“The Medicare Miracle”: Everything The Usual Suspects Have Been Saying About Fiscal Responsibility Is Wrong
So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate.
The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue.
But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
This is a really big deal, in at least three ways.
First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these days, projections of federal debt as a percentage of G.D.P. show it creeping up rather than soaring. We’ll probably have to raise more revenue eventually, but the long-term fiscal gap now looks much more manageable than the deficit scolds would have you believe.
Second, the slowdown in Medicare helps refute one common explanation of the health-cost slowdown: that it’s mainly the product of a depressed economy, and that spending will surge again once the economy recovers. That could explain low private spending, but Medicare is a government program, and shouldn’t be affected by the recession. In other words, the good news on health costs is for real.
But what accounts for this good news? The third big implication of the Medicare cost miracle is that everything the usual suspects have been saying about fiscal responsibility is wrong.
For years, pundits have accused President Obama of failing to take on entitlement spending. These accusations always involved magical thinking on the politics, assuming that Mr. Obama could somehow get Republicans to negotiate in good faith if only he really wanted to. But they also implicitly dismissed as worthless all the cost-control measures included in the Affordable Care Act. Inside the Beltway, cost control apparently isn’t considered real unless it involves slashing benefits. One pundit went so far as to say, after the Obama administration rejected proposals to raise the eligibility age for Medicare, “America gets the shaft.”
It turns out, however, that raising the Medicare age would hardly save any money. Meanwhile, Medicare is spending much less than expected, and those Obamacare cost-saving measures are at least part of the story. The conventional wisdom on what is and isn’t serious is completely wrong.
While we’re on the subject of health costs, there are two other stories you should know about.
One involves the supposed savings from running Medicare through for-profit insurance companies. That’s the way the drug benefit works, and conservatives love to point out that this benefit has ended up costing much less than projected, which they claim proves that privatization is the way to go. But the budget office has a new report on this issue, and it finds that privatization had nothing to do with it. Instead, Medicare Part D is costing less than expected partly because enrollment has been low and partly because an absence of new blockbuster drugs has led to an overall slowdown in pharmaceutical spending.
The other involves the “sticker shock” that opponents of health reform have been predicting for years. Bulletin: It’s still not happening. Over all, health insurance premiums seem likely to rise only modestly next year, and they are on track to be flat or even falling in several states, including Connecticut and Arkansas.
What’s the moral here? For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all.
When it comes to ensuring that Americans have access to health care, the message of the data is simple: Yes, we can.
By: Paul Krugman, Op-Ed Columnist, The New York Times, August 31, 2014
“Build We Won’t”: Weakening The Economy In The Short Run While Undermining Its Prospects For The Long Run
You often find people talking about our economic difficulties as if they were complicated and mysterious, with no obvious solution. As the economist Dean Baker recently pointed out, nothing could be further from the truth. The basic story of what went wrong is, in fact, almost absurdly simple: We had an immense housing bubble, and, when the bubble burst, it left a huge hole in spending. Everything else is footnotes.
And the appropriate policy response was simple, too: Fill that hole in demand. In particular, the aftermath of the bursting bubble was (and still is) a very good time to invest in infrastructure. In prosperous times, public spending on roads, bridges and so on competes with the private sector for resources. Since 2008, however, our economy has been awash in unemployed workers (especially construction workers) and capital with no place to go (which is why government borrowing costs are at historic lows). Putting those idle resources to work building useful stuff should have been a no-brainer.
But what actually happened was exactly the opposite: an unprecedented plunge in infrastructure spending. Adjusted for inflation and population growth, public expenditures on construction have fallen more than 20 percent since early 2008. In policy terms, this represents an almost surreally awful wrong turn; we’ve managed to weaken the economy in the short run even as we undermine its prospects for the long run. Well played!
And it’s about to get even worse. The federal highway trust fund, which pays for a large part of American road construction and maintenance, is almost exhausted. Unless Congress agrees to top up the fund somehow, road work all across the country will have to be scaled back just a few weeks from now. If this were to happen, it would quickly cost us hundreds of thousands of jobs, which might derail the employment recovery that finally seems to be gaining steam. And it would also reduce long-run economic potential.
How did things go so wrong? As with so many of our problems, the answer is the combined effect of rigid ideology and scorched-earth political tactics. The highway fund crisis is just one example of a much broader problem.
So, about the highway fund: Road spending is traditionally paid for via dedicated taxes on fuel. The federal trust fund, in particular, gets its money from the federal gasoline tax. In recent years, however, revenue from the gas tax has consistently fallen short of needs. That’s mainly because the tax rate, at 18.4 cents per gallon, hasn’t changed since 1993, even as the overall level of prices has risen more than 60 percent.
It’s hard to think of any good reason why taxes on gasoline should be so low, and it’s easy to think of reasons, ranging from climate concerns to reducing dependence on the Middle East, why gas should cost more. So there’s a very strong case for raising the gas tax, even aside from the need to pay for road work. But even if we aren’t ready to do that right now — if, say, we want to avoid raising taxes until the economy is stronger — we don’t have to stop building and repairing roads. Congress can and has topped up the highway trust fund from general revenue. In fact, it has thrown $54 billion into the hat since 2008. Why not do it again?
But no. We can’t simply write a check to the highway fund, we’re told, because that would increase the deficit. And deficits are evil, at least when there’s a Democrat in the White House, even if the government can borrow at incredibly low interest rates. And we can’t raise gas taxes because that would be a tax increase, and tax increases are even more evil than deficits. So our roads must be allowed to fall into disrepair.
If this sounds crazy, that’s because it is. But similar logic lies behind the overall plunge in public investment. Most such investment is carried out by state and local governments, which generally must run balanced budgets and saw revenue decline after the housing bust. But the federal government could have supported public investment through deficit-financed grants, and states themselves could have raised more revenue (which some but not all did). The collapse of public investment was, therefore, a political choice.
What’s useful about the looming highway crisis is that it illustrates just how self-destructive that political choice has become. It’s one thing to block green investment, or high-speed rail, or even school construction. I’m for such things, but many on the right aren’t. But everyone from progressive think tanks to the United States Chamber of Commerce thinks we need good roads. Yet the combination of anti-tax ideology and deficit hysteria (itself mostly whipped up in an attempt to bully President Obama into spending cuts) means that we’re letting our highways, and our future, erode away.
By: Paul Krugman, Op-Ed Columnist, The New York Times, July 3, 2014
“Fear Of Wages”: For Some People, It’s Always 1979
Four years ago, some of us watched with a mixture of incredulity and horror as elite discussion of economic policy went completely off the rails. Over the course of just a few months, influential people all over the Western world convinced themselves and each other that budget deficits were an existential threat, trumping any and all concern about mass unemployment. The result was a turn to fiscal austerity that deepened and prolonged the economic crisis, inflicting immense suffering.
And now it’s happening again. Suddenly, it seems as if all the serious people are telling each other that despite high unemployment there’s hardly any “slack” in labor markets — as evidenced by a supposed surge in wages — and that the Federal Reserve needs to start raising interest rates very soon to head off the danger of inflation.
To be fair, those making the case for monetary tightening are more thoughtful and less overtly political than the archons of austerity who drove the last wrong turn in policy. But the advice they’re giving could be just as destructive.
O.K., where is this coming from?
The starting point for this turn in elite opinion is the assertion that wages, after stagnating for years, have started to rise rapidly. And it’s true that one popular measure of wages has indeed picked up, with an especially large bump last month.
But that bump is probably a snow-related statistical illusion. As economists at Goldman Sachs have pointed out, average wages normally jump in bad weather — not because anyone’s wages actually rise, but because the workers idled by snow and storms tend to be less well-paid than those who aren’t affected.
Beyond that, we have multiple measures of wages, and only one of them is showing a notable uptick. It’s far from clear that the alleged wage acceleration is even happening.
And what’s wrong with rising wages, anyway? In the past, wage increases of around 4 percent a year — more than twice the current rate — have been consistent with low inflation. And there’s a very good case for raising the Fed’s inflation target, which would mean seeking faster wage growth, say 5 percent or 6 percent per year. Why? Because even the International Monetary Fund now warns against the dangers of “lowflation”: too low an inflation rate puts the economy at risk of Japanification, of getting caught in a trap of economic stagnation and intractable debt.
Over all, then, while it’s possible to argue that we’re running out of labor slack, it’s also possible to argue the opposite, and either way the prudent thing would surely be to wait: Wait until there’s solid evidence of rising wages, then wait some more until wage growth is at least back to precrisis levels and preferably higher.
Yet for some reason there’s a growing drumbeat of demands that we not wait, that we get ready to raise interest rates right away or at least very soon. What’s that about?
Part of the answer, I’d submit, is that for some people it’s always 1979. That is, they’re eternally vigilant against the danger of a runaway wage-price spiral, and somehow they haven’t noticed that nothing like that has happened for decades. Maybe it’s a generational thing. Maybe it’s because a 1970s-style crisis fits their ideological preconceptions, but the phantom menace of stagflation still has an outsized influence on economic debate.
Then there’s sado-monetarism: the sense, all too common in banking circles, that inflicting pain is ipso facto good. There are some people and institutions — for example, the Basel-based Bank for International Settlements — that always want to see interest rates go up. Their rationale is ever-changing — it’s commodity prices; no, it’s financial stability; no, it’s wages — but the recommended policy is always the same.
Finally, although the current monetary debate isn’t as openly political as the previous fiscal debate, it’s hard to escape the suspicion that class interests are playing a role. A fair number of commentators seem oddly upset by the notion of workers getting raises, especially while returns to bondholders remain low. It’s almost as if they identify with the investor class, and feel uncomfortable with anything that brings us close to full employment, and thereby gives workers more bargaining power.
Whatever the underlying motives, tightening the monetary screws anytime soon would be a very, very bad idea. We are slowly, painfully, emerging from the worst slump since the Great Depression. It wouldn’t take much to abort the recovery, and, if that were to happen, we would almost certainly be Japanified, stuck in a trap that might last decades.
Is wage growth actually taking off? That’s far from clear. But if it is, we should see rising wages as a development to cheer and promote, not a threat to be squashed with tight money.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 13, 2014
“They’ll Never Rally Behind A Single Plan”: The GOP’s Push To Replace ObamaCare Is Cynical And Doomed
On Friday, House Majority Leader Eric Cantor (R-Va.) is gathering key members of his caucus to work toward coming up with a single, official Republican alternative to the Democrats’ Affordable Care Act (ACA), or ObamaCare. Republican lawmakers have several competing bills to work with, and putting the party’s weight behind one plan or piece of legislation would be great for the country: Finally, America could have a real discussion about the best way to reform America’s health care insurance system.
But an official Republican health care plan would also be great for Democrats — which is reason No. 1 Republicans aren’t going to actually rally behind a single plan.
They will, of course, make a public effort. “GOP leaders have been clear that ahead of the 2014 elections, the conference wants to show what it is for, not simply what it is against,” says Daniel Newhauser at Roll Call. “Similarly, they want to show that they are not in favor of simply returning to the old health care system, which is viewed unfavorably by the electorate.” But any viable plan needs 218 votes from the fractured GOP caucus.
Cantor and his fellow House Republicans have at least three separate House bills to consider — from Reps. Tom Price (R-Ga.), Paul Broun (R-Ga.), and Phil Roe (R-Tenn.) — and a plan from Sens. Tom Coburn (R-Okla.), Richard Burr (R-N.C.), and Orrin Hatch (R-Utah) that was unveiled to much fanfare in January. There’s also a bill, from Rep. Todd Young (R-Ind.), that would raise ObamaCare’s definition of full-time employment to 40 hours a week, from 30. And a George W. Bush administration economist named Edward Lazear is pushing what he calls BushCare.
As they sort through these plans, what criteria will they use? If they can agree on one proposal, says Roll Call‘s Newhauser, it’s “likely to include poll-tested measures that have broad agreement in the GOP conference, including allowing the purchase of health insurance across state lines, allowing insurance portability between jobs, expanding access to health savings accounts, and limiting medical malpractice lawsuits.”
Another way of putting that: Republicans are looking for popular talking points that sound different enough from ObamaCare to win support from the more conservative factions of the GOP caucus. The problem, as The Washington Post notes, is that “there are only so many ways to preserve the patient protections that the ACA offers, which Republicans say they want to keep, while maintaining a private insurance market and assisting those who can’t afford coverage.”
Once Republicans hold up a specific plan, the Congressional Budget Office gets to issue its verdict and the public gets to weigh the proposals not just against ObamaCare but also the GOP’s attacks against ObamaCare.
The CBO analysis for Rep. Young’s bill to raise full-time employment to 40 hours, for example, found that the bill would raise the federal deficit by $74 billion while reducing the number of people getting employer-sponsored health insurance by about a million; about half of those people would go on Medicaid or other public programs, the other half would be uninsured.
It’s not clear the other Republican proposals would be popular in practice, either. Some of them, as the Washington Post editors note, would be better than ObamaCare at holding down health care costs and incentivizing people to buy private health insurance. But they are more disruptive to the status quo — especially post-ObamaCare — and almost all of them would be ripe for articles about sick people losing coverage or watching their health insurance costs skyrocket.
All of the GOP alternative plans, in other words, have their own drawbacks. Some people will lose, and some people will win. They would reduce the role of the federal government in most cases, but increase the power of insurance companies. Many of the policies are really interesting. Here are some examples of the big ideas from the GOP plans:
Cap or end employer tax breaks for providing health insurance: The idea here is that the insurance market is distorted by the tax incentives for employers to offering their workers insurance. It’s a fair point. But capping the tax breaks, as Coburn-Burr-Hatch does, or eliminating them would almost certainly cause employers to drop their plans. Almost 60 percent of Americans get their health insurance through work.
Provide tax breaks for individuals to buy their own insurance: With no employer-offered health plans, individuals and families would buy their own insurance on the open market. The Coburn-Burr-Hatch plan, for example, offers age-adjusted tax credits to people at up to 300 percent of the federal poverty line: Individuals 18 to 34 would get $1,560 a year, while those 50 to 64 would get $3,720 a year (families would get more than double those figures). Lazear’s BushCare would give all Americans with any type of health insurance $7,500 a year in tax breaks, or $15,000 for families; if people opted to buy low-cost, low-coverage insurance, they’d pocket the difference.
Allow insurance to be sold across state lines: This is a perennial GOP proposal to lower health insurance costs. The idea is that if insurers could sell the same policies to any state, regardless of that state’s own insurance regulations, it would increase market competition and drive down prices. A 2005 CBO report estimated those savings to consumers at about 5 percent overall, with the savings skewed toward the young and healthy; the old and sick would pay more. Enacting this option would require scrapping the minimum standards required for all plans under ObamaCare — a selling point for conservatives who argue we use too much health care, anyway.
“The fact that Republicans are coalescing around healthcare reform plans of their own could be very bad news for ObamaCare,” says Sally C. Pipes at Forbes. “Once voters see that the Republican alternative adds up to sensible and affordable health care, ObamaCare’s days will be numbered.”
But the opposite is almost certainly true. And House Republicans know that.
The GOP has gotten a lot of mileage out of its push to repeal ObamaCare — with a big assist, since October, from the Obama administration — but now the law is signing up real people (four million and counting) for real insurance policies. Republicans have to do better than provide plausible-sounding alternatives. They have to come up with a plan that Americans will think is much better than ObamaCare, and worth the disruption of overhauling the health care system again.
Here’s the bottom line: If reforming America’s health care system to provide near-universal affordable coverage were easy, it would have been done 60 years ago — or at any point since. Several Democratic presidents had tried and failed before President Obama. If Republicans had wanted to take their own bite at the apple, they had plenty of chances, too.
This isn’t spitballing. If Republicans want to be relevant voices in the health care debate, they have to come up with something. They should come up with a plan they can try to sell to America.
“One of the unseemly aspects of the last four-plus months is watching some on the right root for ObamaCare to fail,” says Forbes‘ Avik Roy, one of ObamaCare’s wonkiest critics. Among some conservatives, “there has been a kind of intellectual laziness, a belief that there’s no need for critics to come up with better reforms, because Obamacare will ‘collapse under its own weight,’ relieving them of that responsibility.” But it’s clear now that’s not going to happen, he adds. “And that makes the development of a credible, market-oriented health-reform agenda more urgent than ever.”
Well, don’t hold your breath.
The Affordable Care Act was written and enacted by Democrats — with a few exceptions — and that’s one of its main weaknesses: If Republicans had helped shape and pass the law, they probably wouldn’t have spent the last four years attacking and undermining it. They now have at least 10 months left to criticize the law without having to take any serious action to replace it. Don’t expect them to squander the opportunity.
By: Peter Weber, The Week, February 26, 2014
“Didn’t See That One Coming”: How Paul Ryan Helped Save Medicare And Social Security By Trying To Gut Them
President Obama’s new budget will not include a proposal to implement “chained CPI” to slow the growth of Social Security benefits, according to White House officials.
And there’s one man who deserves most of the credit for making sure there will be no cuts to benefits to seniors until at least 2017 — ironically the politician who has worked the hardest to reduce the promises made to America’s retirees — Rep. Paul Ryan (R-WI).
The president had included the reform measure in his 2013 budget as an attempt to provoke a so-called Grand Bargain with House Republican leaders. Such a deal would have required them to end some tax breaks for the rich. That was never going to happen and the White House’s acceptance of this fact helps focus the 2014 elections on votes most Republicans in Congress have taken in the past to cut both Social Security and Medicare, thanks to Paul Ryan.
The chairman of the House Budget Committee’s first budget plan in 2011 not only privatized Social Security — a proposal that President George W. Bush could not even get a vote on when the GOP controlled both houses of Congress — it remade Medicare into a voucher program that radically shifted the financial burden to seniors without doing much to reduce the overall cost of health care. The plan was so popular — at least with Republican donors — that it instantly made Ryan a national hero and possible presidential candidate.
The chances of enacting the plan with President Obama in office were zero, but Ryan, buoyed by his new stardom, helped guide House Speaker John Boehner (R-OH) into a debt-limit crisis that shook global markets still dizzy from the financial crisis. House Republicans demanded a dollar in cuts for every dollar the debt ceiling was raised and President Obama obliged with a plan that not only included chained CPI, but also raised the Medicare eligibility age. To sell this plan to Democrats, the president demanded a small percentage of new revenues by ending tax breaks on upper-income Americans.
Boehner was about to make the deal, when Ryan “dropped a bomb” on it, fearing it would guarantee Obama’s re-election. Instead both sides settled on the sequester.
Ryan released another budget in 2012 that dropped Social Security privatization and added a public option to his Medicare plan. Desperate for Tea Party credibility, Mitt Romney selected Ryan to be his running mate after being forced to embrace the congressman’s budget during the primary. Together, the two men re-elected the president.
After Obama’s re-election, Speaker Boehner reportedly tried to take the offer Ryan had rejected in 2011. The president told him it was off the table, and likely will be for the rest of his term unless Republicans consider higher taxes on the rich, which they won’t.
In the past two years, the deficit has been cut in half and is projected to be even lower within 10 years as a share of GDP than if the Simpson-Bowles debt plan or Paul Ryan’s first budget had become law. If the reforms to Medicare implemented in the Affordable Care Act continue to slow the growth of costs as they have since 2010, our long-term debt crisis may be solved, despite Paul Ryan’s best efforts.
By: Jason Sattler, The National Memo, February 20, 2014
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