decision?

Chart: Torture?

Chart: Are we engaged in financial warefare with China?

Chart: Spending?

Chart: The Arab Spring?

Chart: Syria?

Chart: What about Gitmo?

Note: this post was updated on Monday, November 14, 2011 to correct a misspelled word in the torture chart.

How Nero Must Have Felt When He Stopped Fiddling

get-motivated-bushWhat a mess. Somebody should have stopped me.

I have been fortunate to have had many people who encouraged me toward self-improvement. An early example was an employer’s requirement to complete Dale Carniegie’s training to learn “How to Win Friends and Influence People.” As those of you who know me might expect, it did require staying after class a few times. I almost dropped out when I was required to stand up in front of the class and yell with believable enthusiasm, “Boy, do I feel good.” But somehow, I got through it and completed the course. Other than making some great friends in the class and remembering their names for a few months, the long-term affect was not as dramatic as was hoped. I do still remember to “live in a day tight compartment” and that “any fool can criticize, condemn and complain.”

Admittedly, my anti-establishment beliefs ran and still run deep. I didn’t buy their politics, their wars, their attitudes on race or religion, their dog-eat-kennel mentality. I didn’t want to dress like them, talk like them or concentrate on my golf swing. I didn’t want to demure to the “man” or respect a fool for his money or power. And still don’t.

Subsequently, I was encouraged by employers to be Ziglarized, motivated, sold on success, taught to be productive and trained to be a leader. I’ve listened to 10,000 miles of cassettes, read dozens of books, done exercises, been coached, retreated, meditated, counseled and cajoled (George W. Bush wasn’t on tour during my self-improvement phase). Generally, with the same result. As I once said to my wife about technology, but the same is true for me when it comes to self-improvement, “the mind is like a rock. Pour the water of knowledge on it and it looks wet, but almost nothing sinks in.” Okay, I do remember a Ziglar story from “See You at The Top” that I loved – how to train fleas. I love it because I suffer from flea training and still observe friends and their children who suffer from it. It goes something like this:

“To train fleas you place some fleas in a jar with a lid on the jar. The fleas will, of course, begin to jump, repeatedly hitting the lid in their attempt to escape. Wait about 20 minutes. The fleas begin to grow tired of hitting their head on the jar lid. They just give up and will no longer jump as high. Once they become accustomed to the fact that if they jump too high they will hit their heads on the lid. You can remove the lid and the fleas will continue to jump at the same height, never escaping the jar.”

One exception to those who watered my rock was Mooney Player. You’ve probably never heard of him. For much of his life, Mooney was a high school football coach in South Carolina at Saluda High School and Lower Richland. His teams won five state championships in his 18-years of coaching. Ken Burger, executive sports director at the Charleston Post and Courier, said of Mooney,

“He won 90 percent of his games by turning ordinary players into true believers.”*

In 1974, after a year as an assistant coach to Lou Holtz, the University of South Carolina was looking to replace Paul Dietzel and Mooney wanted the job. He campaigned publicly for it, saying that, “if his teams didn’t win at least 10 games, he wouldn’t accept a salary.” Of course, the university would never hire a high school football coach (hired Jim Carlen) and Mooney stopped coaching and became a motivational consultant. That’s when I met Mooney.

Mooney taught me to be productive and helped me learn to communicate without pissing off everyone in the process (I’m still working on that lesson). He didn’t have books or tapes and generally worked from a notebook more fitting for a football sideline. Mooney taught me to establish goals, break them into meaningful steps that could be accomplished and to set priorities. He taught me to plan each day with A, B and C priorities and to only do the A’s. His thinking was if you take care of the big things, the small things weren’t worth doing. I believed him and it works.

That is until you either run out of goals, or you live in “the worst economy since the great depression.” For many of us, business just stopped last year. Those of us who know a thing or two about a lousy economy or depression know that you gotta re-up. Set new goals. Break out the steps. Learn new things. Implement. Stay productive. Keep good habits. Stay busy. Most of us quickly accomplished our social marketing. We updated our sales tools. We streamlined. We planned. We called. We met. We scaled back. And we tried harder.

After a while of not having A priorities that could be accomplished (see training fleas, above) and being bored silly with B priorities, I found myself compulsively accomplishing C priorities. Those easy things to accomplish that fill our lives and have almost no positive consequence, except the sense of accomplishment that comes from crossing things off a list. I’m over that.

I know unemployment will likely worsen. That small business will likely not see an upturn for a year or more. That the worst may be behind us, but the future is going to be awfully hard. I know the stimulus won’t help me much. That health care reform, should it pass, won’t help me until after the next presidential election when it would go into effect. That doesn’t have anything to do with me. I’m not looking for Washington to solve my problems. I’m setting new goals. I’m going to break them into daily steps that I can accomplish. And I’m going cold-turkey on the C priorities.

I’m guessing that is how Nero must have felt when he stopped fiddling and looked out to see Rome in ashes. What a mess. Let’s get out the broom and get to work.

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*”Looking back at Mooney the motivator.” The Post and Courier (Charleston, SC). 2001. Retrieved November 04, 2009 from accessmylibrary.