Cutting Through The Medicare Charade
In his Wall Street Journal op-ed today, House Budget Committee Chairman Paul Ryan (R-Wis.) said the Republican budget plan is focused on “saving Medicare.”
Of course, in this context, this is intended to strip the word “save” of all meaning. Even the Wall Street Journal yesterday noted that the GOP proposal “would essentially end Medicare,” which happens to be true.
Medicare is very easy to understand — it’s a popular system of socialized, single-payer health care for seniors. Beneficiaries love it, and the system works pretty well. The House Republican scheme for Medicare is a little more complicated, but still pretty straightforward — the GOP intends to privatize it. The resulting system would, ironically, look quite a bit like the Affordable Care Act, with seniors entering exchanges, where they would take a subsidy to purchase private insurance.
So, what’s the problem? Republicans intend to rig the game, scrapping the existing system and ending the guarantee of set benefits, while at the same giving beneficiaries a voucher that wouldn’t keep up with costs.
This isn’t “saving Medicare”; it’s ending Medicare and screwing over seniors.
Josh Marshall had a good piece on this yesterday, calling the plan “Medicare Phase-out legislation.”
The Ryan plan is to get rid of Medicare and in place of it give seniors a voucher to buy health care insurance from private insurers. Now, what if you can’t buy as much as insurance or as much care as you need? Well, start saving now or just too bad.
Now, by any reasonable standard, that’s getting rid of Medicare. Abolishing Medicare. Phasing it out. Whatever you want to call it. Medicare is this single payer program that guarantees seniors health care, as noted above. Ryan’s plan pushes seniors into the private markets and give them a voucher. That’s called getting rid of the program. There’s simply no ifs or caveats about. That’s not cuts or slowing of the growth. That’s abolishing the whole program. Saying anything else is a lie.
Yep.
I’d just add that some folks may have forgotten why Medicare was created in the first place. The nature of the human body is that ailments are more common as we get older, and profit-seeking insurance companies weren’t keen on covering those who cost so much more to cover. On average, folks who’ve lived more than six decades often have pre-existing conditions, and we know all too well what insurers think of those with pre-existing conditions.
Seniors relied on this system for many years, but it didn’t work. We created Medicare because relying on private insurers didn’t work.
And now Republicans want to roll back the clock.
By: Steve Benen, Washington Monthly, Political Animal, April 5, 2011
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
A SUCKER’S BET: Are Republicans Really Prepared To “Gamble On Entitlement Reform”?
The effort to pass a budget for the remainder of the fiscal year will be the principal challenge for policymakers over the next few days, but while that work continues, congressional Republicans will also start a massive fight over the next budget.
We’ll have more on this later — sneak preview: the GOP wants to gut entitlements — but as the process gets underway, it’s worth pausing to appreciate the politics here. The Weekly Standard‘s Stephen Hayes has a lengthy new report, arguing that Republicans are prepared to “gamble on entitlement reform,” and the GOP thinks it can win this time.
If there is one thing that political strategists, pollsters, and elected officials of both parties have agreed on for decades, it’s that entitlement reform is a sure political loser. Social Security is the “third rail” — touch it and you die. Suggest changes to Medicaid and you don’t care about the poor. Propose modest reforms to Medicare and you’re the target of a well-funded “Mediscare” campaign that ensures your defeat.
No longer.
“People are getting it that these things are unsustainable,” says Karl Rove. “For so many people, debt is no longer abstract. It’s more concrete. I don’t know if it’s seeing Greece on TV or what. It’s still tough, but it’s not the political loser it used to be.”
Other influential Republicans go further. They believe that getting serious about entitlement reform can be politically advantageous.
“I think it can be a real winner for Republicans if we handle it the right way,” says South Carolina senator Jim DeMint.
The piece goes on to quote all kinds of Republicans, all of whom genuinely seem to believe there’s a public appetite for their entitlement agenda. GOP officials have been too scared to tackle this in earnest before, the theory goes, but bolstered by public support, this time will be different. This time, they say, Americans want entitlement cuts, and Democratic criticisms will fall on deaf ears.
Time will tell, I suppose, but all of the available evidence suggests these folks have no idea what they’re talking about, and are poised to pursue one of the most dramatic examples of political overreach we’ve seen in a very long time.
Republicans can presumably read polls as easily as I can, but let’s focus for a moment on the latest CNN poll, released late last week. Asked, for example, about Medicaid funding, a combined 75% want funding levels to stay the same or go up. For Social Security, 87% of Americans want funding levels to stay the same or go up. For Medicare, 87% want funding levels to stay the same or go up — and most want funding to increase, not stay the same.
For some reason, Hayes and his allies look at numbers like these and think Republicans will benefit from pushing entitlement cuts. No, seriously, that’s what they think. GOP leaders are not only arguing this, they’re actually counting on it as part of a larger political strategy.
Karl Rove, ostensibly the GOP’s most gifted strategist, believes Americans may be “seeing Greece on TV,” and suddenly find themselves favoring Medicare cuts.
I don’t think he’s kidding.
Hayes noted in his piece, “So have things really changed? We’ll soon find out.”
On this point, we agree.
By: Steve Bensen, Washington Monthly, April 4, 2011
Don’t Try This At Home But, How You Can Pull A General Electric On Taxes
There’s been a firestorm this week over the news that General Electric will pay no tax—at least, no federal corporate income tax—on last year’s profits.
But if you’re like a lot of people, your first reaction was probably: “Hmmm. How can I get that kind of deal?”
If General Electric pays close to zero in Federal Income taxes, can you? Brett Arends tells Kelsey Hubbard how even a “regular Joe” can lower their tax bill, especially if they are self-employed.
You’d be surprised. You might. And without being either a pauper or a major corporation.
I spoke to Gil Charney, principal tax researcher at H&R Block‘s Tax Institute, to see how a regular Joe could pull a GE. The verdict: It’s more feasible than you think—especially if you’re self-employed.
Let’s say you set up business as a consultant or a contractor, something a lot of people have been doing these days. And, to make this a challenge on the tax front, let’s say you do well and take in about $150,000 in your first year.
First off, says Mr. Charney, for 2010 you can write off up to $10,000 in start-up expenses. (In subsequent years it’s only $5,000.)
Okay, let’s say you claim $7,000. That takes your income down to $143,000.
You can also write off all legitimate business expenses. Mr. Charney emphasizes that this only applies to legitimate expenses.
He didn’t say, but everyone seems to understand, that this can be quite a flexible term. Even if you buy a computer, a cellphone and a car primarily for business use, you can use them for personal purposes as well. If you happen to take a business trip to Florida in, say, January, no one is going to stop you from enjoying the sunshine or taking a dip in the pool.
So let’s say you manage to write off another $10,000 a year in business expenses.
That brings your income, for tax purposes, down to $133,000.
You’ll have to pay Medicare and Social Security taxes (just like GE). Because you’re self-employed, you have to pay both sides: the employee and the employer. That will come to about $19,000.
However, you can deduct half of that, or $9,500, from your taxable income. So that brings your total down to $123,500 so far.
Now comes the creative bit. The self-employed have access to terrific tax breaks on their investment and retirement accounts. The best deal for many is going to be a self-employed 401(k), sometimes known as a Solo 401(k).
This will let you save $43,100 and write it off against your taxes. That money goes straight into a sheltered investment account, as with a regular 401(k).
Why $43,100? That’s because with a Solo 401(k), you’re both the employer and the employee. As the employee you get to contribute a maximum of $16,500, as with any regular 401(k). But as the employer you also get to lavish yourself with an incredibly generous company match of up to 20% of net income.
Yes, being the boss has its privileges. (And if you’re 50 or over, your limit as an employee is raised from $16,500 each to $22,000.)
You can save another $10,000 by also contributing to individual retirement accounts—$5,000 for you, $5,000 for your spouse. If you use a traditional IRA, rather than a Roth, that reduces your taxable income as well. If you’re 50 or over, the limit rises to $6,000 apiece.
If you contribute $43,100 to your Solo 401(k), and $10,000 to two IRAs, that brings your income for tax purposes down to just over $70,000.
We haven’t stopped there either, says Mr. Charney.
Now come the usual itemized deductions. You can write off your state and local taxes. Let’s say these come to $10,000.
You can write off interest on your mortgage. Call that another $10,000. That’s enough to pay 5% interest on a $200,000 home loan.
That gets us down to about $50,000 And we’re not done.
If you’re self-employed, health insurance is probably a big headache. But the news isn’t all bad. You can write off the premiums for yourself, your spouse, and your kids.
And if you use a qualifying high-deductible health insurance plan—there are a variety of rules to make sure a plan qualifies—you get another break. You can contribute $3,050 a year into a tax-sheltered Health Savings Account, or $6,150 for a family. You can write those contributions off against your taxable income. The investments grow sheltered from tax. And if you spend the money on qualifying health costs, the withdrawals are tax-free as well.
So call this $10,000 for the premiums and $6,150 for the HSA contributions. That gets your income, for tax purposes, all the way down to about $34,000.
If you have outstanding student loans, you can write off $2,500 in interest. And you can write off $4,000 of your kid’s college tuition and fees.
Then there’s a personal exemption: $3,650 per person. If you’re married with one child, that’s $10,950.
Taxable income: just under $17,000. That’s on a gross take of $150,000. You’d owe less than $1,700 in federal income tax.
And it doesn’t stop there. Because now you can bring in some of the tax credits. Unlike deductions, these come off your tax liability, dollar for dollar.
GE got big write-offs related to green energy. There are some for you too, although on a small scale. You can claim credits for things like installing solar panels, heat pumps or energy-efficient windows or boilers in your home. Let’s say you use a home equity loan to pay for the improvements and take the maximum $1,500 write-off.
That gets your tax liability down to $200.
Can we get rid of that? Sure, says Mr. Charney.
If your spouse spends, say, $1,000 on qualifying adult-education courses or training programs, you can claim $200, or 20% of the cost, in Lifetime Learning Credits. (The maximum is $2,000.)
That wipes out the remaining liability.
Congratulations. You’ve pulled a GE. You owe no federal income taxes at all.
OK, it’s just an illustration. Few will be quite so fortunate. On the other hand, it’s not comprehensive either. There are plenty of other deductions and credits we didn’t mention. You could have written off up to $3,000 by selling loss-making investments. Your spouse may be able to use a 401(k) deduction as well. There are lots of ways to tweak the numbers.
In this case, you’ve paid no federal income tax, and meanwhile you’ve saved $19,000 toward your retirement through Social Security and Medicare, and $53,000 through your 401(k) and IRAs. You’ve paid most of your accommodation costs (that is, the interest and property taxes on your home), covered your health-care costs and quite a lot of personal expenses through your business account, paid $4,000 toward your child’s college costs and had about $2,000 a month left over for cash costs.
Who says GE has all the fun?
By: Brett Arends, The Wall Street Journal, 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
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