“It’s About His Vision For America’s Future”: Why Ben Carson’s Problem With The Truth Really Matters
Ben Carson’s campaign turned into a kaleidoscope of oddities last week: The retired neurosurgeon made fanciful claims about the purpose of Egyptian pyramids and the political experience of the Founding Fathers. He insisted that he was, in fact, a violent youth, but admitted that he wasn’t, in fact, offered admission to West Point—both key highlights of his autobiography. But amid all the attention being paid to his personal background, it’s easy to overlook what Carson is actually running on. Of all the GOP candidates, Carson has put forward the most radical ideas for overhauling country’s entitlement programs. And while he’s lately begun to clumsily retreat to more moderate alternatives, they don’t add up any more than his attempts to explain the factual holes in his autobiography. While his past will surely provide rich fodder for Tuesday night’s third GOP debate, it’s what Carson proposes for America’s future that truly needs more critical attention.
Carson originally proposed to scrap Medicare and Medicaid entirely—a genuinely radical idea, and one with massive policy and political risks. Under his plan, every American would receive a cradle-to-grave health savings account with an annual $2,000 government subsidy, which family members could share. But after the third debate two weeks ago, Carson began running away from that old idea, which had been coming under increasing attack by fellow Republicans, particularly Donald Trump. “Ben wants to get rid of Medicare, Trump said last week. “You can’t get rid of Medicare. It would be a horrible thing to get rid of.”
Carson has begun to roll out an alternative that avoids the political liabilities of blowing up the entire system. But his account of the changes he’s made has been as confusing as the West Point saga. A few days before the last debate, Carson was already claiming on Fox News Sunday that his original plan for entitlement reform had been “gone for several months now.” That confused host Chris Wallace, who—like most of those watching—had definitely not been under that impression. Though he remains hazy on the details, Carson’s new scheme could also be massively disruptive, not only undermining care but also running up costs for the government.
Under Carson’s new plan—at least, from what can be sussed out from his statements—the traditional government programs would stay in place, but people would have the alternative to opt out with private Health Savings Accounts they could use to purchase their own coverage. Unlike his original plan, however, not everyone would get a subsidy in this one. Many of the details remain murky, and Carson’s campaign says a full-blown proposal is forthcoming. But based on his remarks so far, Carson seems to be suggesting that if you qualify for Medicare or Medicaid, you could choose to have the government money that would have paid for your health care to go directly to a private savings account instead. “I would never get rid of the programs. I would provide people with an alternative,” Carson said on Fox News Sunday. “I think they will see that the alternative that we’re going to outline is so much better than anything else that they will flock to it.”
But Carson’s alternative could create a whole host of problems. Those who pick HSAs would likely face very high deductibles and co-pays, which could lead them to forgo necessary care. At the same time, the cost of government health programs could end up rising as well. Healthier people would likely opt out if they could receive cash in private accounts, while sicker people would probably stick with traditional Medicare and Medicaid. “The new plan runs the risk of costing the government more than the current system, since people could game a two-choice system, sticking with a savings account when their spending is low, and switching to a government program once their medical costs rise,” writes The New York Times’s Margot Sanger-Katz.
If Carson’s original plan took a sledgehammer to Medicare and Medicaid, his alternative risks seriously weakening the programs. Despite his medical credentials, Carson seems confused about the very basics of the health care system. In a recent interview, he said that Medicare and Medicaid fraud was costing taxpayers “half a trillion dollars,” a truly astonishing estimate given that the total cost of both programs is $980 billion, as Mother Jones’s Kevin Drum points out. (Experts estimate that the real cost of Medicare and Medicaid fraud could be about $98 billion.)
In previous Republican debates, candidates have treated questions about the factual reality of their policy ideas as an inconvenience to be brushed aside—or as evidence of a media conspiracy to smear conservatives. But it wouldn’t be surprising on Tuesday night, given Carson’s standing in the polls and the scent of his blood in the water, if other Republican candidates go after him on Medicare and Medicaid far more aggressively. Carson won’t be the only likely target: Former Florida Governor Jeb Bush and Senator Marco Rubio have both embraced House Speaker Paul Ryan’s contentious “premium support” proposal, which would give seniors a set amount of money to buy private insurance or traditional Medicare.
Carson’s original idea to overhaul Medicare was far more comprehensive, however, and his new idea is significantly more confusing than his rivals’. Though he’ll likely spend much of Tuesday night defending himself on other scores, his credibility is also on the line when it comes to his policy proposals. We had a preview of what’s to come in the last debate, when Carson was pressed to explain his wild-eyed idea to scrap the current tax code in favor of a ten-percent flat tax. He responded by denying that this was ever his position to begin with, then refused to accept the basic facts behind the idea.
He’s already started to use the same cop-outs when it comes to his health-care ideas, acting as if he had never proposed to get rid of Medicare. This, ultimately, is why Carson’s trouble with truth-telling really does matter: His fuzzy relationship with the facts doesn’t stop with his youth.
By: Suzy Khimm, Senior Editor at The New Republic; November 9, 2015
“Why Republicans Are Hell-Bent On Destroying Medicare”: Belief’s That Spring From Ideological Faith, Not Facts
One way you can identify politicians’ sincere convictions is by looking at the things they do even when they know they’re unpopular. There are few better examples than the half-century-long quest by Republicans to destroy Medicare.
As we move towards the 2016 presidential election, it’s something we’re hearing about yet again. Conservatives know the Democrats will attack them for it mercilessly, and they know those attacks are probably going to work — yet Republicans keeps trying. Which is why it’s clear that they just can’t stand this program.
When Medicare was being debated in the early 1960s, one of its most prominent opponents was a certain future president, who recorded a spoken word album called Ronald Reagan Speaks Out Against Socialized Medicine. In it, he said that if the bill were to pass, “We are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” He failed in that crusade, and ever since, conservatives have watched in pain as the program became more entrenched and more popular.
That popularity didn’t happen by accident. Medicare is popular because it gives seniors something they crave: security. Every American over 65 knows that they can get Medicare, it will be accepted by almost every health care provider, their premiums will be modest, and it won’t be taken away. On the policy level, the program is expensive, but that’s because providing health care for the elderly is expensive. It’s not because the program is inefficient; in fact, Medicare does an excellent job of keeping costs down. Its expenses for overhead (basically everything except health care) are extremely low, somewhere between 1 percent and 5 percent of what it takes in, compared to private insurance costs that can run from 10 percent to 20 percent and, in some cases, even higher. (See here for a good explanation of these figures.)
That’s not to say there’s nothing about the program that could be improved, because there certainly is. The Affordable Care Act tried to institute some Medicare reforms, including moving away from the fee-for-service model (which encourages doctors and hospitals to do as many procedures as possible) and toward a model that creates incentives for keeping patients healthy. It’s still too early to say how great an impact those changes will have. But Medicare is still in most ways the most successful part of the American health insurance system. And if you care about empirical truth, it’s impossible to argue that it’s a failure because it involves too much government.
But Republicans do argue that, and it’s a belief that springs from ideological faith, not facts. In Wednesday’s debate, Rand Paul was asked whether Reagan was right about Medicare, and he responded, “The question always is, what works better, the private marketplace or government? And what distributes goods better? It always seems to be the private marketplace does a better job. Is there an area for a safety net? Can you have Medicare or Social Security? Yes. But you ought to acknowledge the government doesn’t do a very good job at it.” Paul’s ambivalence is obvious — he grudgingly acknowledges that you can have a “safety net,” including Medicare, even as he says it’s terrible. But if that’s so, why not get rid of it entirely?
The presidential candidates who have said anything specific about Medicare all want to move in the direction of privatization, which isn’t too surprising. After all, they believe that it’s impossible for government to do anything better than the private sector, and if you can take a government program and privatize it, that’s what you should do. That’s also what new Speaker of the House Paul Ryan believes: For years he’s been touting a plan to privatize Medicare by essentially turning it into a voucher program. Instead of being an insurer for seniors as it is now, the government would give you a voucher that you could spend to buy yourself private insurance. And if the voucher didn’t cover the cost of the insurance you could find? Tough luck.
When you ask Paul Ryan about this, the first thing he’ll say is that he wants a slow transition to privatizing Medicare, one that won’t affect today’s seniors at all, so they don’t need to worry. In Wednesday’s debate, Marco Rubio made the same argument. “Everyone up here tonight that’s talking about reforms, I think and I know for myself I speak to this, we’re all talking about reforms for future generations,” he said. “Nothing has to change for current beneficiaries. My mother is on Medicare and Social Security. I’m against anything that’s bad for my mother.”
In other words: Medicare is a disaster, but we would never change it for the people who are on it and love it so much. They don’t have to fear the horror of being subject to our plan for Medicare’s future. Which is going to be great.
That contradiction is the essence of the Republicans’ Medicare problem. It’s one of the most successful and beloved social programs America has ever created, and to mess with it is to court political disaster, particularly among seniors who vote at such high rates. And its success is particularly galling, standing as it does as a living rebuke to their fervent belief that there can never be any area in which government might outperform the private sector.
But grant Republicans this: A less ideologically committed group might say, “We don’t like this program, but it’s too politically dangerous to try to undo it. So we’ll just learn to live with it.”
Republicans won’t give up. They want to undermine Medicare, to privatize it, to try in whatever way they can come up with to hasten the day when it disappears. And no matter how often they fail, they keep trying.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, October 30, 2015
“Saving That ‘Worthless’ Medicaid”: The Idea Of ‘Worthless’ Is Correlated To The Idea Of The Life Of Poor Folks Being ‘Worthless’
As noted earlier today, it’s the 50th anniversary of the enactment of Medicare and Medicaid.
I strongly suspect the former will get more attention, because it’s a non-means tested program with an extremely powerful bipartisan constituency (despite constant GOP efforts to screw over future beneficiaries via a phased-in voucherization or some other way to shift costs to old folks). Everybody’s either on it or going to go on it if they live long enough.
Medicaid’s another matter, of course. It’s means-tested with the states having significant control over eligibility and benefits, which means it involves different sets of people (particularly now that half the states have accepted the ACA’s Medicaid expansion while half haven’t) and significantly different benefits and service delivery models in different states. With the exception of a little-understood long-term care component that pays for nursing home care for people who have disposed of most of their assets, Medicaid is a poor folks program–you know, for those people–which because it is state (and to some extent locally) operated means these poor folks are not necessarily dealing with the friendliest policy-makers, administrators or providers, particularly given Medicaid’s relatively low reimbursement rates.
But to the Republicans who have all pretty much agreed upon a policy of “block-granting” Medicaid, which means dumping the Medicaid population on the states with a fixed (and ultimately declining) sum of money and letting them do whatever they want to do with them, the question about Medicaid isn’t whether its structure and financing are giving the poor the kind of health care the rest of us would want, but instead whether it’s worth anything at all. That’s largely the function of prejudice plus a 2013 study in Oregon of people receiving and not receiving Medicaid benefits which provided some startling-sounding data on how little real benefit Medicaid created. It’s hard to read any conservative discussion of Medicaid and not hear the Oregon study “proved” Medicaid’s worthless.
So that’s why with Medicaid’s fate perhaps hanging in the balance after the upcoming election, three excellent policy writers, Harold Pollack, Bill Gardner and Timothy Just, have written an explanation of the Oregon study that rebuts its invidious use.
[P]erhaps the most important limitation of the study stems from an assumption that many readers would be unlikely to notice. [The Oregon researchers] placed a very low value—$25,000—on a year of additional life for Medicaid beneficiaries. The typical threshold used in health services research is much larger, in recent studies far above $100,000 per additional year of (healthy) life. Yet because the median income of the Oregon study participants was about one-fourth of the median income in the United States, the researchers chose to value an additional life-year at about one-fourth of the usual threshold. This assumption powerfully frames everything that follows in this analysis. After all, if you start out by assuming that Medicaid beneficiaries’ lives are worth very little, you will find that it is not worth spending much money to prolong them.
So the idea of Medicaid being “worthless” is closely correlated with the idea of the life of poor folks being relatively “worthless” (there are defensible reasons for this valuation in the study itself, but not for the way it’s being used by anti-Medicaid ax-grinders) as well. If you don’t share that premise, you shouldn’t share the related conclusion, either.
In any event, progressives should gird up their loins for a fight to save Medicaid in the near future. I’ve thought of myself as a warrior for the continuation of Medicaid ever since I was drawn into the 1981 Reagan Budget fight, wherein the administration suffered a rare defeat in its efforts to “cap” federal Medicaid spending, thus gradually making it a state-financed program. The fight just ahead could be even tougher.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, July 30, 2015
“Expand Medicare, You Damn Idiots”: On Its Anniversary, We’re Going To Start Hearing The Usual Attacks On Medicare
Every so often—okay, not very often actually, but more often than I hunt, or “take” (what a verb!), lions—I feel a little wistful about the Republican Party we all once knew. And that feeling is never stronger than when I reflect on the history of Medicare and Medicaid, which I spent part of yesterday doing, what with it being the 50th anniversary of the passage of the bill and all.
Lyndon Johnson went into the 1964 election knowing that he wanted to pass a universal health-care bill. He figured he couldn’t get full-bore socialized medicine, so he settled on socialized medicine for old people, reckoning that was a winner. Immediately upon winning election, he directed aides to get cracking, saying as I recall something to the effect that he was going to lose a little political capital every day, so the sooner the better.
It was big and messy and complicated, just like Obamacare, and frankly, Johnson lied about the cost, back in those pre-Congressional Budget Office days. But it passed, and it passed in a way that wasn’t just like Obamacare at all. Thirteen Republican senators voted for it, and 17 against; and in the House, 70 Republicans supported it, while 68 voted no. In other words, almost exactly half of all voting congressional Republicans, 83 out of 168, voted for the program that Ronald Reagan at the time was warning heralded the arrival of Marxism on our shores.
Pretty different GOP, eh? Well, now check out the numbers from 1983. This was, to be sure, more of a compromise piece of legislation. The Social Security Trust fund was in trouble at the time, so the 1983 amendments raised the payroll tax while increasing the retirement age to 67 for those born in 1960 or after, with the new revenue going to Medicare and Social Security. And of course you had a Republican president then, and not just any Republican president; so if Ronald Reagan was okay with a tax increase, they were, too. It passed both chambers overwhelmingly; House Republicans backed the 1983 changes 97-69, while Republican senators supported them by 47-6. (PDF)
It’s worth recalling all this on the anniversary of this great law because soon enough, we’re going to start hearing the usual attacks on Medicare. Wait, did I say soon enough? We already are! And not from the wingnut caucus. It was the, uh, moderate, Jeb Bush, who said just last week that Medicare is “an actuarially unsound system” and that “we need to figure out a way to phase out this program.”
All right. Now I’ll grant that times have changed since 1965 and 1983, and that we’re going to see all those Baby Boomers retire in the coming years. But let’s be clear about a central fact. The Medicare Trust Fund is not in big trouble right now. A few years ago, it was; there were desperate predictions that it was going to go broke in five years, three. I remember 2017 being mentioned as the ominous year, and 2017 is pretty close.
But that has changed. Now, the experts say Medicare is stable until 2030. Now 2030 isn’t infinity and beyond, but it’s not tomorrow either. The crisis has eased, and it has eased considerably.
What changed? Some of the reasons are just too wonky for me to go into with you in any detail, having to do with things like new strategies to reduce preventable hospital admissions. But another seems to be…wait for it…Obamacare. Ever since the passage of the Affordable Care Act, per-enrollee Medicare costs have decreased a little and are rising more slowly than overall health-care costs, and somehow or another the Medicare trustees have added 13 years to the program’s solvency.
In fact, let’s go mildly wonky here. This is worth knowing. Before the ACA passed, projections of Medicare bankruptcy were pegged, as noted, at 2017. Then shortly after the ACA became law, that was pushed to 2024. Then in 2013, it was nudged to 2026. Now it’s at 2030. See a pattern here? The main reason is simple. Overall spending is lower. You might remember Mitt Romney’s famous attacks on Obama for cutting $716 billion from Medicare, which took some cheek given that a) Republicans’ own projected cuts under Paul Ryan’s budget were far more severe and b) Ryan and other Republicans used the same budgetary assumptions Obama used for all their Medicare “reform” plans.
Just remember all this, will you, as you hear more from the Republicans on this topic. They are all going to say: Medicare is a disaster; it’s broke; Obamacare has made it far worse. They’ll say things that one can hardly believe can be said by a person we’re allegedly supposed to be taking seriously, like Marco Rubio’s amazing comment that Social Security and Medicare “weakened us as a people.”
None of what they say will be true. But they’ll say it and say it, and the conservative media will repeat it and repeat it, and we’ll be in that “no, the sky is green and the grass is blue” territory that we know so well. And of course, their “reform” plans are, aside from being just mean, a total fantasy. The way Medicare works is so complicated and so embedded into our national life that the disruptions to doctors and hospitals and service providers of all kinds would be horrific. Only rich people, who don’t really need Medicare, and ideologues, who despise it, think you can do this. They might as well propose rerouting every single Interstate highway in America.
But most of all, it doesn’t need changing. Or actually it does, but in the direction of being expanded, as Bernie Sanders says. That’s probably not in the cards for the foreseeable future, although it will certainly come one day, perhaps by the time of Medicare’s own 65th birthday, when the people will surely be due for another “weakening.”
By: Michael Tomasky, The Daily Beast, July 31, 2015
“Zombies Against Medicare”: The Right Has Never Abandoned Its Dream Of Killing The Program
Medicare turns 50 this week, and it has been a very good half-century. Before the program went into effect, Ronald Reagan warned that it would destroy American freedom; it didn’t, as far as anyone can tell. What it did do was provide a huge improvement in financial security for seniors and their families, and in many cases it has literally been a lifesaver as well.
But the right has never abandoned its dream of killing the program. So it’s really no surprise that Jeb Bush recently declared that while he wants to let those already on Medicare keep their benefits, “We need to figure out a way to phase out this program for others.”
What is somewhat surprising, however, is the argument he chose to use, which might have sounded plausible five years ago, but now looks completely out of touch. In this, as in other spheres, Mr. Bush often seems like a Rip Van Winkle who slept through everything that has happened since he left the governor’s office — after all, he’s still boasting about Florida’s housing-bubble boom.
Actually, before I get to Mr. Bush’s argument, I guess I need to acknowledge that a Bush spokesman claims that the candidate wasn’t actually calling for an end to Medicare, he was just talking about things like raising the age of eligibility. There are two things to say about this claim. First, it’s clearly false: in context, Mr. Bush was obviously talking about converting Medicare into a voucher system, along the lines proposed by Paul Ryan.
And second, while raising the Medicare age has long been a favorite idea of Washington’s Very Serious People, a couple of years ago the Congressional Budget Office did a careful study and discovered that it would hardly save any money. That is, at this point raising the Medicare age is a zombie idea, which should have been killed by analysis and evidence, but is still out there eating some people’s brains.
But then, Mr. Bush’s real argument, as opposed to his campaign’s lame attempt at a rewrite, is just a bigger zombie.
The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.
What Medicare’s would-be killers usually argue, instead, is that the program as we know it is unaffordable — that we must destroy the system in order to save it, that, as Mr. Bush put it, we must “move to a new system that allows [seniors] to have something — because they’re not going to have anything.” And the new system they usually advocate is, as I said, vouchers that can be applied to the purchase of private insurance.
The underlying premise here is that Medicare as we know it is incapable of controlling costs, that only the only way to keep health care affordable going forward is to rely on the magic of privatization.
Now, this was always a dubious claim. It’s true that for most of Medicare’s history its spending has grown faster than the economy as a whole — but this is true of health spending in general. In fact, Medicare costs per beneficiary have consistently grown more slowly than private insurance premiums, suggesting that Medicare is, if anything, better than private insurers at cost control. Furthermore, other wealthy countries with government-provided health insurance spend much less than we do, again suggesting that Medicare-type programs can indeed control costs.
Still, conservatives scoffed at the cost-control measures included in the Affordable Care Act, insisting that nothing short of privatization would work.
And then a funny thing happened: the act’s passage was immediately followed by an unprecedented pause in Medicare cost growth. Indeed, Medicare spending keeps coming in ever further below expectations, to an extent that has revolutionized our views about the sustainability of the program and of government spending as a whole.
Right now is, in other words, a very odd time to be going on about the impossibility of preserving Medicare, a program whose finances will be strained by an aging population but no longer look disastrous. One can only guess that Mr. Bush is unaware of all this, that he’s living inside the conservative information bubble, whose impervious shield blocks all positive news about health reform.
Meanwhile, what the rest of us need to know is that Medicare at 50 still looks very good. It needs to keep working on costs, it will need some additional resources, but it looks eminently sustainable. The only real threat it faces is that of attack by right-wing zombies.
By: Paul Waldman, Op-Ed Columnist, The New York Times, July 27, 2015
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