“Romney’s Cliff Notes Version Of The Ryan Plan”: Your Guide To “Ending Medicare As We Know It”
It’ll be the next argument in the campaign, so it’s a good time to brush up.
Yesterday, President Obama went to Florida and told seniors that Mitt Romney wants to end Medicare as we know it, and it appears that this argument (and some related ones) will be a central feature of the Obama campaign’s message in the coming days. It’s entirely possible, as Jonathan Chait has suggested, that all the Obama campaign’s attacks on Romney’s finances and record at Bain Capital are the first stage of a two-stage strategy that culminates with an attack on the Ryan budget. Since we’ll be talking about this a lot soon, I thought it might be worthwhile to refresh our memories on what this is all about, particularly with regard to Medicare, and how it relates to the current campaign.
First: Is it fair to tar Mitt Romney with the Ryan plan? No question. While Romney’s own policy proposals are quite a bit more vague than the Ryan plan is, they follow the same contours, and when Romney is asked about the Ryan plan he never hesitates to praise it. When asked about it last month, Romney’s chief strategist Eric Fehrstrom said of his boss, “He’s for the Ryan plan.” Or in Romney’s own words, “I’m very supportive of the Ryan budget plan. It’s a bold and exciting effort on his part and on the part of the Republicans and it’s very much consistent with what I put out earlier.” Enough said.
Next: Does the Ryan plan actually “end Medicare as we know it”? This is the phrase that Democrats have used in the past to describe it, and that Obama will continue to use. Republicans claim the phrase is unfair and demagogic. But while it would be inaccurate to simply say the Ryan plan “ends Medicare,” because if the plan were enacted there would still be a program going by the name of “Medicare,” it is fair to say that Medicare would be a drastically different program, and some of the critical things that make it so successful would no longer exist.
Today’s Medicare is an insurance program. If you’re a senior, you go to your doctor, and your doctor gets paid by Medicare. It is a single-payer program that covers every senior, and though it doesn’t pay for every conceivable procedure, because of Medicare’s universality there are essentially no uninsured seniors in America, no seniors who are subject to the tender mercies of the notoriously unmerciful insurance companies, no seniors who need to worry about their pre-existing conditions or their lifetime limits or any of the other ways those companies find to screw their customers, and almost no seniors who find it impossible to pay their insurance premiums (seniors do contribute premiums to Medicare, but they are quite modest).
The Ryan plan in its initial incarnation eliminated Medicare as an insurance program, and replaced it with “premium support.” There’s an argument about whether premium support can be described accurately as a “voucher,” but that’s nothing more than a silly disagreement about semantics; premium support in practice is no different from any voucher. Under this plan, seniors would have to get their insurance from private companies, and the government would pay part of the cost. If those private premiums go up, then seniors will have to pay more out of their own pockets; indeed, this is a feature, not a bug, of the Ryan plan. The whole point is to limit government spending on Medicare by limiting how much seniors get in their vouchers/premium support.
And those limits could be vicious. The Ryan plan caps the growth of Medicare at GDP growth plus 0.5 percent. If health costs rise faster than that, seniors will have to pick up more and more of the tab. That means that if the Ryan plan were enacted, there would likely be many seniors who couldn’t afford private premiums and would have no health coverage. This feature of the plan eliminates one of the fundamental pillars of Medicare: that it is an entitlement, meaning that if you qualify, you’re entitled to the benefit. If this year’s costs are higher than we’d like, we can make changes to the program for next year, but nobody goes without coverage. Under the Ryan plan, that would no longer be true.
But here’s an important thing to keep in mind: After Ryan released the first version of his plan in 2011 and caught a whole bunch of flak for basically destroying Medicare, he came back with a revised plan earlier this year that has one critical difference: it allows seniors, if they so choose, to stay on traditional Medicare. Mitt Romney’s Medicare plan does the same thing (Romney’s plan, such as it is, is basically a Cliff Notes version of the Ryan plan). In other words, under political pressure they embraced a public option. But since the plan still caps overall spending at GDP+.05, seniors would likely have to pay more and more out of their own pockets, likely thousands of dollars.
At this point, it’s good to remind ourselves that Medicare does a far better job of controlling costs than private insurance does, partly because of the negotiating power it has and partly because it spends just a fraction of what private companies do on overhead (around 98 percent of Medicare’s costs go to paying for care, while private companies often spend 20 percent or more of their costs on administration, marketing, underwriting, and so on). Yet Republican philosophy tells us that no matter what the facts say, this is just impossible. A government program can’t possibly be cheaper and more efficient (and deliver service that its customers love, by the way) than a private sector alternative. So if we introduce private competition, then costs will of course come down.
But there isn’t much reason to believe they will, which means seniors will be left holding the bag, and most importantly, lose the security they have now. Anyhow, to return to the question we started with: Is it fair for the Obama campaign to charge that Mitt Romney wants to end Medicare as we know it? If you define “Medicare as we know it” as an insurance program that provides affordable, efficient, and most importantly secure health coverage for every American senior, then the answer is clearly yes.
By: Paul Waldman, Contributing Editor, The American Prospect, July 20, 2012
“Radical And Anti-Thought”: Remember The Party Of Personal Responsibility?
The House Republicans are going to vote today to repeal the ACA, and the message they’re going to be sending to people who have cancer or diabetes or any number of other diseases but don’t have insurance is simple, and forgive my bluntness in this non-family newspaper where such language, I’m given to understand, is occasionally permisslbe. The message is: Fuck off.
Matt Miller put the matter powerfully in his Post column yesterday:
Here’s what you should do, Mr. President. In the debates this fall, pull out a small laminated card you’ve had made as a prop for this purpose. Then remind Mitt Romney that the ranks of the uninsured today are equal to the combined populations of Oklahoma, Connecticut, Iowa, Mississippi, Kansas, Kentucky, Arkansas, Utah, Oregon, Nevada, New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii, Rhode Island, Montana, Delaware, North Dakota, South Dakota, Alaska, Vermont and Wyoming.
Read that list slowly, Mr. President. Then ask your opponent: Would America turn its back on the citizens of these 25 states if everyone there lacked basic health coverage? That’s what we’ve been doing for decades. You knew it was right to act when you were governor of Massachusetts, Mitt. How can you pretend we don’t need to solve this for the nation? And how can you object with a straight face when your own pioneering plan was my model?
Can I get an amen to that? And then he might add something like, “As you said many times yourself, Governor, the point of requiring people to buy insurance is to instill a sense of personal responsibility. No free riders. No trips to the emergency room that the rest of us pay for. Why did you believe in personal responsibility then but are against it now?”
I swear, as I noted yesterday, this is starting to smell to me like an issue the Democrats can win votes on this fall. Believe me, if I thought the opposite, I’d say so. I did think the opposite just a few weeks ago. What changed?
John Roberts, basically. Politically, his signing on to the decision lends a bulletproofness to the Democratic position, changes the whole mentality of the debate. If it had been Kennedy with the liberals, meh. But Roberts’ stamp of approval on the plan allows the Democrats some room to play offense. And that offense is built around one simple claim: Republicans would deny coverage to sick people and let them die.
Sprinkling a little personal responsibility sugar on top can’t hurt. Use their blind extremism against them. Here is a position that was once theirs, that they came up with and that they’ve now abandoned, just because Obama took it up. It’s a great marker of how radical and anti-thought they’ve become, that they’re now willing to let people suffer and die in the hopes that they can defeat a political adversary.
By: Michael Tomasky, The Daily Beast, July 11, 2012
“Everybody Is A RINO But Me”: The Wind Is Blowing In Just One Direction In The Republican Party
One of the odder phenomena of contemporary political discourse is the regular denial by Republicans that their party has significantly moved to the right in the last few years. No! they insist, it’s Democrats who’ve moved left! (you know, by embracing what used to be Republican policy positions like a a private-sector based system for expanding health insurance via an individual mandate, and a market-based cap-and-trade system for reducing greenhouse gas emissions). You’d think self-conscious conservatives would be a little louder and prouder of their victory over the moderate Republicans of yore (a victory confirmed by the fact that virtually no Republican pol would dare self-identify as “moderate”).
This act of deception finds its most definitive refutation in Republican primaries, where candidates call themselves “conservatives” or “true conservatives” or “constitutional conservatives” with almost every breath, while describing opponents as though they were Jacob Javits reincarnated. Check out this snippet from Dave Weigel about the reaction to the Supreme Court decision on ACA from the two GOP candidates running for the Senate in Texas, which began with the observation that Ted Cruz used to talk about John Roberts as his favorite jurist:
When Roberts helped save “Obamacare,” Cruz immediately blasted the Court for having “abdicated its responsibility to safeguard the Constitution.” He didn’t mention Roberts by name, but he insisted that the decision was more proof that Republicans needed to reject Cruz’s opponent, Lt. Gov. David Dewhurst. “My opponent is, by nature and by over a decade of political office, a conciliator. Now is not a time for conciliation.” Take that, Larry Tribe. Stuff it, Walter Dellinger.
Over to Dewhurst. Cruz has campaigned against him as a liberal sellout — on blogs, he’s become known as “Dewcrist.” Was he going to blow the chance to point out that Cruz’s ally had saved Obamacare? No. “Supreme Court Justice John Roberts,” said Dewhurst, “sold constitutional conservatives down the river.”
Maybe the point is that conservatives can’t admit they’ve taken over the GOP and driven it straight to Goldwater Country (the 1964 Goldwater, not the one who took to criticizing the Christian Right in his older years) because then it would be hard to describe it as a rat’s nest of RINOs that needs to be cleaned out by fill-in-the-blank.
Still, it’s odd. I recall from way, way back a runoff for Lieutenant Governor in Georgia between the famous ax-handle seggie Lester Maddox and a better-educated but still flamboyant right-wing demagogue named Peter Zack Geer. Each of the two race-baiters tried to label each other an “extremist” (Geer won, though Maddox went on to become Governor later after edging out some guy named Jimmy Carter for a runoff spot). Were they around today and running in a Republican primary, I imagine Maddox and Geer would be calling each other “sellouts” and “conciliators.” The wind is blowing in just one direction in the contemporary Republican Party, and it’s not towards the Left Coast.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, July 10, 2012
“It’s A Tax! It’s A Penalty!”: It’s A Stupid Argument Over Semantics
The press assumes people are stupid, thereby making them no less stupid.
Since not much campaign news happens over the July 4th holiday, Mitt Romney took the opportunity to change his campaign’s tune on whether the penalty in the Affordable Care Act for those who can afford health insurance but refuse to get it is a “tax.”
To review, the Supreme Court said the government has the authority under its taxing power to penalize those who refuse to get insurance, leading Republicans to cry, “Tax! Tax! Tax!” with all of their usual policy nuance and rhetorical subtlety. The only problem this poses for Romney is that calling it a tax means that Romney imposed a tax with his health-care plan in Massachusetts, which means admitting that Romney sinned against the tax gods. First his spokesman came out and said that no, it’s really just a penalty, but then Romney came out and said, well, if the Supreme Court said it’s a tax then it’s a tax, but it wasn’t a tax when I did it, because the Supreme Court didn’t call it that.
What does all this arguing over semantics tell us? It tells us that the press and public are both complicit in creating the hurricane of stupidity into which all presidential campaigns devolve.
As for the press, they could treat this as the inconsequential semantic quibble it is. The fact is it doesn’t matter whether you call it a “tax,” a “penalty,” a “freedom fee,” or a “Lenin levy.” It’s the same thing. And for the record, according to the Urban Institute, only 2 percent of Americans will be subject to the tax/penalty. And the whole idea is that most of them will be motivated by the tax/penalty to get health insurance, so the whole idea of the tax/penalty is that almost no one will end up paying it.
But the press has treated the question of what Mitt Romney will call the fee as though it matters. Because of some weird nostalgia, I get the dead-tree editions of both The New York Times and The Washington Post, and when I went outside into the 150-degree heat to get my papers this morning (note to self: get time machine, go back and convince George Washington to put the nation’s capital in someplace cold and rainy like Seattle), I found that both front pages had stories about this virtually meaningless issue.
That’s partly because it’s a slow news day, but also because the press knows just how dumb the electorate is. If all voters were at least reasonably informed about things, stuff like this would matter far less. No one who actually knows even the first thing about the Affordable Care Act could possibly have their opinion altered by what we decide to call the penalty for not carrying insurance. No one who thinks it’s a necessary measure will say, “Gee, now that people are calling it a ‘tax,’ that really changes how I think about it.” And if you didn’t like it before, you won’t like it any more or less if we put a different name on it.
But the press operates on the unspoken assumption that meaningful numbers of people actually will react that way. In other words, they assume the public is stupid, and that assumption leads them to make decisions that do nothing to make the public any less stupid. At the same time, if the public knew more about the actual consequences of the election, reporters would certainly pick up on it and alter their coverage accordingly. But since only 55 percent of the public even knows what the result of the most important Supreme Court decision on a policy issue in decades even was, reporters will stick to assuming the public is clueless, and they’ll largely be right.
By: Paul Waldman, Contributing Editor, The American Prospect, July 5, 2012
“Ignore The Republican Hysteria”: Understanding The Health Care Law Is A Public Responsibility
In a sane climate, Mitt Romney would be running for president on his one big success as a politician: achieving something close to universal private health insurance coverage as governor of Massachusetts. Romneycare cut costs, improved health care outcomes and is quite popular there.
Alas, President Obama’s election has driven many Republicans so crazy that the putative nominee makes an unconvincing show of despising his own brainchild.
Has there ever been a more unconvincing faker in American politics? Romney acts as if he thinks voters are morons. But then, right-wing hysteria over the Supreme Court’s upholding “Obamacare” shows he could be correct.
Mandating health insurance wasn’t Romney’s own idea. The conservative Heritage Foundation saw it as a way to realize the practical and moral benefits of a socialized, government-run health care system like Canada’s through private, for-profit insurance companies — the best of both worlds.
Romney even wrote a 2009 USA Today column advising President Obama about the mandate’s advantages: “Using tax penalties, as we did [in Massachusetts], or tax credits, as others have proposed,” he wrote, “encourages ‘free riders’ to take responsibility for themselves rather than pass their medical costs on to others.”
The president put it this way in reacting to the Supreme Court’s validating Obamacare: “People who can afford to buy health insurance should take the responsibility to do so.”
So is it a tax, or is it a penalty?
The correct answer is “who cares?” Provide your family with the security of a decent health insurance policy and you don’t need to pay it.
Tyranny? Oh, grow up. The government can already make you sign up for Social Security, educate your children, vaccinate your dog, send you to fight a war in Afghanistan, limit how many fish you can catch, and put you in prison and seize your property for growing pot.
Furthermore, Justice Roberts is right. The U.S. government encourages all kinds of virtuous behavior through the tax code. You can get married, or pay higher taxes. Buy a house, have children, invest in a retirement account, even raise cattle (my personal favorite) or pay higher taxes.
And buying health insurance is an intolerable offense against liberty?
Ask Rush Limbaugh who pays for his Viagra. Answer: his employer-provided health insurance company. Only impoverished people, deadbeats and fools go without it.
And guess what? You’re already paying for their medical expenses when time and chance happens to them. As it happens to everybody, even right-wing Supreme Court justices who think it’s clever to compare an inessential food like broccoli to a universal human need like health care.
You can eat your vegetables or not; it’s entirely up to you.
But you can’t not get sick or hurt. And moral considerations aside, the rest of us can’t risk letting you lie down and die on the road. After all, it might be communicable. So there’s no non-participation in the health care system. Even if they drag you in feet-first, there you are.
And somebody’s got to pay for it.
It follows that the minority’s distinction between “activity” and “inactivity” with regard to health insurance is not merely specious legalistic jargon. Frankly, it’s downright adolescent.
Justice Scalia may increasingly resemble a small, volcanic Caribbean nation — eat your vegetables, Tony — but even he is not an island. We’re all in this together.
Previous to Obamacare, the United States has had the most inefficient health care finance in the advanced world, spending by far the highest percentage of its GDP on health care while getting worse results. Most western countries spend a fraction of what we do on health care and their citizens are demonstrably healthier.
Ending the perennial war between hospital bureaucrats and number crunchers at insurance companies and government agencies over who’s going to pay for indigent care should begin to change that.
Meanwhile, now that Obamacare has passed constitutional muster, it’s time for the wise and judicious American public to get off their lazy keisters, ignore the hysteria and learn what’s in the law and what’s not.
I recently took a brief online quiz sponsored by the Kaiser Foundation. I hope you won’t think I’m bragging by saying I got a perfect score. It’s my job to know the basics. Apparently, most Americans don’t. The percentage of citizens ignorant of even the new law’s most basic provisions was shocking.
Granted, the White House has done a terrible marketing job. But no, there’s no new government-run insurance company. If you’ve already got a policy you like, keep it. No, small businesses with fewer than 50 employees need not provide insurance; but, yes, they get tax credits if they do. No, undocumented immigrants aren’t eligible for help.
Many of you have mistakenly trusted carnival barkers like Limbaugh and Sarah Palin. Now that Obamacare’s the law, ignorance is no longer an excuse.
By: Gene Lyons, The National Memo, July 4, 2012
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