What if Mitt Romney was actually elected President, how might America be transformed?

Based on the statements he has made and his pandering allegiance to the right wing extremists in his party, one can reasonably extrapolate out what policies and laws Romney would support and approve.

To begin, it is conceivable that the GOP could retain the House and win over the Senate. It’s also conceivable that having seen how effective their use of the filibuster was against Obama, Senate Republicans could pass rules limiting the use of it by Democrats.

In such an admittedly hypothetical scenario, the damage to the American society and democracy we have come to know could be severe and long term, with numerous permanent aspects.

The End of Medicare as an Entitlement

The Ryan Plan, which Romney heartily supports, transforms Medicare from being an entitlement into a partial subsidy for buying health insurance. Thus, Americans would no longer be entitled to health insurance when they grew older. This would have a profound and devastating impact on tens of millions of seniors and society in general.

The amount a senior would received from Medicare, as a Ryan-type subsidy program, would be insufficient to fully pay for corporate insurance premiums. At current rates, seniors would have to pay an additional $6,000 a year to have basic medical insurance that would give them less coverage than they receive now between Medicare and Part B. As time goes by, that gap and the percentage of their premium they will have to pay will grow, requiring them to pay $10,000 annually, then $20,000 and on and on until more and more are priced out of being able to afford health insurance. The CBO estimates that by 2030, under the Ryan plan, 65 year olds would be required to pay 68% of the total cost of their coverage, which includes premiums, deductibles, and other out-of-pocket costs.  That compares with the 25 percent they would pay under current law.

And if seniors can’t afford to pay that growing amount of their premium that their subsidy doesn’t cover? They don’t get partial insurance, they get none. No health insurance. End of story. There are around 40 million senior citizens, many of whom live on a very limited budget with Social Security as their primary income (more on this below) and simply can’t afford this additional expense. The numbers of  uninsured senior citizens will grow and one result will be that millions of Americans will die younger as part of this Romney/GOP plan to make the wealthy wealthier.

Ryan and the GOP have cynically played the selfish card on seniors to win their support, assuring them that their changes to Medicare wouldn’t affect them, just their children and grandchildren. In other words, we assume you’re greedy and selfish like us so as long as you get yours, screw the rest of your family. Fortunately, the push back by seniors after Ryan’s first proposed budget reflected that even elderly parents care about the welfare of their children and grandchildren. However, with Romney in the White House and Republican control of Congress, there may be no stopping such a drastic change.

So in addition to the shocking precedent of shrinking lifespans in a modern, industrialized nation, how else might our society be affected by having tens of millions of seniors unable to afford health insurance?

Emergency rooms would likely become increasingly congested with the millions of elderly who don’t have insurance. Since they would not have been treated regularly, many will have more severe conditions, requiring more time and resources at emergency rooms. This will severely tax the already burdened emergency room system, financially and staff-wise, eventually past the point of their capabilities. In such an environment, what kind of care, resources and attention will those without insurance, who only have the emergency room for treatment, receive? And what about people who are brought to an emergency room due to a car accident or severe illness? How quickly will they be able to receive care when many other patients are ahead of them with just as urgent life-threatening conditions?

What happens when the ranks of the uninsured swell towards one third of the nation’s population? When emergency rooms and hospitals have waiting times that double and triple? Or after hospitals close from being bankrupted by their unpaid emergency room costs that multiply? When the resulting domino effect is created that overloads and bankrupts other emergency rooms?

And add to that the cost to society of the potential for mass outbreaks of illnesses and diseases that result from so many Americans not having regular medical care.

This viable scenario would devastate our society.

The End of Social Security as an Entitlement

There was a time in our past when people who worked their whole lives would get too old and/or ill to keep a job and live out the remainder of their lives as desperate and indigent. Some might bring a financial burden on their children, others might be reduced to a horrible life of squalor. To most Americans, that would seem like a tragedy of the past but for Mitt Romney and the GOP, they welcome our returning to those times.

The reason for their wanting to privatize Social Security is obvious. They want to take the over $2.6 trillion in the Social Security trust fund out of government hands and pour it into Wall Street coffers where it can be sucked away by them in part or in whole.

We all know what can happen to the majority’s money when Wall Street has their hands on it. As bad as it has been, imagine what would have happened in the midst of the 2008 economic crash if the 40 million senior citizens who rely primarily on Social Security to pay their monthly expenses and Medicare Part B insurance, had that money in the stock market instead of Social Security. What kind of hell would America be with the majority of seniors unable to pay for a roof over their head, food, health insurance and medicine (add the privatizing of Medicare into the mix and you multiply the disaster)?

This massive economic crash would have been made exponentially worse if seniors had all of their Social Security money in the market and in a crisis, they had to sell their stocks for whatever they could get. Add to that, the steep loss of seniors’ spending that would result and further deepen an economic disaster (which of course didn’t occur and helped the economy in this recent case, thanks to Social Security being as it is).

The depth of such a depression that would result from seniors losing everything because their Social Security was in the stock market could dwarf the original Depression and fully climbing out under such a rigged system might not even be possible.

How can we choose to have 99% of our elderly vulnerable to losing their home, food and health insurance when the market has its next crash?

That is of no concern to Mitt Romney and the GOP. Though many of them inherited their wealth and advantage in society as Romney did, they will give lip service to “the dignity of self determination” while actually working to take away the security and independence of the elderly because it interferes with the wealthy achieving greater wealth.

The Destruction of Democracy, the Middle Class and an Inclusive Economy

It is a cornerstone of the modern GOP to continue down the path of cutting taxes for the wealthy and gutting services for the poor and the rest of the 99% of Americans who aren’t wealthy. The overall scheme includes keeping downward pressure on salaries, limiting economic mobility and gaming the system to maximize the accumulation of wealth for the top 1% by taking it from the bottom 99%. Along with this is the perversion of our democracy into a plutocracy, where those with money control elections and use their advertising and marketing expertise to sell the public on voting for “products” that will, in the end, serve only the wealthy.

The ideal America for Romney and his Republican colleagues is one where the wealthy freely buy the White House and Congress that best serves them, reroute the tax revenues from social programs into their pockets, remove all regulations that prevent them from polluting, economic fraud and harming the public if preventing it interferes with greater profits.

Their America has only two classes, the wealthy and workers. The middle class is already shrinking and hastening this is part of the scheme. Attacking unions (which created the Middle Class), job protections, rights and through off shoring, depressing the salary value of American workers.

In 2000, corporate America was already off shoring jobs at a fast clip, sharply reducing the number of jobs it had in the US. When the economic crash of 2008 hit, it just accelerated the off shoring.

These are jobs that are lost forever and are never coming back…unless American wages drop down to being more competitive with third world wages. The whole Free Trade scam was presented as something that would bring up wages around the world and add more jobs in the US due to exports. In fact, it was designed to do just the opposite, to slash labor costs for corporations and put severe downward pressure on workers’ wages in the US. And it has worked well.

The Romney/GOP agenda is to seal the deal on America as a plutocracy, a country of the wealthy, for the wealthy and by the wealthy. They have drilled Orwellian terms into the minds of Americans, deeming the greedy as benevolent “Job Creators” even though all evidence proves that they are willfully not creating high paid jobs in America (the job growth in the public sector has been coming primarily from small businesses).

Romney is running on being wealthy, that is his central platform, “I made a lot of money so that means I’m a good businessman and would make a good President.” Donald Trump flirted with running for President for the same reason, because they define wealth as success. So the reverse would be true, those like Romney view those who aren’t wealthy as failures and lesser people. Thus, it is not so bewildering to see how Romney stumbles around regular Americans like a king trying to pander to those he sees more like odd human-like animals than people like him.

So the concept of the majority’s purpose being that of serving Romney and his ilk is a mentality they already possess. For them, empathy for most Americans just doesn’t compute. With such a President, the depth of exploitation and oppression of the majority would have no limit, there would not be a conscience to say, “That policy would hurt too many people’s lives,” so even if he does it merely to benefit his fellow elitists and isn’t motivated by harming others, he could be capable of subjecting the American people to damaging things and being as oblivious of its impact as he is of how his constant gaffes are perceived.

A President Romney would be in a position to appoint perhaps two or more Supreme Court justices which could cement a right wing SCOTUS for generations. The lasting damage from the last dozen years of Gore v. Bush, Citizens United, etc. is already profound but another thirty to forty years of such pro-corporate, anti-democratic decisions could permanently cast the nation in the image of the wealthy and the majority of Americans as powerless, second class citizens.

War and Conflict That Destroys Our Future

America is pretty war weary. We’re getting out of Iraq, we’re slowly getting out of Afghanistan but trillions of dollars and precious lives have already been lost and continue to be. Americans want it to be over.

To that, Mitt Romney says, “My party’s core says, ‘Screw that! War rocks!’ so I do too!”

Romney has absolutely no foreign affairs experience or education so he merely adopts the stances of those in the Republican right wing he panders to and has hired as consultants. And they profit from the military industry. So, war with Iran sounds good to them. Hostility towards China and calling Russia our enemy, that’s good for business.

If not influenced by others, Romney doesn’t seem like the war mongering type but being greedy and self-serving, Romney would take any position if it benefited him. And threatening war with one country after another yields a gold mine of campaign donations.

What would happen if the US started a war with Iran? Even if it was just air strikes, it could create a hostile backlash against the US around the world while miring us in a very complicated war we could never win, using an already overused and depleted military that could deteriorate as a whole.

What would happen to gas prices and oil prices in this fragile economy, if the Straight of Hormuz became a war zone? How would it affect inflation and jobs in this country if the price of gas went up towards $10 per gallon?

Yes, Romney and the GOP exude hypocrisy when attacking Obama on gas prices while whipping up support for war with Iran but it would be naive to think they wouldn’t be just fine with energy costs skyrocketing…along with revenues for oil companies…who are the top GOP sponsors anyway.

Our remarkable volunteer army has been stretched thin in two simultaneous wars over the last ten years and another war could require more soldiers than we have able to serve. By creating a growing lower class of unemployed and economically excluded people, they have created a great ongoing supply of cannon fodder for their eternal wars-for-profit, draining our nation of blood and treasure.

The Ryan budget and Romney’s budget greatly increase military spending while insisting on reducing the deficit and balancing budgets so there is no alternative but for ongoing war to be financed by degrading America’s social and physical infrastructure even more than it has been and it is already past the point of sustainability.

At the same time, their insistence on cutting taxes paid by the wealthy will transfer that loss of revenue from social programs to the wealthy, adding a greater hacking away at social programs on top of what would already be occurring.

Conclusion

A Romney Presidency, especially when coupled with a Republican Congress could be a profound and devastating blow to the future of this nation. This is not because Romney is a worse person than other GOP candidates (GW Bush can’t be argued to be better) but because America is at a tipping point in so many ways that each Presidential term during this period is make or break.

Had President Obama made disastrous decisions after taking office, never passing a stimulus bill, agreeing to drastic slashing of Medicare and Social Security with no revenue increases, we could have tumbled down into an economic depression beyond what we could have imagined.

If Romney is enabled to tear apart Medicare and Social Security, lock in a pro-corporate SCOTUS for 30 years, cement plutocracy and economic injustice into place and be the vehicle for legally oppressing minorities and women in America, it would be hard to imagine ever fully reversing the damage to the nation.

These are the concrete kind of considerations that should be discussed on the MSM instead of  “scandals” like President Obama not literally saying that he supports gay marriage or puff pieces on how Ann Romney helps “humanize” Romney.

There are serious and powerful issues at stake right now, we can’t afford to be distracted by the trivia of the horse race and gotcha games in the media.

We need to have the public discussing what really matters and what country America is going to be in reality, not just in mindless nationalistic blather.

There might not be a more important election in our lifetimes than the one we will have in November. The value of keeping that in mind and impressing that on others can’t be understated.

They’ve Got the Best Health Care Tax Payers’ Money Can Buy

For the Justices of the Supreme Court, and the members of the Congress opposed to the Affordable Care Act there is no risk for them if the ACA is knocked down. They will continue to enjoy very fine, very affordable coverage in a tax payer supported program that does as much for them as the ACA hopes to do for most citizens and more. But they have no reason to be personally concerned about throwing health care reform under the bus. They are covered.

Simply put, the ultimate goal of The Affordable Care Act, (a.k.a. Obamacare), is to provide most Americans with the level of care the President, Congress, the Supreme Court and most federal employees have for themselves and their immediate families.

I know about this care from my 30-year experience as an active (now retired) federal civilian employee. The plan is great. But you wouldn’t think so given what the GOP has put forth regarding ACA.

The GOP has so intensely and successfully embedded the notion that the ACA will bankrupt the nation while destroying the quality of our health care that there is widespread popular support for setting Obamacare aside. This obsession with the debt is curious when that same GOP had few problems with two wars, massive tax cuts, an explosion in the size of the government, Medicare D, and a host of supports for big business when their impact on the national debt has been and continues to be far greater than that of the ACA.

The $2 trillion cost of two wars which have reaped very few benefits over 8 years is acceptable, but the $1.76 trillion cost for health care reform over a 10 year period is deemed excessive. Furthermore, that $1.76 trillion cost is offset by explicit savings and new funding sources. In fact, the CBO projections show it reducing the deficit in the mid and long term. No such claims could be made for those two wars.

THE FEDERAL EMPLOYEE HEALTH BENEFIT (FEHB) AND HOW IT WORKS

The President, the members of the Supreme Court, the members of the Congress, and most of their staffs and other federal employees count on the FEHB to care for their health needs.

The Office of Personnel Management (OPM) manages the FEHB Plan. It negotiates costs with the insurance companies and health care providers for services to its members. It functions as an insurance exchange much like the one the ACA proposes to establish for those who are not privately insured or insured through an employer.

President Obama said early in his presidency that he wanted all Americans to have the same quality health care that he and Congress access. It’s the same kind of plan the Supreme Court now holds in its hands.

In the federal program the key is choice. Many plans are available from which to choose. They vary throughout the country; costs depend on location. I live in California. My plan offers Blue Cross/Blue Shield (BC/BS); Health Net; Kaiser, et al. I have BC/BS. Within that plan are several providers: Catholic Healthcare West (CHW), Kaiser, Sutter Health, etc.

Every year, from mid-November to early December, the Office of Personnel Management (OPM) offers Open Season during which members make changes in providers, adjust payments, select or jettison various coverage elements, and even change plans entirely without loss of benefit. A member’s plan cannot be cancelled unless personally requested in writing. If that choice is made, coverage is lost; the member may not re-enroll.

EXAMPLES OF SERVICES AND COSTS

The costs have always been reasonable and the coverage excellent even for Basic Medical. But for the first time, three years ago, OPM negotiated for Vision and Dental care, the costs of which, like Medical, are borne by members and deducted from current or retirement pay. Vision covers one exam per year with one pair of free glasses. MetLife Dental for a single person such as myself provides annual coverage of $10,000 including the rarely covered implants.

Here are the monthly BC/BS premiums for Basic coverage, reflected in its Service Benefit Plan manual. Fees are deducted from current or retirement pay:

Individual Coverage:
Medical: $121.88
Dental: $48.00
Vision: $24.00
Prescriptions $10.00
Total: $203.88

So, when I had a vision problem here is what two office visits to my general practitioner and one referral visit to an ophthalmologist cost as billed on the same PHYSICIAN STATEMENT:

Total Charges: $682.00
Plan Allowance: $207.00
BC/BS Payment to Medical Providers: $132.00
MY DIRECT PAYMENT TO MEDICAL PROVIDERS: $75.00

The Plan Allowance is the OPM-negotiated cost. Great deal, yes?

How does the plan do with hospital related costs? Here is one example. In a cluster of four billings for my 2010 surgery, the surgeon fee, hospital care, in-hospital prescriptions, x-rays, MRI, physical therapy, two weeks in an assisted care facility, and six in-home nurse visits were billed at:

Total Charges: $79,888.00
Plan Allowance: $10,875.00
BC/BS Payment to Medical Providers: $9154.00
MY DIRECT PAYMENT TO MEDICAL PROVIDERS: $1,721.00

The cumulative charges (all billing) for the surgery/hospital/recovery was: $146,095.00. My plan allowance was $22,585.00. BC/BS paid $18,921.00. My out of pocket cost (what I paid directly to the medical providers) was $3,664.00.

THE BOTTOM LINE
The Bigger the Pool, the Bigger the Savings

Why was this so affordable? The United States Government is the greatest negotiator in the world. Insurance companies and health providers agree to accept specific maximum limits for their services, which are far less than they bill individual clients. Of course, this is also true of insurance policies in general. Most insurers pay 30 to 38 percent of the “billed” cost of medical care. Think of those medical bills in the same way as smart new car shoppers think of the sticker price on a car- only far more inflated.

The Federal Government gets the best rates because its pool is so large (FEHB plus Medicare plus Medicaid plus Veterans Affairs ). Imagine what National Single Payer (Medicare for All) would do?

This is why so many other developed nations with national health care programs get so much more coverage for so many more people for so much less money.

The SCOTUS, the President, the Congress etc. have an excellent federal health care insurance plan but when it comes to providing such a plan for most of its citizens, it seems that not only are the GOP in Congress, joined by a number of state governments, willing to throw the citizens under the bus, but the SCOTUS’s conservative justices may also be willing to drive the bus that runs over the rest of us.

Sources:
http://phobias.about.com/od/treatment/a/obamaplan.htm
http://www.aarp.org/work/employee-benefits/info-12-2010/benefits_what_does_congress_really_get.html?plckOnPage=2
http://usgovinfo.about.com/od/uscourtsystem/a/scotusretire.htm
https://www.pcip.gov/
http://content.healthaffairs.org/content/25/1/57.long

Acknowledgement: The author appreciates the assistance provided by MurphtheSurf3 in research, editing and the publication process.

Facts not Slogans

THE PRESIDENT:  Thank you very much.  (Applause.)  Please have a seat.  Well, good afternoon, and thank you to Dean Singleton and the board of the Associated Press for inviting me here today.  It is a pleasure to speak to all of you — and to have a microphone that I can see.  (Laughter.)  Feel free to transmit any of this to Vladimir if you see him.  (Laughter.)

Clearly, we’re already in the beginning months of another long, lively election year.  There will be gaffes and minor controversies, be hot mics and Etch-a-Sketch moments.  You will cover every word that we say, and we will complain vociferously about the unflattering words that you write — unless, of course, you’re writing about the other guy — in which case, good job.  (Laughter.)

But there are also big, fundamental issues at stake right now — issues that deserve serious debate among every candidate, and serious coverage among every reporter.  Whoever he may be, the next President will inherit an economy that is recovering, but not yet recovered, from the worst economic calamity since the Great Depression.  Too many Americans will still be looking for a job that pays enough to cover their bills or their mortgage.  Too many citizens will still lack the sort of financial security that started slipping away years before this recession hit.  A debt that has grown over the last decade, primarily as a result of two wars, two massive tax cuts, and an unprecedented financial crisis, will have to be paid down.

In the face of all these challenges, we’re going to have to answer a central question as a nation:  What, if anything, can we do to restore a sense of security for people who are willing to work hard and act responsibly in this country?  Can we succeed as a country where a shrinking number of people do exceedingly well, while a growing number struggle to get by?  Or are we better off when everyone gets a fair shot, and everyone does their fair share, and everyone plays by the same rules?

This is not just another run-of-the-mill political debate.  I’ve said it’s the defining issue of our time, and I believe it. It’s why I ran in 2008.  It’s what my presidency has been about. It’s why I’m running again.  I believe this is a make-or-break moment for the middle class, and I can’t remember a time when the choice between competing visions of our future has been so unambiguously clear.

Keep in mind, I have never been somebody who believes that government can or should try to solve every problem.  Some of you know my first job in Chicago was working with a group of Catholic churches that often did more good for the people in their communities than any government program could.  In those same communities I saw that no education policy, however well crafted, can take the place of a parent’s love and attention.

As President, I’ve eliminated dozens of programs that weren’t working, and announced over 500 regulatory reforms that will save businesses and taxpayers billions, and put annual domestic spending on a path to become the smallest share of the economy since Dwight Eisenhower held this office — since before I was born.  I know that the true engine of job creation in this country is the private sector, not Washington, which is why I’ve cut taxes for small business owners 17 times over the last three years.

So I believe deeply that the free market is the greatest force for economic progress in human history.  My mother and the grandparents who raised me instilled the values of self-reliance and personal responsibility that remain the cornerstone of the American idea.  But I also share the belief of our first Republican President, Abraham Lincoln — a belief that, through government, we should do together what we cannot do as well for ourselves.

That belief is the reason this country has been able to build a strong military to keep us safe, and public schools to educate our children.  That belief is why we’ve been able to lay down railroads and highways to facilitate travel and commerce.  That belief is why we’ve been able to support the work of scientists and researchers whose discoveries have saved lives, and unleashed repeated technological revolutions, and led to countless new jobs and entire industries.

That belief is also why we’ve sought to ensure that every citizen can count on some basic measure of security.  We do this because we recognize that no matter how responsibly we live our lives, any one of us, at any moment, might face hard times, might face bad luck, might face a crippling illness or a layoff.  And so we contribute to programs like Medicare and Social Security, which guarantee health care and a source of income after a lifetime of hard work.  We provide unemployment insurance, which protects us against unexpected job loss and facilitates the labor mobility that makes our economy so dynamic.  We provide for Medicaid, which makes sure that millions of seniors in nursing homes and children with disabilities are getting the care that they need.

For generations, nearly all of these investments — from transportation to education to retirement programs — have been supported by people in both parties.  As much as we might associate the G.I. Bill with Franklin Roosevelt, or Medicare with Lyndon Johnson, it was a Republican, Lincoln, who launched the Transcontinental Railroad, the National Academy of Sciences, land grant colleges.  It was Eisenhower who launched the Interstate Highway System and new investment in scientific research.  It was Richard Nixon who created the Environmental Protection Agency, Ronald Reagan who worked with Democrats to save Social Security. It was George W. Bush who added prescription drug coverage to Medicare.

What leaders in both parties have traditionally understood is that these investments aren’t part of some scheme to redistribute wealth from one group to another.  They are expressions of the fact that we are one nation.  These investments benefit us all.  They contribute to genuine, durable economic growth.

Show me a business leader who wouldn’t profit if more Americans could afford to get the skills and education that today’s jobs require.  Ask any company where they’d rather locate and hire workers –- a country with crumbling roads and bridges, or one that’s committed to high-speed Internet and high-speed railroads and high-tech research and development?

It doesn’t make us weaker when we guarantee basic security for the elderly or the sick or those who are actively looking for work.  What makes us weaker is when fewer and fewer people can afford to buy the goods and services our businesses sell, or when entrepreneurs don’t have the financial security to take a chance and start a new business.  What drags down our entire economy is when there’s an ever-widening chasm between the ultra-rich and everybody else.

In this country, broad-based prosperity has never trickled down from the success of a wealthy few.  It has always come from the success of a strong and growing middle class.  That’s how a generation who went to college on the G.I. Bill, including my grandfather, helped build the most prosperous economy the world has ever known.  That’s why a CEO like Henry Ford made it his mission to pay his workers enough so they could buy the cars that they made.  That’s why research has shown that countries with less inequality tend to have stronger and steadier economic growth over the long run.

And yet, for much of the last century, we have been having the same argument with folks who keep peddling some version of trickle-down economics.  They keep telling us that if we’d convert more of our investments in education and research and health care into tax cuts — especially for the wealthy — our economy will grow stronger.  They keep telling us that if we’d just strip away more regulations, and let businesses pollute more and treat workers and consumers with impunity, that somehow we’d all be better off.  We’re told that when the wealthy become even wealthier, and corporations are allowed to maximize their profits by whatever means necessary, it’s good for America, and that their success will automatically translate into more jobs and prosperity for everybody else.  That’s the theory.

Now, the problem for advocates of this theory is that we’ve tried their approach — on a massive scale.  The results of their experiment are there for all to see.  At the beginning of the last decade, the wealthiest Americans received a huge tax cut in 2001 and another huge tax cut in 2003.  We were promised that these tax cuts would lead to faster job growth.  They did not.  The wealthy got wealthier — we would expect that.  The income of the top 1 percent has grown by more than 275 percent over the last few decades, to an average of $1.3 million a year.  But prosperity sure didn’t trickle down.

Instead, during the last decade, we had the slowest job growth in half a century.  And the typical American family actually saw their incomes fall by about 6 percent, even as the economy was growing.

It was a period when insurance companies and mortgage lenders and financial institutions didn’t have to abide by strong enough regulations, or they found their ways around them.  And what was the result?  Profits for many of these companies soared. But so did people’s health insurance premiums.  Patients were routinely denied care, often when they needed it most.  Families were enticed, and sometimes just plain tricked, into buying homes they couldn’t afford.  Huge, reckless bets were made with other people’s money on the line.  And our entire financial system was nearly destroyed.

So we tried this theory out.  And you would think that after the results of this experiment in trickle-down economics, after the results were made painfully clear, that the proponents of this theory might show some humility, might moderate their views a bit.  You’d think they’d say, you know what, maybe some rules and regulations are necessary to protect the economy and prevent people from being taken advantage of by insurance companies or credit card companies or mortgage lenders.  Maybe, just maybe, at a time of growing debt and widening inequality, we should hold off on giving the wealthiest Americans another round of big tax cuts.  Maybe when we know that most of today’s middle-class jobs require more than a high school degree, we shouldn’t gut education, or lay off thousands of teachers, or raise interest rates on college loans, or take away people’s financial aid.

But that’s exactly the opposite of what they’ve done.  Instead of moderating their views even slightly, the Republicans running Congress right now have doubled down, and proposed a budget so far to the right it makes the Contract with America look like the New Deal.  (Laughter.)  In fact, that renowned liberal, Newt Gingrich, first called the original version of the budget “radical” and said it would contribute to “right-wing social engineering.”  This is coming from Newt Gingrich.

And yet, this isn’t a budget supported by some small rump group in the Republican Party.  This is now the party’s governing platform.  This is what they’re running on.  One of my potential opponents, Governor Romney, has said that he hoped a similar version of this plan from last year would be introduced as a bill on day one of his presidency.  He said that he’s “very supportive” of this new budget, and he even called it “marvelous” — which is a word you don’t often hear when it comes to describing a budget.  (Laughter.)  It’s a word you don’t often hear generally.  (Laughter.)

So here’s what this “marvelous” budget does.  Back in the summer, I came to an agreement with Republicans in Congress to cut roughly $1 trillion in annual spending.  Some of these cuts were about getting rid of waste; others were about programs that we support but just can’t afford given our deficits and our debt.  And part of the agreement was a guarantee of another trillion in savings, for a total of about $2 trillion in deficit reduction.

This new House Republican budget, however, breaks our bipartisan agreement and proposes massive new cuts in annual domestic spending –- exactly the area where we’ve already cut the most.  And I want to actually go through what it would mean for our country if these cuts were to be spread out evenly.  So bear with me.  I want to go through this — because I don’t think people fully appreciate the nature of this budget.

The year after next, nearly 10 million college students would see their financial aid cut by an average of more than $1,000 each.  There would be 1,600 fewer medical grants, research grants for things like Alzheimer’s and cancer and AIDS.  There would be 4,000 fewer scientific research grants, eliminating support for 48,000 researchers, students, and teachers.  Investments in clean energy technologies that are helping us reduce our dependence on foreign oil would be cut by nearly a fifth.

If this budget becomes law and the cuts were applied evenly, starting in 2014, over 200,000 children would lose their chance to get an early education in the Head Start program.  Two million mothers and young children would be cut from a program that gives them access to healthy food.  There would be 4,500 fewer federal grants at the Department of Justice and the FBI to combat violent crime, financial crime, and help secure our borders.  Hundreds of national parks would be forced to close for part or all of the year.  We wouldn’t have the capacity to enforce the laws that protect the air we breathe, the water we drink, or the food that we eat.

Cuts to the FAA would likely result in more flight cancellations, delays, and the complete elimination of air traffic control services in parts of the country.  Over time, our weather forecasts would become less accurate because we wouldn’t be able to afford to launch new satellites.  And that means governors and mayors would have to wait longer to order evacuations in the event of a hurricane.

That’s just a partial sampling of the consequences of this budget.  Now, you can anticipate Republicans may say, well, we’ll avoid some of these cuts — since they don’t specify exactly the cuts that they would make.  But they can only avoid some of these cuts if they cut even deeper in other areas.  This is math.  If they want to make smaller cuts to medical research that means they’ve got to cut even deeper in funding for things like teaching and law enforcement.  The converse is true as well.  If they want to protect early childhood education, it will mean further reducing things like financial aid for young people trying to afford college.

Perhaps they will never tell us where the knife will fall — but you can be sure that with cuts this deep, there is no secret plan or formula that will be able to protect the investments we need to help our economy grow.

This is not conjecture.  I am not exaggerating.  These are facts.  And these are just the cuts that would happen the year after next.

If this budget became law, by the middle of the century, funding for the kinds of things I just mentioned would have to be cut by about 95 percent.  Let me repeat that.  Those categories I just mentioned we would have to cut by 95 percent.  As a practical matter, the federal budget would basically amount to whatever is left in entitlements, defense spending, and interest on the national debt — period.  Money for these investments that have traditionally been supported on a bipartisan basis would be practically eliminated.

And the same is true for other priorities like transportation, and homeland security, and veterans programs for the men and women who have risked their lives for this country.  This is not an exaggeration.  Check it out yourself.

And this is to say nothing about what the budget does to health care.  We’re told that Medicaid would simply be handed over to the states — that’s the pitch:  Let’s get it out of the central bureaucracy.  The states can experiment.  They’ll be able to run the programs a lot better.  But here’s the deal the states would be getting.  They would have to be running these programs in the face of the largest cut to Medicaid that has ever been proposed — a cut that, according to one nonpartisan group, would take away health care for about 19 million Americans — 19 million.

Who are these Americans?  Many are someone’s grandparents who, without Medicaid, won’t be able to afford nursing home care without Medicaid.  Many are poor children.  Some are middle-class families who have children with autism or Down’s Syndrome.  Some are kids with disabilities so severe that they require 24-hour care.  These are the people who count on Medicaid.

Then there’s Medicare.  Because health care costs keep rising and the Baby Boom generation is retiring, Medicare, we all know, is one of the biggest drivers of our long-term deficit.  That’s a challenge we have to meet by bringing down the cost of health care overall so that seniors and taxpayers can share in the savings.

But here’s the solution proposed by the Republicans in Washington, and embraced by most of their candidates for president:  Instead of being enrolled in Medicare when they turn 65, seniors who retire a decade from now would get a voucher that equals the cost of the second cheapest health care plan in their area.  If Medicare is more expensive than that private plan, they’ll have to pay more if they want to enroll in traditional Medicare.  If health care costs rise faster than the amount of the voucher — as, by the way, they’ve been doing for decades — that’s too bad.  Seniors bear the risk.  If the voucher isn’t enough to buy a private plan with the specific doctors and care that you need, that’s too bad.

So most experts will tell you the way this voucher plan encourages savings is not through better care at cheaper cost.  The way these private insurance companies save money is by designing and marketing plans to attract the youngest and healthiest seniors — cherry-picking — leaving the older and sicker seniors in traditional Medicare, where they have access to a wide range of doctors and guaranteed care.  But that, of course, makes the traditional Medicare program even more expensive, and raise premiums even further.

The net result is that our country will end up spending more on health care, and the only reason the government will save any money — it won’t be on our books — is because we’ve shifted it to seniors.  They’ll bear more of the costs themselves.  It’s a bad idea, and it will ultimately end Medicare as we know it.

Now, the proponents of this budget will tell us we have to make all these draconian cuts because our deficit is so large; this is an existential crisis, we have to think about future generations, so on and so on.  And that argument might have a shred of credibility were it not for their proposal to also spend $4.6 trillion over the next decade on lower tax rates.

We’re told that these tax cuts will supposedly be paid for by closing loopholes and eliminating wasteful deductions.  But the Republicans in Congress refuse to list a single tax loophole they are willing to close.  Not one.  And by the way, there is no way to get even close to $4.6 trillion in savings without dramatically reducing all kinds of tax breaks that go to middle-class families — tax breaks for health care, tax breaks for retirement, tax breaks for homeownership.

Meanwhile, these proposed tax breaks would come on top of more than a trillion dollars in tax giveaways for people making more than $250,000 a year.  That’s an average of at least $150,000 for every millionaire in this country — $150,000.

Let’s just step back for a second and look at what $150,000 pays for:  A year’s worth of prescription drug coverage for a senior citizen.  Plus a new school computer lab.  Plus a year of medical care for a returning veteran.  Plus a medical research grant for a chronic disease.  Plus a year’s salary for a firefighter or police officer.  Plus a tax credit to make a year of college more affordable.  Plus a year’s worth of financial aid.  One hundred fifty thousand dollars could pay for all of these things combined — investments in education and research that are essential to economic growth that benefits all of us.  For $150,000, that would be going to each millionaire and billionaire in this country.  This budget says we’d be better off as a country if that’s how we spend it.

This is supposed to be about paying down our deficit?  It’s laughable.

The bipartisan Simpson-Bowles commission that I created — which the Republicans originally were for until I was for it — that was about paying down the deficit.  And I didn’t agree with all the details.  I proposed about $600 billion more in revenue and $600 billion — I’m sorry — it proposed about $600 billion more in revenue and about $600 billion more in defense cuts than I proposed in my own budget.  But Bowles-Simpson was a serious, honest, balanced effort between Democrats and Republicans to bring down the deficit.  That’s why, although it differs in some ways, my budget takes a similarly balanced approach:  Cuts in discretionary spending, cuts in mandatory spending, increased revenue.

This congressional Republican budget is something different altogether.  It is a Trojan Horse.  Disguised as deficit reduction plans, it is really an attempt to impose a radical vision on our country.  It is thinly veiled social Darwinism.  It is antithetical to our entire history as a land of opportunity and upward mobility for everybody who’s willing to work for it; a place where prosperity doesn’t trickle down from the top, but grows outward from the heart of the middle class.  And by gutting the very things we need to grow an economy that’s built to last  — education and training, research and development, our infrastructure — it is a prescription for decline.

And everybody here should understand that because there’s very few people here who haven’t benefitted at some point from those investments that were made in the ’50s and the ’60s and the ’70s and the ’80s.  That’s part of how we got ahead.  And now, we’re going to be pulling up those ladders up for the next generation?

So in the months ahead, I will be fighting as hard as I know how for this truer vision of what the United States of America is all about.  Absolutely, we have to get serious about the deficit. And that will require tough choices and sacrifice.  And I’ve already shown myself willing to make these tough choices when I signed into law the biggest spending cut of any President in recent memory.  In fact, if you adjust for the economy, the Congressional Budget Office says the overall spending next year will be lower than any year under Ronald Reagan.

And I’m willing to make more of those difficult spending decisions in the months ahead.  But I’ve said it before and I’ll say it again — there has to be some balance.  All of us have to do our fair share.

I’ve also put forward a detailed plan that would reform and strengthen Medicare and Medicaid.  By the beginning of the next decade, it achieves the same amount of annual health savings as the plan proposed by Simpson-Bowles — the Simpson-Bowles commission, and it does so by making changes that people in my party haven’t always been comfortable with.  But instead of saving money by shifting costs to seniors, like the congressional Republican plan proposes, our approach would lower the cost of health care throughout the entire system.  It goes after excessive subsidies to prescription drug companies.  It gets more efficiency out of Medicaid without gutting the program.  It asks the very wealthiest seniors to pay a little bit more.  It changes the way we pay for health care — not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to improve their results.

And it slows the growth of Medicare costs by strengthening an independent commission — a commission not made up of bureaucrats from government or insurance companies, but doctors and nurses and medical experts and consumers, who will look at all the evidence and recommend the best way to reduce unnecessary health care spending while protecting access to the care that the seniors need.

We also have a much different approach when it comes to taxes — an approach that says if we’re serious about paying down our debt, we can’t afford to spend trillions more on tax cuts for folks like me, for wealthy Americans who don’t need them and weren’t even asking for them, and that the country cannot afford. At a time when the share of national income flowing to the top 1 percent of people in this country has climbed to levels last seen in the 1920s, those same folks are paying taxes at one of the lowest rates in 50 years.  As both I and Warren Buffett have pointed out many times now, he’s paying a lower tax rate than his secretary.  That is not fair.  It is not right.

And the choice is really very simple.  If you want to keep these tax rates and deductions in place — or give even more tax breaks to the wealthy, as the Republicans in Congress propose — then one of two things happen:  Either it means higher deficits, or it means more sacrifice from the middle class.  Seniors will have to pay more for Medicare.  College students will lose some of their financial aid.  Working families who are scraping by will have to do more because the richest Americans are doing less.  I repeat what I’ve said before:  That is not class warfare, that is not class envy, that is math.

If that’s the choice that members of Congress want to make, then we’re going to make sure every American knows about it.  In a few weeks, there will be a vote on what we’ve called the Buffett Rule.  Simple concept:  If you make more than a million dollars a year — not that you have a million dollars — if you make more than a million dollars annually, then you should pay at least the same percentage of your income in taxes as middle-class families do.  On the other hand, if you make under $250,000 a year — like 98 percent of American families do — then your taxes shouldn’t go up.  That’s the proposal.

Now, you’ll hear some people point out that the Buffett Rule alone won’t raise enough revenue to solve our deficit problems.  Maybe not, but it’s definitely a step in the right direction.  And I intend to keep fighting for this kind of balance and fairness until the other side starts listening, because I believe this is what the American people want.  I believe this is the best way to pay for the investments we need to grow our economy and strengthen the middle class.  And by the way, I believe it’s the right thing to do.

This larger debate that we will be having and that you will be covering in the coming year about the size and role of government, this debate has been with us since our founding days. And during moments of great challenge and change, like the ones that we’re living through now, the debate gets sharper; it gets more vigorous.  That’s a good thing.  As a country that prizes both our individual freedom and our obligations to one another, this is one of the most important debates that we can have.

But no matter what we argue or where we stand, we have always held certain beliefs as Americans.  We believe that in order to preserve our own freedoms and pursue our own happiness, we can’t just think about ourselves.  We have to think about the country that made those liberties possible.  We have to think about our fellow citizens with whom we share a community.  We have to think about what’s required to preserve the American Dream for future generations.

And this sense of responsibility — to each other and our country — this isn’t a partisan feeling.  This isn’t a Democratic or Republican idea.  It’s patriotism.  And if we keep that in mind, and uphold our obligations to one another and to this larger enterprise that is America, then I have no doubt that we will continue our long and prosperous journey as the greatest nation on Earth.

Thank you.  God bless you.  God bless the United States of America.  (Applause.)  Thank you.

MR. SINGLETON:  Thank you, Mr. President.  We appreciate so much you being with us today.  I have some questions from the audience, which I will ask — and I’ll be more careful than I was last time I did this.

Republicans have been sharply critical of your budget ideas as well.  What can you say to the Americans who just want both sides to stop fighting and get some work done on their behalf?

THE PRESIDENT:  Well, I completely understand the American people’s frustrations, because the truth is that these are eminently solvable problems.  I know that Christine Lagarde is here from the IMF, and she’s looking at the books of a lot of other countries around the world.  The kinds of challenges they face fiscally are so much more severe than anything that we confront — if we make some sensible decisions.

So the American people’s impulses are absolutely right.  These are solvable problems if people of good faith came together and were willing to compromise.  The challenge we have right now is that we have on one side, a party that will brook no compromise.  And this is not just my assertion.  We had presidential candidates who stood on a stage and were asked, “Would you accept a budget package, a deficit reduction plan, that involved $10 of cuts for every dollar in revenue increases?” Ten-to-one ratio of spending cuts to revenue.  Not one of them raised their hand.

Think about that.  Ronald Reagan, who, as I recall, is not accused of being a tax-and-spend socialist, understood repeatedly that when the deficit started to get out of control, that for him to make a deal he would have to propose both spending cuts and tax increases.  Did it multiple times.  He could not get through a Republican primary today.

So let’s look at Bowles-Simpson.  Essentially, my differences with Bowles-Simpson were I actually proposed less revenue and slightly lower defense spending cuts.  The Republicans want to increase defense spending and take in no revenue, which makes it impossible to balance the deficit under the terms that Bowles-Simpson laid out — unless you essentially eliminate discretionary spending.  You don’t just cut discretionary spending.  Everything we think of as being pretty important — from education to basic science and research to transportation spending to national parks to environmental protection — we’d essentially have to eliminate.

I guess another way of thinking about this is — and this bears on your reporting.  I think that there is oftentimes the impulse to suggest that if the two parties are disagreeing, then they’re equally at fault and the truth lies somewhere in the middle, and an equivalence is presented — which reinforces I think people’s cynicism about Washington generally.  This is not one of those situations where there’s an equivalence.  I’ve got some of the most liberal Democrats in Congress who were prepared to make significant changes to entitlements that go against their political interests, and who said they were willing to do it.  And we couldn’t get a Republican to stand up and say, we’ll raise some revenue, or even to suggest that we won’t give more tax cuts to people who don’t need them.

And so I think it’s important to put the current debate in some historical context.  It’s not just true, by the way, of the budget.  It’s true of a lot of the debates that we’re having out here.

Cap and trade was originally proposed by conservatives and Republicans as a market-based solution to solving environmental problems.  The first President to talk about cap and trade was George H.W. Bush.  Now you’ve got the other party essentially saying we shouldn’t even be thinking about environmental protection; let’s gut the EPA.

Health care, which is in the news right now — there’s a reason why there’s a little bit of confusion in the Republican primary about health care and the individual mandate since it originated as a conservative idea to preserve the private marketplace in health care while still assuring that everybody got covered, in contrast to a single-payer plan.  Now, suddenly, this is some socialist overreach.

So as all of you are doing your reporting, I think it’s important to remember that the positions I’m taking now on the budget and a host of other issues, if we had been having this discussion 20 years ago, or even 15 years ago, would have been considered squarely centrist positions.  What’s changed is the center of the Republican Party.  And that’s certainly true with the budget.

MR. SINGLETON:  Mr. President, the managing director of the (inaudible) for continuation of United States leadership (inaudible) economic issues, and underscored the need for a lower deficit and lower debt.  How can you respond to that claim?

THE PRESIDENT:  Well, look, she’s absolutely right.  It’s interesting, when I travel around the world at these international fora — and I’ve said this before — the degree to which America is still the one indispensable nation, the degree to which, even as other countries are rising and their economies are expanding, we are still looked to for leadership, for agenda setting — not just because of our size, not just because of our military power, but because there is a sense that unlike most superpowers in the past, we try to set out a set of universal rules, a set of principles by which everybody can benefit.

And that’s true on the economic front as well.  We continue to be the world’s largest market, an important engine for economic growth.  We can’t return to a time when by simply borrowing and consuming, we end up driving global economic growth.

I said this a few months after I was elected at the first G20 summit.  I said the days when Americans using their credit cards and home equity loans finance the rest of the world’s growth by taking in imports from every place else — those days are over.  On the other hand, we continue to be a extraordinarily important market and foundation for global economic growth.

We do have to take care of our deficits.  I think Christine has spoken before, and I think most economists would argue as well, that the challenge when it comes to our deficits is not short-term discretionary spending, which is manageable.  As I said before and I want to repeat, as a percentage of our GDP, our discretionary spending — all the things that the Republicans are proposing cutting — is actually lower than it’s been since Dwight Eisenhower.  There has not been some massive expansion of social programs, programs that help the poor, environmental programs, education programs.  That’s not our problem.

Our problem is that our revenue has dropped down to between 15 and 16 percent — far lower than it has been historically, certainly far lower than it was under Ronald Reagan — at the same time as our health care costs have surged, and our demographics mean that there is more and more pressure being placed on financing our Medicare, Medicaid and Social Security programs.

So at a time when the recovery is still gaining steam, and unemployment is still very high, the solution should be pretty apparent.  And that is even as we continue to make investments in growth today — for example, putting some of our construction workers back to work rebuilding schools and roads and bridges, or helping states to rehire teachers at a time when schools are having a huge difficulty retaining quality teachers in the classroom — all of which would benefit our economy, we focus on a long-term plan to stabilize our revenues at a responsible level and to deal with our health care programs in a responsible way.  And that’s exactly what I’m proposing.

And what we’ve proposed is let’s go back, for folks who are making more than $250,000 a year, to levels that were in place during the Clinton era, when wealthy people were doing just fine, and the economy was growing a lot stronger than it did after they were cut.  And let’s take on Medicare and Medicaid in a serious way — which is not just a matter of taking those costs off the books, off the federal books, and pushing them onto individual seniors, but let’s actually reduce health care costs.  Because we spend more on health care with not as good outcomes as any other advanced, developed nation on Earth.

And that would seem to be a sensible proposal.  The problem right now is not the technical means to solve it.  The problem is our politics.  And that’s part of what this election and what this debate will need to be about, is, are we, as a country, willing to get back to common-sense, balanced, fair solutions that encourage our long-term economic growth and stabilize our budget.  And it can be done.

One last point I want to make, Dean, that I think is important, because it goes to the growth issue.  If state and local government hiring were basically on par to what our current recovery — on par to past recoveries, the unemployment rate would probably be about a point lower than it is right now.  If the construction industry were going through what we normally go through, that would be another point lower.  The challenge we have right now — part of the challenge we have in terms of growth has to do with the very specific issues of huge cuts in state and local government, and the housing market still recovering from this massive bubble.  And that — those two things are huge headwinds in terms of growth.

I say this because if we, for example, put some of those construction workers back to work, or we put some of those teachers back in the classroom, that could actually help create the kind of virtuous cycle that would bring in more revenues just because of economic growth, would benefit the private sector in significant ways.  And that could help contribute to deficit reduction in the short term, even as we still have to do these important changes to our health care programs over the long term.

MR. SINGLETON:  Mr. President, you said yesterday that it would be unprecedented for a Supreme Court to overturn laws passed by an elected Congress.  But that is exactly what the Court has done during its entire existence.  If the Court were to overturn individual mandate, what would you do, or propose to do, for the 30 million people who wouldn’t have health care after that ruling?

THE PRESIDENT:  Well, first of all, let me be very specific. We have not seen a Court overturn a law that was passed by Congress on a economic issue, like health care, that I think most people would clearly consider commerce — a law like that has not been overturned at least since Lochner.  Right?  So we’re going back to the ’30s, pre New Deal.

And the point I was making is that the Supreme Court is the final say on our Constitution and our laws, and all of us have to respect it, but it’s precisely because of that extraordinary power that the Court has traditionally exercised significant restraint and deference to our duly elected legislature, our Congress.  And so the burden is on those who would overturn a law like this.

Now, as I said, I expect the Supreme Court actually to recognize that and to abide by well-established precedence out there.  I have enormous confidence that in looking at this law, not only is it constitutional, but that the Court is going to exercise its jurisprudence carefully because of the profound power that our Supreme Court has.  As a consequence, we’re not spending a whole bunch of time planning for contingencies.

What I did emphasize yesterday is there is a human element to this that everybody has to remember.  This is not an abstract exercise.  I get letters every day from people who are affected by the health care law right now, even though it’s not fully implemented.  Young people who are 24, 25, who say, you know what, I just got diagnosed with a tumor.  First of all, I would not have gone to get a check-up if I hadn’t had health insurance. Second of all, I wouldn’t have been able to afford to get it treated had I not been on my parent’s plan.  Thank you and thank Congress for getting this done.

I get letters from folks who have just lost their job, their COBRA is running out.  They’re in the middle of treatment for colon cancer or breast cancer, and they’re worried when their COBRA runs out, if they’re still sick, what are they going to be able to do because they’re not going to be able to get health insurance.

And the point I think that was made very ably before the Supreme Court, but I think most health care economists who have looked at this have acknowledged, is there are basically two ways to cover people with preexisting conditions or assure that people can always get coverage even when they had bad illnesses.  One way is the single-payer plan — everybody is under a single system, like Medicare.  The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room.

That doesn’t work, and so, as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.

So I don’t anticipate the Court striking this down.  I think they take their responsibilities very seriously.  But I think what’s more important is for all of us, Democrats and Republicans, to recognize that in a country like ours — the wealthiest, most powerful country on Earth — we shouldn’t have a system in which millions of people are at risk of bankruptcy because they get sick, or end up waiting until they do get sick and then go to the emergency room, which involves all of us paying for it.

MR. SINGLETON:  Mr. President, you’ve been very, very generous with your time, and we appreciate very much you being here.

THE PRESIDENT:  Thank you so much, everybody.  (Applause.)  Thank you.—

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In the Supreme Court’s hearings this week on the constitutionality of the Affordable Care Act, a surprising variety of ridiculous and small minded thinking was put on display by some of the justices. Antonin Scalia who is for some reason described as an intellectual (just as Moon Unit Gingrich is…”intellectual” must be Republican for “crazy”), tried to argue that universal health care is a slippery slope to government enforced broccoli.

Now, any right wing brain-damaged ideologue would agree that the national health insurance market is identical to a supermarket in that each have the word “market” in them. Otherwise, for those of us not required to take anti-psychotic medication, the idea that having universal health insurance (as nearly all other western nations have) is comparable to or a slippery slope to a vegan tyranny, is quite insane. It would be fascinating to hear Scalia’s explanation of how European countries, Japan and other nations throughout the world have been able to provide health care to all while somehow avoiding the natural progression to broccogeddon.

Poor Samuel Alito, he had such high hopes for his inanity taking the gold medal for the Conclusion High Jump in this Special Session Olympics but Scalia’s years of petrifying his brain into a hard and impenetrable substance similar to a stale Abba Zabba bar, forced him to settle for the silver.

Alito did try his best though when he said:

“I don’t see the difference. You can get burial insurance. You can get health insurance. Most people are going to need health care. Everybody is going to be buried or cremated at some point. What’s the difference?”

His unreasoned question is hard to argue against…unless one has a high school education or better (i.e. “elitist”). As Alito points out, the burial industry, like the health insurance industry, is a crucial part of our economy and its rapidly rising costs are responsible for plunging the nation into trillions in deficits and endangering the nation’s future.

I can’t tell you how many people have been bankrupted and have lost their homes having to pay for their own sudden burial and the ongoing costs of remaining dead which could grow into hundreds of thousands and even millions of dollars. Really, I can’t tell you.

In fact, the argument Alito advances, that the burial industry could be bankrupted by people only paying for burials AFTER they die, does hold water…like the Titanic. Using Alito’s logic, if universal health care was upheld, then wouldn’t government have the power to insist that burials be paid for by people who are alive so that those who have been more responsible and died first, don’t have to deal with higher burial costs on top of being dead?

Samuel Alito isn’t taking his loss to Scalia on moronic rationalizing lying down. In fact, anticipating that the US may eventually pass an Affordable Casket Act, he has invested in his own new startup, “Caskets R’ Us!”.

Putting a fresh spin on the burial business, Alito’s Caskets R Us creates custom caskets for the deceased, in the shapes of objects most associated with the deceased. Here are a few samples from their brochure that use well known Republican figures as potential clients:

Rush Limbaugh’s Casket

Mitt Romney’s Casket

 Antonin Scalia’s Casket

The Koch Brothers’ Caskets

John Boehner’s Casket

If you have any casket suggestions, Sam Alito and Caskets R Us invite you to post them below and you’ll be entered in a drawing for your own custom casket (free custom casket certificate expires in 90 days so act now!).

(BTW, props or blame go to Chernynkaya for encouraging me to write this post!)

The Core of this challenge is whether the Mandate that everyone have health insurance is constitutional. There are secondary issues, but this is the heart of the matter.

If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservatives. Getting everyone into the pool sharing the costs of the entire system is seen as the only way to keep costs down and maintain the insurance system. Jurists across the country are leaning slightly in favor of this as the likely outcome based on previous efforts to regulate commerce.

If the Court finds the mandate unconstitutional, do they find it severable from the rest of the law? If not, that will strike the whole ACA down. This according to the jurists seems like the least likely outcome.

If, on the other hand, they do invoke severability, the ball is back in the White House’s court. At that point the White House will have to answer this question: Can health care reform be successful without the individual mandate?

Why is the Mandate essential? First, if we don’t require everyone to buy insurance, then insurance will be disproportionately purchased by those who need it, the likely sick, making it more expensive/unaffordable. This would lead many to discontinue coverage in a continuous cycle that drives the price higher and higher until no one but the very rich can afford insurance any more and the system collapses.

Second, if a person is not covered by health insurance then any bills he/she accrues must be paid by the individual. If he/she cannot pay the bills, then civil suits are one remedy. If there are insufficient assets for a suit to be successful, then the cost is either covered by the care giver (as a loss) or by the government (in direct aid to care givers).

However, if the entire system is under-financed then the ability to continue bearing losses or covering expenses via government subsidy is at risk.

So….What happens if the Supreme Court strikes down the individual mandate but rules that severability applies? Two options. The Obama administration washes its hands of health reform, proclaiming that it can’t be done without the individual mandate because costs will rise too rapidly and the insurance system will collapse. Or the Obama Administration forges onward with a modified system.

Option one is terrible politics with the President and his Democratic allies admitting defeat on one of the defining aspects of the Obama presidency. Moreover, it would have tremendous negative implications for the future of health reform initiatives generally.

Option two looks good politically but it could destroy the health insurance market and hurt Americans in the process. If it shapes up that way it would be an example of very bad leadership and be incredibly painful.

But, could it be done in a way that demonstrates sound leadership and minimizes the pain. New evidence suggests that the pain might not be as great as many fear. Simulation models from the Kaiser Foundation and John Sheils and Randall Haught of the Lewin Group have found that health reform without the individual mandate would result in fewer people being covered and insurance premiums increasing, but things would still be better than if we did nothing at all.

According to their findings, without reform 51.6 million remain uninsured. With mandate based reform 20.7 million remain uninsured. Without the mandate but with reform continuing 28.5 million remain uninsured. Premiums without reform rise by 15.9%. Premiums with reform (but without the mandate) rise by 12.6%.

However. the CBO is not nearly as optimistic with many more uninsured and the costs much higher but there would still be some improvement. The CBO expects that axing the individual mandate will mean 44 millon insured persons and a premium increase between 14 and 16%

If the Court finds the individual mandate unconstitutional, the White House will have more actuaries and health economists crunching numbers than you can imagine and the political pressure on the GOP will increase tremendously.

How so?

If the Supreme Court finds the ACA unconstitutional in any way THEN the Obama campaign will launch an Information Campaign that will feature all the features immediately endangered by the decision. The following, the campaign would say, are now on the chopping block—-

1) …insurance companies are prohibited from imposing annual and lifetime dollar limits on essential coverage.

2) …job-based health plans and new individual plans aren’t allowed to deny or exclude coverage for children (under age 19) based on a pre-existing condition including a disability.

3) …children under age 26, covered by their parent’s insurance if it covers dependent children at all.

3) …if income is less than the equivalent of about $88,000 for a family of four today, and employment doesn’t offer affordable coverage, families may get tax credits to help pay for insurance. (THIS IS 28.6 MILLION AMERICANS, by the way)

4) …pregnancy and newborn care, along with vision and dental coverage for children, is covered in all exchange plans and new plans sold to individuals and small businesses.

ALL OF THAT GONE?

DONE AWAY WITH BY A SUPREME COURT DECISION?

And then the White House will push what WOULD HAVE BEEN IN PLACE by 2014 when public exchanges and subsidies would have expanded the number of insured tremendously, health insurance premium oversight would increase and the protections now applied to children would be expanded to cover everyone. NONE OF THAT HAPPENS IF THE LAW IS STRUCK DOWN.

IT WILL EMPHASIZE THE IMPORTANCE OF HAVING APPOINTMENTS TO THE COURT WHO ARE NOT FIRST AND FOREMOST AGENTS OF THE GOP. IT WILL EMPHASIZE THAT THE GOP HAS NO PLAN TO DEAL WITH HEALTH CARE NEEDS.

Two likely results? If that info campaign is successful, the Obama campaign will be lifted as Americans suddenly realize ALL they have lost and turn on the GOP in large numbers. The White House, buoyed by public response will push ahead with reform without the mandate demanding that Congress find a way to fund the program fully. And the Health Care Reform debates begins again.

Sources:
http://www.kevinmd.com/blog/2011/11/supreme-court-strikes-individual-mandate.html
http://www.huffingtonpost.com/2012/03/26/supreme-court-health-care-reform-affordable-care-act-obamacare_n_1379805.html
http://www.washingtonpost.com/business/affordable-care-act-provisions-get-historic-review-by-supreme-court/2012/03/26/gIQAVKNBcS_story.html
http://www.nytimes.com/2012/03/25/opinion/sunday/a-moment-of-truth-for-health-care-reform.html?_r=1&ref=affordablecareact