When Lies Don’t Work, Try “Bait And Switch”: What Paul Ryan’s Budget Actually Does
Paul Ryan’s plan for Medicare and Paul Ryan’s plan for Medicaid rely on the same bait-and-switch: They use a reform to disguise a cut.
In Medicare’s case, the reform is privatization. The current Medicare program would be dissolved and the next generation of seniors would choose from Medicare-certified private plans on an exchange. But that wouldn’t save money. In fact, it would cost money. As the Congressional Budget Office has said (pdf), since Medicare is cheaper than private insurance, beneficiaries will see “higher premiums in the private market for a package of benefits similar to that currently provided by Medicare.”
In Medicaid’s case, the reform is block-granting. Right now, the federal government shares Medicaid costs with the states. That means their payments increase or decrease with Medicaid’s actual rate of spending. Under a block grant system, that’d stop. They’d simply give states a lump sum at the beginning of the year and that’d have to suffice. And if a recession hits and more people need Medicaid or a nasty flu descends and lots of disabled beneficiaries end up in the hospital with pneumonia? Too bad.
In both cases, what saves money is not the reform. It’s the cut. For Medicare, the cut is that the government wouldn’t cover the full cost of the private Medicare plans, and the portion they would cover is set to shrink as time goes on. In Medicaid, the block grants are set to increase more slowly than health-care costs, which is to say, the federal government will shoulder a smaller share of the costs than it currently does. The question for both plans is the same: What happens to beneficiaries?
Remember how the Affordable Care Act was really, really, really long? There was a reason for that. It was full of delivery-system reforms meant to make the health-care system cheaper and more efficient — things like bundling payments for illnesses and reducing reimbursements to hospitals with high rates of infection and creating a center tasked with seeding cost-control experiments throughout Medicare and encouraging the formation of Accountable Care Organizations. The hope is that those reforms will cut costs, which will make the rest of the bill’s cuts possible (more on that here). Republicans, notably, have been skeptical that these reforms will work, and have argued that the cuts won’t stick because beneficiaries will revolt.
To my knowledge, Ryan’s budget doesn’t attempt to reform the medical-care sector. It just has cuts. The hope is that those cuts will force consumers to be smarter shoppers and doctors to be more economical and states to be more innovative. But all that’s been tried, and it hasn’t been enough. That’s why the Affordable Care Act had to go so much further, digging deep into the delivery system, and why Republicans had at least a plausible case that some of its cuts wouldn’t stick. But now the GOP needs to apply the same skepticism to their own programs: Cuts aren’t enough, and if they somehow manage to distract people from the cuts by repeating the words “block grants” and “flexibility” and “premium support” over and over again, they’ll simply end up seeing their cuts ignored when it becomes clear that they’ll mean leaving the old and the poor without health care. What Ryan has here isn’t so much a plan to control spending as a plan to cut spending, whatever the consequences.
By: Ezra Klein, The Washington Post, April 4, 2011
Terry Jones Koran Burning Abuses The Constitution
Efforts to pass a constitutional amendment banning flag-burning have, thankfully, not been successful. Approve an amendment banning burning of the flag, and you might as well burn the U.S. Constitution while you’re at it. That’s the point of the First Amendment; even stupid “speech” is protected.
But it’s still stupid, and stupider, still, when a previously-obscure pastor at a tiny Florida church burns a Koran.
Terry Jones, who heads the small, Gainesville, Fla., Dove World Outreach Center, warrants skepticism and suspicion aside from the Koran matter; as Kevin Sieff writes in a very thoroughly-reported piece tucked inside Monday’s Washington Post, Jones treated the church like his own “personal fiefdom,” using parishioners for unpaid work and dividing families when some members displayed less-than-full allegiance to him.
Last year, Jones threatened to burn a Koran on the anniversary of the September 11 attacks. He wisely backed off, and one would think he wouldn’t bother to rethink the idea, since he got a great deal of media attention just for talking about it. But perhaps the attention had waned too much for Jones; members of the church apparently did conduct a symbolic burning of a Koran, putting the evidence on the Internet in case news didn’t spread quickly or far enough to get a reaction.
It got a reaction, all right: More than 20 people have been killed and many more injured in three days of violent protests against the burning, which Muslims (along with sensible non-Muslims as well) rightly found offensive. Is it right to kill out of protest over a symbolic burning of a holy book? No. Was it worth it for Jones to make his little First Amendment stand by doing something that was, by definition, intended to incite anger? Ask the families of the victims of the violence that ensued from the protests.
General David Petraeus condemned the burnings, and the U.S. Senate may follow. Perhaps that is what Jones and his ilk are looking for—a chance to portray President Obama, wrongly and ridiculously, as secretly Muslim, and the saner members of Congress as sympathizers to followers of a faith many Americans don’t understand. This country was founded on a great democratic tradition, one we should be proud of showcasing to those who don’t fully understand us. Abusing the rights guaranteed in the Constitution isn’t the way to do it.
By: Susan Milligan, U.S. News and World Report, April 4, 2011
Government Shutdown: A Hostile Act Against A Civil Society By A “Band Of Rebels”
Shutting down the federal government is a hostile act against civil society.
The Civil War started 150 years ago in April 1861, and we are still getting over it, still talking about it, still writing about it. Some in the South have still not made peace with the end of the Civil War and hold fast to “heroes,” notably General Robert E. Lee. President Abraham Lincoln showed what he thought of Lee when he seized Arlington, Lee’s stately home and slave plantation across the Potomac River, and started burying the dead Union soldiers in the ground there.
Lincoln’s message could not be clearer: Leading an assault on the Union was not a Sunday picnic in the country. Serious consequences followed, hitting home.
Now we have a band of rebels—87 of them newcomers—in the House Republican majority, who are fixin’ for a fight. Spoiling to see the Capitol Dome go dark. Acting as if that’s the mission, the reason they crossed lines to come into the heart of the enemy. Washington is a staging ground for their defiant anger at the Union. The republic is under a new kind of siege.
If they have their way, the federal government will be closed this time next week, not what we need right now with so many American households hanging by a thread.
Now a few facts to concentrate the mind. First, the Tea Party is part of the problem. But hold the whole lot of House Republicans and their leaders responsible. If there are any grown-ups in the House, they are allowing their most radical element, unschooled freshmen, to dominate in a delicate showdown looming with the Senate and the White House.
Second, remember the Senate is controlled by a Democratic majority, a fact conveniently forgotten by the lower chamber, whose members often brag about the last election. The 2010 outcome was actually an evenly divided government, with a Democratic president to play his part in final outcomes, laws, and budgets. That’s the way it should be, if Senate Democrats and President Obama will only stand up to the rebels.
Third, the scope of the House Republican “defunding” demands is tantamount to waging war on our civil society as we know it. I don’t mean just NPR. Some of the priceless “commons” are at risk, in the proposed degradation of environmental programs. Social programs like family planning and women’s health are on the chopping block in an offensive against women’s health and reproductive rights. Chris Van Hollen, a House Democrat from Maryland, reads it right: Across the aisle is an extreme agenda to impose a right-wing ideology on town and country, using budget cuts as a vehicle.
Fourth and finally, whether $33 billion or $60 billion is cut from the budget, it will be too much. For the collective health of the nation, either number is like going on a diet when you’re starving. It’s really no use the two congressional chambers meeting in the middle, because the rebels can say they won the day—and they might be “right” in more ways than one. They skewed the debate by passing their draconian budget early and talking it up every day since.
What the GOP House freshmen lack in knowledge, they make up with sophomoric enthusiasm. They are so gung ho to camp out in the dark. Remembering Lincoln, don’t let the rebels take over and turn the lights out on us.
By: Jamie Stiehm, U.S. News and World Report, April 4, 2011
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