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
Republican Balanced Budget Amendment: The Worst Idea In Washington
Bruce Bartlett takes a look at the Balanced Budget Amendment all 47 Republicans signed their names to and pronounces it “quite possibly the stupidest constitutional amendment I think I have ever seen. It looks like it was drafted by a couple of interns on the back of a napkin.”
I think “stupid” is the wrong word. “Dangerous” is more like it. And maybe “radical.” This isn’t just a Balanced Budget Amendment. It also includes a provision saying that tax increases would require a two-thirds majority in both houses of Congress — so, it includes a provision making it harder to balance the budget — and another saying that total spending couldn’t exceed 18 percent of GDP. No allowances are made for recessions, though allowances are made for wars. Not a single year of the Bush administration would qualify as constitutional under this amendment. Nor would a single year of the Reagan administration. The Clinton administration would’ve had exactly two years in which it wasn’t in violation.
Read that again: Every single Senate Republican has endorsed a constitutional amendment that would’ve made Ronald Reagan’s fiscal policy unconstitutional. That’s how far to the right the modern GOP has swung.
But the problem isn’t simply that the proposed amendment is extreme. It’s also unworkable. The baby boomers are retiring and health costs are rising. Unless you have a way to stop one or the other from happening — and no one does — spending as a percentage of GDP is going to have to rise. This proposal doesn’t interrupt those trends. It simply refuses to acknowledge them — or, to be more generous, it rules them unconstitutional. This is the equivalent of trying to keep your kid cute by passing a law saying he’s not allowed to grow up.
Another problem: In a recession, tax revenue plummets and GDP stops growing, but spending has to be sustained, or even increased, to a) give people unemployment insurance and Medicaid and other services they need and b) keep the economy from contracting violently. This amendments includes no provisions for recessions, meaning that when the economy contracted, the government would have to contract as well. That is to say, we’re still not out of one of the deepest recessions in American history, and every Senate Republican has co-sponsored a constitutional amendment to make future recessions worse. It’s just breathtaking.
A world in which this amendment is added to the Constitution is a world in which America effectively becomes California. It’s a world where the procedural impediments to passing budgets and raising revenues are so immense that effective fiscal management is essentially impossible; it’s a world where we can’t make public investments or sustain the safety net; it’s a world where recessions are much worse than they currently are and the government has to do more of its work off-budget through regulation and gimmickry. I would like to say something positive about this proposal, say there’s some silver lining here. But there isn’t. This is economic demagoguery, and nothing more. It’s so unrealistic that it would’ve ruled all but two of the last 30 years unconstitutional, which means it’s so unrealistic that there has not yet been a Republican president who has proven it can be done. And that doesn’t just suggest it can’t be done: It suggests that when Republicans are actually in power and have control of the budget, they know perfectly well that it shouldn’t be done. They’re just pretending otherwise for the moment.
By: Ezra Klein, The Washington Post, April 1, 2011
Republican Policies Don’t Care About Poor People
I’m not saying that congressional Republicans don’t care about poor people. But they really care about rich people. So far, the policy agenda they’ve pushed has been a mixture of very expensive tax cuts for the very wealthy and very deep cuts to a lot of programs that focus on the very poor. It’s . . . curious.
Think back to the tax deal. The GOP’s demands were: 1) the extension of the Bush tax cuts for high-earners; and 2) a massive cut in the estate tax. Put together, the two items will increase the deficit by close to a trillion dollars over 10 years. If the GOP had wanted, they could’ve used that money for more tax cuts for the poor, or even the middle class. The Obama administration would’ve happily signed onto that compromise. But Republicans did not want that. If we were going to increase the deficit, we were going to do it on behalf of the wealthy.
Now they’ve moved onto deficit reduction, or at least spending cuts, and their priorities in the 2011 budget are telling. Their cuts are coming from non-defense discretionary spending. That’s a category of spending, as you can see here, that tends to focus on services to the poor, the jobless and children. Among other cuts, they’ve proposed slicing more than $1 billion off Head Start, $1.1 billion off the Public Housing Capital Fund, $752 million from the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, and $5.7 billion from Pell Grants. I could, of course, go on. Democrats have tried to widen the cuts out to other categories so their impact falls less heavily on the disadvantaged, but so far, Republicans have refused. If we’re going to cut spending, we’re going to do it on the backs of the poor.
As for the 2012 budget, we know Social Security is being left alone, and we know Medicaid — which is to say, health care for poor people — is taking a $1 trillion cut. If we’re going to reform entitlements, it seems, we’re going to start with the one that serves the poor.
It’s very difficult to argue that these programs are the most wasteful in the federal government. The Pentagon is burning through a lot more cash than Head Start. Medicare spends much more for health services than Medicaid. The mortgage-interest tax deduction is regressive, as is the deduction for employer-based health care, but as of yet, Republicans haven’t proposed reforming either. Again, I’m not saying Republicans don’t care about poor people. But so far, their policy proposals don’t. And you can’t chalk it up to an appetite for sacrifice, because for all that the GOP is asking from the poor, they’ve fought hard to protect the rich from having to make any sacrifices. So far, it’s been program cuts for the poor and tax cuts for the rich. It’s a disappointing set of priorities.
By: Ezra Klein, The Washington Post, April 1, 2011
America Is Suffering The Effects Of Short-Sighted GOP Policies
I spent much of last week in a hospital in Cincinnati with my dad. He has Parkinson’s disease, which sucks. He’s home now, with my mom, brother, and sister doing all they can to care for him. And it hit home for me that we are living not only with the consequences of a horrible disease, but also with the consequences of decisions made in Washington over the last 10 years.
Where would we be with Parkinson’s treatment if George Bush hadn’t banned federal funding of embryonic stem cell research for eight precious years? A hell of a lot further along than we are.
Would my parents, a retired educator and a small businesswoman, be struggling to pay tens of thousands of dollars in out-of-pocket prescription drug costs if back in the ’90s Republicans had allowed Medicare to negotiate drug prices? Nope.
Would their retirement savings and those of millions of others have been hit so hard by the economic collapse if there had been meaningful regulation of Wall Street? No.
You really don’t need a crystal ball to see the future. Usually a rear view mirror will do just fine. We know what shortsighted Republican policies have done to this country. The Bush years are America’s own lost decade. For my parents, these losses are profound and personal, as they are for millions of others.
Now Republicans seem determined to make this yet another decade when America treads water or risks sinking further.
Right now, Republicans are blocking any meaningful effort to reduce our dependence on foreign oil and stop climate change in order to protect big oil and some big business.
Right now, while middle class families struggle mightily, Republicans are all about the mighty–going to the mat to preserve tax breaks for the wealthy and loopholes that let corporations pay literally zero taxes.
Right now, budget cuts are being demanded that will provide fewer children with Head Start, cut college loans, and gut Social Security and Medicare.
And right now, somewhere in America, a husband, a father, a mother, a wife is being told they have Parkinson’s. President Obama lifted the Bush ban soon after taking office, but we’ll never get those eight years back. For many of those suffering with Parkinson’s and other diseases that stem cell research could help, the stroke of George Bush’s pen signed away a measure of hope.
Past is precedent. We know our dependence on oil is killing us, so let’s start doing what we must now to end it. We know what happens in the future when kids get shut out of Head Start now, so let’s not do it. We know tax breaks for large corporations and the wealthy won’t strengthen the economy (we’ve tried that), so let’s repeal them. We know Social Security and Medicare will continue to be lifelines for millions, so let’s not cut them.
The hard-won historic change of the last two years has only just begun to undo the damage of the preceding eight. There is no turning back. We haven’t got a decade to lose. Because we know the wrong policies have real casualties.
My dad is one of them.
By: Greg Pinelo, U.S. News and World Report, March 31, 2011
Congressional Budget Proposals And Why We’re Fasting
I stopped eating on Monday and joined around 4,000 other people in a fast to call attention to Congressional budget proposals that would make huge cuts in programs for the poor and hungry.
By doing so, I surprised myself; after all, I eat for a living. But the decision was easy after I spoke last week with David Beckmann, a reverend who is this year’s World Food Prize laureate. Our conversation turned, as so many about food do these days, to the poor.
Who are — once again — under attack, this time in the House budget bill, H.R. 1. The budget proposes cuts in the WIC program (which supports women, infants and children), in international food and health aid (18 million people would be immediately cut off from a much-needed food stream, and 4 million would lose access to malaria medicine) and in programs that aid farmers in underdeveloped countries. Food stamps are also being attacked, in the twisted “Welfare Reform 2011” bill. (There are other egregious maneuvers in H.R. 1, but I’m sticking to those related to food.)
These supposedly deficit-reducing cuts — they’d barely make a dent — will quite literally cause more people to starve to death, go to bed hungry or live more miserably than are doing so now. And: The bill would increase defense spending.
Beckmann, who is president of Bread for the World, made me want to join in just by talking about his commitment. For me, the fast is a way to demonstrate my interest in this fight, as well as a way to remind myself and others that there are bigger things in life than dinner. (Shocking, I know.) I expect I’ll learn something about patience and fortitude while I’m at it. Thirty-six hours into the fast, my senses are heightened and everything feels a bit strange. Odors from the cafeteria a floor away drift down to my desk. In the elevator, I can smell a muffin; on the street, I can smell everything — good and bad. But as hungry as I may get, we know I’ll eat well soon. (Please check my blog for a progress report.)
Many poor people don’t have that option, and Beckmann and his co-organizers are calling for God to create a “circle of protection” around them. Some are fasting for a day, many for longer. (I’m fasting until Friday, and Beckmann until Monday. And, no, it’s not too late to join us.)
When I reminded Beckmann that poor people’s hunger was hardly a new phenomenon, and that God hasn’t made a confirmed appearance recently — at least that I know of — he suggested I read Isaiah 58, in which God says that if we were more generous while we fasted he’d treat us better. Maybe. But a billion people are just as hungry, human, and as deserving now as the Israelites were when they were fleeing Egypt, and I don’t see any manna.
This isn’t about skepticism, however; it’s about ironies and outrages. In 2010, corporate profits grew at their fastest rate since 1950, and we set records in the number of Americans on food stamps. The richest 400 Americans have more wealth than half of all American households combined, the effective tax rate on the nation’s richest people has fallen by about half in the last 20 years, and General Electric paid zero dollars in U.S. taxes on profits of more than $14 billion. Meanwhile, roughly 45 million Americans spend a third of their posttax income on food — and still run out monthly — and one in four kids goes to bed hungry at least some of the time.
It’s those people whom Beckmann and his allies (more than 30 organizations are on board) are trying to protect. The coalition may be a bit too quick to support deficit reduction, essentially saying, “We understand the need for fiscal responsibility, but we don’t want to sacrifice the powerless, nearly voiceless poor in its name. As Beckmann knows, however, deficit reduction isn’t as important as keeping people from starving: “We shouldn’t be reducing our meager efforts for poor people in order to reduce the deficit,” he told me by phone. “They didn’t get us into this, and starving them isn’t going to get us out of it.”
This is a moral issue; the budget is a moral document. We can take care of the deficit and rebuild our infrastructure and strengthen our safety net by reducing military spending and eliminating corporate subsidies and tax loopholes for the rich. Or we can sink further into debt and amoral individualism by demonizing and starving the poor. Which side are you on?
If faith increases your motivation, that’s great, but I doubt God will intervene here. Instead, we need to gather and insist that our collective resources be used for our collective welfare, not for the wealthiest thousand or even million Americans but for a vast majority of us in the United States and, indeed, for citizens of the world who have difficulty making ends meet. Or feeding their kids.
Though Beckmann is too kind to say it, he and many other religious leaders believe that true worship can’t take place without joining this struggle: “You can’t have real religion,” he told me, “unless you work for justice for hungry and poor people.”
I don’t think you can have much humanity, either.
By: Mark Bittman, The New York Times Opinion Page, March 29, 2011
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