Round one of the season’s big budget battle is over, with no real winners. Rounds two and three—the 2012 fiscal year budget and the debt ceiling—are bound to be nastier and more difficult. And it’s not just because budget-cutting is no fun and the Hill is so partisan. It’s that we now have a new element in the war against congressional impasse: the government suicide bomber.
It used to be, in budget battles past, that there was a common element that served as both a brake on emotional decision-making and an impetus for compromise. No one wanted to stop the entire government from operating, to deny basic services to people far away, literally and figuratively, from the partisan fights on the Hill. The floor fights had personal implications, as well, with lawmakers engaging in vitriolic, in-person arguments on the floor. I have a vivid memory of former Rep. Richard Gephardt somehow managing to slam the swinging doors in frustration as he exited the House chamber during one such battle. I remember former Rep. Ron Dellums, dressed exquisitely in a tuxedo—and not in honor of the budget fight vgb—as he pleaded for progress so he could attend the wedding of one of his children. “Mr. Speaker, can I please go love my son?” the former California lawmaker said.
As bad as those days were, they at least included a human element, and a common desire to avoid hurting their constituents. Now, lawmakers rarely debate each other on the House floor—they are more likely to come to the floor, make a two- or three-minute speech, then head back to their offices or party caucus meetings. And now, just as we have learned to adapt to airline security in a post-9/11 world, we have to contend with a federal budget terrorist mindset—the camp that is prepared to bring us all down to advance a political mission. What was once an ominous threat is now a battle cry, with antigovernment, Tea Party forces gleefully yelling “shut it down!”—as though all that was needed for peace and prosperity was to send home government workers.
There is a great deal of hypocrisy in some of that crowd; Michael Fletcher smartly reports in the Washington Post about the antigovernment mood in Oklahoma, which as a state benefits greatly from federal largesse. But while worries about the federal debt and deficit are justifiable, contempt for the very existence of government—and, by extension, the democratic process—is not. Members of Congress were elected to serve in the U.S. Capitol, not blow it up.
By: Susan Milligan, U.S. News and World Report, April 11, 2011
Ezra Klein, responding to the widespread perception that Paul Ryan has a plan to tackle medical cost inflation and Democrats don’t, points out that this is the opposite of the truth:
The Affordable Care Act’s central hope is that Medicare can lead the health-care system to pay for value, cut down on overtreatment, and cut out treatments that simply don’t work. The law develops Accountable Care Organizations, in which Medicare pays one provider to coordinate all of your care successfully, rather than paying many doctors and providers to add to your care no matter the cost or outcome, as is the current practice. It also begins experimenting with bundled payments, in which Medicare pays one lump-sum for all care related to the successful treatment of a condition rather than paying for every piece of care separately. To help these reforms succeed, and to help all doctors make more cost-effective treatment decisions, the law accelerates research on which drugs and treatments are most effective, and creates and funds the Patient-Centered Outcomes Research Institute to disseminate the data.
If those initiatives work, they head over to the Independent Payment Advisory Board (IPAB), which can implement cost-controlling reforms across Medicare without congressional approval — an effort to make continuous reform the default for Medicare, even if Congress is gridlocked or focused on other matters. And if they don’t work, then it’s up to the Center for Medicare and Medicaid Innovation, a funded body that will be continually testing payment and practice reforms, to keep searching and experimenting, and when it hits on successful ideas, handing them to the IPAB to implement throughout the system.
The law also goes after bad and wasted care: It cuts payments to hospitals with high rates of re-admission, as that tends to signal care isn’t being delivered well, or isn’t being follow up on effectively. It cuts payments to hospitals for care related to infections caught in the hospitals. It develops new plans to help Medicare base its purchasing decisions on value, and new programs to help Medicaid move patients with chronic illnesses into systems that rely on the sort of maintenance-based care that’s been shown to successfully lower costs and improve outcomes.
Keep in mind that the Congressional Budget Office made the very conservative decision not to assign savings to these measures, on the assumption that since they had never been tried before, there was no way of measuring how well they would work, so it gave them no financial savings value. And the Affordable Care Act also included a limit on the tax deduction for expensive health insurance, a powerful cost-saving tool that the CBO did score.
But to zoom out for a second, what Klein’s identifying here is part of a larger phenomenon. It’s not just that the debate about health care costs seems to take place as if the ACA never happened. The entire political debate seems to take place as if the ACA never happened. Moderate liberal Jacob Weisberg lamented liberal opposition to Paul Ryan as advocating government health care for the old but nobody else — when of course we now have government-provided health insurance for everybody else (except illegal immigrants.)
The deficit hawks embrace Paul Ryan’s plan as a starting point of a debate about deficit. (David Brooks today: “Because he had the courage to take the initiative, Paul Ryan’s budget plan will be the starting point for future discussions.”) But of course the ACA was not just a starting point but an enormous stride forward. Ryan proposes to undo much of it. Yet he is the courageous leader, and his critics passive observers.
What happened? The details of the ACA’s cost-containment are wonky, and few people paid attention to them. Staunch liberals either didn’t care about cost containment, or devoted their energy to agitating for more sweeping alternatives. Moderate liberals supported the measure, but, taking their cue from policy wonks, took the very honest posture of conceding that some parts might not work as planned, and thus contributed to a massive asymmetry of passion. Centrists simply assumed that any deficit plan that wasn’t a grand bipartisan deal could not be a real deficit plan, since their fundamental premise is that a grand bipartisan deal is the only way to address the deficit. And the whole health care issue was sucked into the vortex of an unhinged debate, so that millions of conservatives understand the whole package as nothing more than an assault on freedom, with little or no grasp of the particulars.
The end result of all this is a debate around an issue with a peculiar backwards character.
By: Jonathan Chait, The New Republic, April 4, 2011
As with any election, there are competing narratives about what message the voters were sending last November when Democrats got routed in the mid-terms. Each party has offered a view on the meaning of the election. In the Democrats’ view, an economically anxious electorate was focused on jobs and repudiated Obama’s party for not delivering on job growth. In this telling, voters did not reject a liberal agenda but saw health care and other issues as diversions from their immediate pressing economic concerns. And there is some evidence to support this view: Nearly two out of three voters picked the economy as the single most important issue in deciding their vote, and Republicans won that vote. Republicans, on the other hand, argue that voters threw out Democrats in record numbers because they recoiled at incredible levels of government spending. And, indeed, some exit polling showed that voters registered their opposition to a more activist federal government: 56 percent said the government is doing too much, while only 38 percent said the government should do more to solve problems. Meanwhile, 40 percent of voters favored deficit-reduction.
Now, Republicans are intent on using their interpretation of the election to achieve their policy goals. They are offering a budget blueprint that slashes spending on Medicare and Medicaid and other government programs. Representative Paul Ryan’s plan dramatically cuts services to the middle class. As my colleague Jonathan Chait has pointed out, these cuts would be made by lowering taxes on the wealthy and corporations. The whole proposal, in other words, represents a giant redistribution of wealth away from the middle class toward the rich. As the Congressional Budget Office notes about Ryan’s plan for Medicare, for example, “most elderly people would pay more for their health care than they would pay under the current Medicare system.” What Ryan is really saying, then, is in the middle of this recession, after a decade of declining wages, the real problem in our country is that middle-class Americans have too many services and the rich have been too put upon. And he seems to think he has public support to back him up.
But are Ryan and other Republicans about to walk over quicksand, fooled by the illusion of firm ground beneath their feet after the November elections? Do Americans really want slashes to programs that serve them? Evidence suggests not—meaning Paul Ryan is teetering on the edge of a cliff, threatening to take all House Republicans down with him.
Even the Tea Party movement, whose momentum was built on outrage at government spending, seems to be waning somewhat; the movement’s rallies that once boasted huge numbers now bring only hundreds to the Capitol. As poll analyst Charlie Cook has pointed out, independents have also shifted to being more neutral toward government intervention in the economy over the last few months—from 60 percent saying the government was trying to do too much in October to only 47 percent agreeing with that idea now. (Or, seen from another angle, in the same time frame, people saying the government should do more has risen from 38 percent to 51 percent). And, perhaps even more ominous for Republicans, according to a recent Kaiser poll, 56 percent of Americans do not support any Medicare reductions, 35 percent support minor reductions, and only 8 percent support major reductions. The story is the same with Medicaid: 47 percent do not support Medicaid reductions, 39 percent support minor reductions and 13 percent support major reductions.
Dress it up as he likes, Paul Ryan is proposing to do just what polls show the American people don’t want—to shift more costs shift to individuals, including middle-class Americans. And many House Republicans agree with him, although, already, a few members are refusing to embrace the Ryan budget proposal. Politico has reported that several more vulnerable Republican members, including Blake Farenthold, Sean Duffy, and Ann Marie Buerkle, have called the plan bold, yet not embraced the details.
After every election, the victors try to define and act on their mandate. As Ryan and other Republicans rush through their effort to slash spending, however, they would do well to ask themselves whether it’s what the public really wants—or whether they’re woefully misreading the voters, and setting themselves up for disaster in the next election.
By: Neera Tanden, The New Republic, April 7, 2011