Pay Close Attention To The Insurers Behind Rep Paul Ryan’s Curtain
Democrats who think Paul Ryan and his Republican colleagues have foolishly wrapped their arms around the third rail of American politics by proposing to hand the Medicare program to private insurers will themselves look foolish if they take for granted that the public will always be on their side.
Rep. Ryan’s budget proposal would radically reshape both the Medicare and Medicaid programs. It would turn Medicaid into a block grant, which would give states more discretion over benefits and eligibility. And it would radically redesign Medicare, changing it from what is essentially a government-run, single-payer health plan to one in which people would choose coverage from competing private insurance firms, many of them for-profit.
Poll numbers would seem to give the Democrats the edge in what will undoubtedly be a ferocious debate over the coming months and during the 2012 campaigns. An NBC/Wall Street Journal poll (pdf) conducted February 27-28 showed that 76 percent of Americans considered cuts to Medicare unacceptable. The public is almost as resistant to cutting Medicaid, at least for now: 67 percent of Americans said they found cutting that program unacceptable as well.
According to a story in Politico this week, Democrats “with close ties to the White House” think Ryan has handed them a gift that will keep on giving. They believe the Ryan blueprint will enable them to portray Republicans as both irresponsible and heartless, hellbent on unraveling the social safety net that has protected millions of Americans for decades. That message will be the centerpiece of the Democrats’ advertising and fundraising efforts, unnamed party strategists told Politico.
Perhaps. But know this: Ryan et al would never propose such a fundamental reshaping of those programs unless they were confident that corporate America stands ready to help them sell their ideas to the public. Like big business CEOs, Congressional Republicans wouldn’t think of rolling out Ryan’s budget plan without a carefully-crafted political and communications strategy and the assurance that adequate funding would be available to carry it out.
Republicans know they can rely on health insurance companies — which would attract trillions of taxpayer dollars if Ryan’s dream comes true — to help bankroll a massive campaign to sell the privatization of Medicare to the public.
The Secret Meeting, and the Secret PR Plot
Four years ago, in a secret insurance industry meeting in Philadelphia, I saw numbers that were similar to those in the NBC/Wall Street Journal poll. The industry’s pollster, Bill McInturff of Public Opinion Strategies, told insurance company executives, who had assembled to begin planning a campaign to shape the health care reform debate, that Americans were rapidly losing confidence in the private health insurance market.
For the first time ever, he said, more than 50 percent of Americans believed that the government should do more to solve the many problems that plagued the U.S. health care system. In fact, he said, a fast-growing percentage of Americans were embracing the idea of a government run “Medicare-for-All” type program to replace private insurers.
The executives came to realize at the meeting that the industry’s very survival depended upon the successful execution of a comprehensive campaign to change public attitudes toward private insurers. They needed to convince Americans they “added value” to the health care system, and that what the public should fear would be more government control.
Knowing that a campaign publicly identified with the industry would have little credibility, the executives endorsed a strategy that would use their business and political allies — and front groups — as messengers.
The main front group was Health Care America. It was set up and operated out of the Washington PR firm APCO Worldwide. The first objective was to discredit Michael Moore’s documentary, Sicko, which was about to hit movie screens nationwide. Moore’s film compared the U.S. health care system to those in countries that had “Medicare-for-All” type programs run by governments. The American system, dominated by private insurers, did not fare well in Moore’s cinematic interpretation.
The front group painted Moore as a socialist but also went about the larger task of scaring the public away from “a government takeover of the health care system.” Part of that work involved persuading Americans that any reform bill expanding Medicare or including a “public option” would represent a government takeover.
The industry knew it had to enlist the support of longtime allies such as the U.S. Chamber of Commerce, the National Federation of Independent Business and the National Association of Health Underwriters to repeat the term “government takeover” like a mantra. It also had to get conservative talk show hosts, pundits and politicians to play along. And play along they did. In the debate preceding one key House vote involving a public option, a parade of Republicans took to the floor to repeat the industry’s favorite term: government takeover.
To help make sure the term stuck, America’s Health Insurance Plans (AHIP), the insurers’ lobbying group, funneled $86 million to the Chamber of Commerce to help finance its advertising and PR campaign against any reform legislation that included the public option. It worked like a charm. Polls showed during the course of the debate that public opinion was increasingly turning against the Democrats’ vision of reform. By the time the bill reached President Obama in March 2010, the public option had been stripped out, and public support for reform was well below 50 percent.
“Government Takeover of Health Care”: 2010’s Lie of the Year, Courtesy of Insurers
As a testament to the success of the industry’s campaign, PolitiFact, the St. Petersburg Times’ independent fact-checking website, chose “a government takeover of health care” as its Lie of the Year in 2010. (The 2009 Lie of the Year was the fabrication that the Democrats’ reform bill would create Medicare “death panels.”)
While they were leading the effort to torpedo the public option, the insurers were lobbying hard for a provision in the bill requiring all of us to buy coverage from them if we’re not eligible for a public program like Medicare or Medicaid. They won that round, too. That provision alone will guarantee billions of dollars in revenue the insurers would never have seen had it not been for the bill the president signed.
But even that is not enough for the insurers. For many years, they’ve lobbied quietly for privatization of Medicare, with significant success. They were behind the change in the Medicare program in the 1980s that allowed insurers to offer what are now called “Medicare Advantage” plans. The federal government not only pays private insurers to market and operate these plans, it pays them an 11 percent bonus. That’s right: People enrolled in Medicare Advantage plans cost the taxpayers 11 percent more than people enrolled in the basic Medicare program.
During the Bush administration, the insurers persuaded lawmakers to allow them to administer the new Medicare Part D prescription drug program. That has been a major source of new income for the many big for-profit insurers that participate in the program.
Rest assured that insurers have promised Ryan and his colleagues a massive, industry-financed PR and advertising campaign to support his proposed corporate takeover of Medicare. If Democratic strategists really believe that Ryan has all but guaranteed the GOP’s demise by proposing to shred the social safety net for some of our most vulnerable citizens, they will soon be rudely disabused of that notion. The insurers and their allies have demonstrated time and again that they can persuade Americans to think and act — and vote — against their own best interests.
By: Wendell Potter, Center for Media and Democracy, April 7, 2011
The Efficacy Of A Republican Hostage Strategy
Matt Yglesias offered a helpful reminder this morning about leverage.
Details on the appropriations deal are still hard to come by, but you don’t need the details to know that substantial short-term cuts in domestic discretionary spending will hurt the poor while harming macroeconomic performance. The problem with not agreeing to the deal, of course, is that a government shutdown would also hurt the poor while harming macroeconomic performance.
If you genuinely don’t care about the interests of poor people and stand to benefit electorally from weak economic growth, this gives you a very strong hand to play as a hostage taker. And John Boehner is willing to play that hand.
Right. A hostage strategy works well when the hostage taker makes it clear that killing the hostage is a perfectly viable option.
In this case, President Obama knew he was facing an unpleasant choice: accept spending cuts, which would hurt working families and undermine the economy, or allow Republicans to shut down the government, which would hurt working families and undermine the economy. As much as I really don’t like the agreement reached last night, I’m not unsympathetic to the dilemma.
But it’s worth appreciating the dynamic itself. The moment it was clear that the White House and congressional Democrats were determined to avert a shutdown, and congressional Republicans saw a shutdown as a reasonable, if not attractive, option — one that their base would celebrate — the rules of the game were already written to guarantee a discouraging result.
By some measures, Dems entered the process with the better hand. Democrats not only had the White House and the Senate majority, but polls showed the American mainstream opposed to the GOP agenda. But they also made clear that they were ready to make concessions — because they were determined to save that hostage, and Republicans didn’t much care either way.
Or as Greg Sargent put it this morning, “Republicans knew full well that the White House wouldn’t allow a government shutdown, allowing them to continue to move the spending-cut goalposts in the knowledge that Dems would follow — again ensuring that the debate unfolded on the GOP’s turf.”
The variable here would, ideally, be electoral considerations — Republicans wouldn’t kill the hostage because they’d be afraid of a voter backlash, creating a built-in incentive for the GOP to act responsibly. In theory, this gives Dems at least some leverage, too — “If you shut down the government, we’ll blame you and you’ll lose in 2012.”
So why doesn’t that work more? Probably because Republicans know that news organizations feel obligated to blame “both sides” at all times for everything, enough so that the GOP is willing to take its chances. Besides, even if they are blame, GOP officials can count on the party, the Koch Brothers, and Karl Rove to run a bunch of attack ads that will help them stay in office in anyway.
Ludicrous and Cruel: America Is Being Punked By GOP Voodoo Economics
Many commentators swooned earlier this week after House Republicans, led by the Budget Committee chairman, Paul Ryan, unveiled their budget proposals. They lavished praise on Mr. Ryan, asserting that his plan set a new standard of fiscal seriousness.
Well, they should have waited until people who know how to read budget numbers had a chance to study the proposal. For the G.O.P. plan turns out not to be serious at all. Instead, it’s simultaneously ridiculous and heartless.
How ridiculous is it? Let me count the ways — or rather a few of the ways, because there are more howlers in the plan than I can cover in one column.
First, Republicans have once again gone all in for voodoo economics — the claim, refuted by experience, that tax cuts pay for themselves.
Specifically, the Ryan proposal trumpets the results of an economic projection from the Heritage Foundation, which claims that the plan’s tax cuts would set off a gigantic boom. Indeed, the foundation initially predicted that the G.O.P. plan would bring the unemployment rate down to 2.8 percent — a number we haven’t achieved since the Korean War. After widespread jeering, the unemployment projection vanished from the Heritage Foundation’s Web site, but voodoo still permeates the rest of the analysis.
In particular, the original voodoo proposition — the claim that lower taxes mean higher revenue — is still very much there. The Heritage Foundation projection has large tax cuts actually increasing revenue by almost $600 billion over the next 10 years.
A more sober assessment from the nonpartisan Congressional Budget Office tells a different story. It finds that a large part of the supposed savings from spending cuts would go, not to reduce the deficit, but to pay for tax cuts. In fact, the budget office finds that over the next decade the plan would lead to bigger deficits and more debt than current law.
And about those spending cuts: leave health care on one side for a moment and focus on the rest of the proposal. It turns out that Mr. Ryan and his colleagues are assuming drastic cuts in nonhealth spending without explaining how that is supposed to happen.
How drastic? According to the budget office, which analyzed the plan using assumptions dictated by House Republicans, the proposal calls for spending on items other than Social Security, Medicare and Medicaid — but including defense — to fall from 12 percent of G.D.P. last year to 6 percent of G.D.P. in 2022, and just 3.5 percent of G.D.P. in the long run.
That last number is less than we currently spend on defense alone; it’s not much bigger than federal spending when Calvin Coolidge was president, and the United States, among other things, had only a tiny military establishment. How could such a drastic shrinking of government take place without crippling essential public functions? The plan doesn’t say.
And then there’s the much-ballyhooed proposal to abolish Medicare and replace it with vouchers that can be used to buy private health insurance.
The point here is that privatizing Medicare does nothing, in itself, to limit health-care costs. In fact, it almost surely raises them by adding a layer of middlemen. Yet the House plan assumes that we can cut health-care spending as a percentage of G.D.P. despite an aging population and rising health care costs.
The only way that can happen is if those vouchers are worth much less than the cost of health insurance. In fact, the Congressional Budget Office estimates that by 2030 the value of a voucher would cover only a third of the cost of a private insurance policy equivalent to Medicare as we know it. So the plan would deprive many and probably most seniors of adequate health care.
And that neither should nor will happen. Mr. Ryan and his colleagues can write down whatever numbers they like, but seniors vote. And when they find that their health-care vouchers are grossly inadequate, they’ll demand and get bigger vouchers — wiping out the plan’s supposed savings.
In short, this plan isn’t remotely serious; on the contrary, it’s ludicrous.
And it’s also cruel.
In the past, Mr. Ryan has talked a good game about taking care of those in need. But as the Center on Budget and Policy Priorities points out, of the $4 trillion in spending cuts he proposes over the next decade, two-thirds involve cutting programs that mainly serve low-income Americans. And by repealing last year’s health reform, without any replacement, the plan would also deprive an estimated 34 million nonelderly Americans of health insurance.
So the pundits who praised this proposal when it was released were punked. The G.O.P. budget plan isn’t a good-faith effort to put America’s fiscal house in order; it’s voodoo economics, with an extra dose of fantasy, and a large helping of mean-spiritedness.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 7, 2011
No, Rep Paul Ryan’s Budget Proposal Is Not Brave
Prominent opinion writers have spent the last few days fawning over Rep. Paul Ryan’s budget plan, which would essentially abolish Medicare and Medicaid while lowering taxes on top earners, and many of them have deployed a litany of superlatives usually reserved for costumed superheroes. Commentators like David Brooks and Jacob Weisberg have described Ryan’s plan as “brave,” and “bold,” and the word “courageous” has been ubiquitous.
But the closer people look at Ryan’s plan, the clearer it becomes that the plan isn’t all that brave. Let’s take stock of all the recent revelations about it.
Ryan’s plan included a laughably implausible unemployment analysis from Heritage predicting it would bring unemployment down to 4 percent by 2015 and 2.8 percent by 2012 — an analysis Heritage then quitely retracted by attempting to disappear it from the internet. Ryan’s plan claims to save money while repealing the Affordable Care Act, even though the CBO has said repealing the ACA will increase the deficit. Ryan implied that his plan was supported by President Bill Clinton’s former OMB Director Alice Rivlin, even though it isn’t. It cuts taxes on top earners, when the easiest way to reduce the deficit is to let the Bush tax cuts expire.
Ryan’s misleading claims aren’t the only thing that isn’t particularly brave about his plan. After accusing Democrats of “raiding” Medicare with the Affordable Care Act, Ryan spares the elderly voters who supported Republicans in 2010 by making sure only he guts medical care for future seniors (he still calls it “saving Medicare,” however). And as the Center for Budget and Policy Priorities noted, 2.9 trillion in Ryan’s budget comes from cuts in programs focused on low-income Americans. It doesn’t touch defense spending.
In other words, it focuses on cuts to programs that benefit those most likely to vote Democratic, while preserving programs that serve those more likely to vote Republican.Rewarding your constituencies while punishing the other side’s is how partisan politics usually works, but there’s nothing particularly brave about it.
Ryan himself said during the rollout that his plan isn’t so much a budget as a “cause.” As Steve Benen wrote yesterday, the cause here is destroying the modern welfare state so that rich people have to pay less in taxes. The only reason so many people think Ryan’s plan is “brave” is because they agree with this cause.
When we call a person brave, what we usually mean is that his or her “bravery” is being employed towards an end we agree with. In this case, those who are hailing Ryan’s proposal as brave are doing so because they agree with its goal, which — no matter how many times people insist otherwise — is not deficit reduction. It’s destroying the social safety net. It just so happens that’s a cause a lot of wealthy people with a disproportionate influence on our political discourse happen to believe in. So they think it’s brave, even if the numbers are phony and even if it disproportionately punishes the poor. But there’s nothing at all brave about it.
By: Adam Serwer, The Washington Post, April 7, 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
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