Is Paul Ryan’s Medicare A Voucher System Or Not: Who Is Demagoguing Who?
During the White House meeting this week between President Obama and the Republican leadership, Rep. Paul Ryan took the President to task for demagoguing Ryan’s proposed Medicare changes.
According to the Congressman, the insistence on the part of the President- and his brother and sister Democrats – that the program is a voucher system rather than the ‘premium support’ program Ryan steadfastly claims the idea to be, is grossly misleading Americans, all for the purpose of political gain.
While Ryan’s confrontation with Obama brought cheers from the GOP freshman class who fill the corridors of Congress these days, the question that needs to be asked is, ”Who is demagoguing who?”
In truth, the concepts behind premium support and voucher programs are fairly close, each with a similar objective – the government helping out the beneficiary by paying a portion of a benefit, in this case an insurance premium.
Rep. Ryan likes to point out that his proposed Medicare program is the same as that employed by the Federal Employees Benefits Program and the Medicare Part D benefit that helps seniors pay for their prescription drugs. Both these programs operate using government premium support, whereby the government contributes towards the payment of the premiums charged by the private insurance carrier to the beneficiary, but makes the government’s share of the premium payment directly to the insurance company issuing the policy.
This direct payment is what is often considered the point of distinction between a voucher and premium support. In a voucher program the government gives the financial support directly to the beneficiaries who are then on their own to do what they will with the money, so long as they don’t look to the government to do anything else for them.
Using this standard alone, Rep. Ryan would have a point.
Indeed, his plan proposes seniors going to private insurers for their health care coverage with the government contributing a share of the premium charges and making the payment directly to the insurance company. This is just as the federal government does in the cases of federal employee benefits and Medicare Part D.
However, there is a more important distinction between premium support plans and vouchers.
In the plan that provides heath care benefits for federal employees, on which Ryan relies to make his premium support case, if a government employee’s premium costs go up –and they always do – the government increases the premium support in lockstep with the increased premium.
Not so with RyanCare.
Ryan’s proposal, that would turn Medicare into a private insurance program with the government providing assistance to seniors on their premium payments, limits increases in that support to the cost of living index – an amount wholly insufficient to cover the extra costs as we know that rising costs of health care and premium charges always exceed annual cost of living increases. Thus, if premiums increase (and of course they will) the costs of these increases will be shifted to our senior citizens who, in most instances, would not appear to have the ability to take on these increased costs on their fixed retirement budgets.
This, by anyone’s definition, is a voucher program.
In a recent piece by Washington Post blogger Ezra Klein, Ezra interviewed Henry Aaron of the Brookings Institute and Bob Reischauer of the Urban Institute. Messrs. Aaron and Brookings are the two gentlemen who originally came up with the term “premium support” to describe their idea for a Medicare system where the program is opened up to competition by private insurers but has safeguards built in to protect Medicare beneficiaries from the very cost shifting program the Ryan plan proposes.
While Ryan has largely adopted this model – the two originators make clear that he has done so without the key cost shifting safeguards that they believe are so essential to it working.
According to Aaron-
If one does the arithmetic, income grows a few percentage points faster than prices. Health-care spending grows faster than income by a couple of percentage points. So we’re looking at linking to an index that grows less rapidly than health-care costs by three to four percentage points a year. Piled up over 10 years, and that’s a huge erosion of coverage. It’s vouchers, not premium support.
Clearly, Ryan’s plan bears a far greater resemblance to a voucher program than the premium support programs he looks to as back up for what he is selling.
We can have a debate as to whether we would be better off turning Medicare over to the private markets. While I believe it is an idea fraught with dangerous consequences to our future seniors (those who are not yet 55 years of age), an honest debate to discuss these different ideas cannot hurt.
However, when Ryan and friends continue to play the political game of blaming the President for misleading the public when it is, in fact, Ryan who is attempting to mislead, there will be no honest debate.
It is not the President who is demagoguing on this one – it is Paul Ryan.
By: Rick Ungar, The Policy Page, Forbes, June 5, 2011
GOP Has 2012 Trouble: Attacking Medicare And Social Security Could Be Death Of Republicans’ 2012 Hopes
Recent weeks have finally defined the race for the 2012 Republican presidential nomination. The field has finally achieved a greater level of clarity as many candidates have opted out, running the absurd-to-formidable gamut from Donald Trump to Mitch Daniels. A smaller number have opted in, running the has-been to may-never-be gamut from Newt Gingrich to Tim Pawlenty, not to mention former Massachusetts Gov. Mitt Romney, who officially entered the race yesterday.
A former Minnesota governor, Pawlenty officially joined the wannabe ranks last week with a speech aimed at defining himself as a fearless teller of hard truths (previously he had perhaps best been known for lacking any definition at all). This is smart on several levels. He quickly moved to fill the void left by Daniels, the governor of Indiana, whom many in the party had yearned for as a tough-minded fiscal hawk. And in part it is a strong bid for the mantel of not-Romney, the alternative to the former Massachusetts governor and current GOP front-runner. Romney is a laughably transparent flip-flopper, so Pawlenty’s new truth-teller frame could make him an ideal foil.
Politicians love to position themselves as tellers of hard truths, brave enough to boldly level with the voters. And the current tempestuous political climate, with its roiling discontent with politics as usual, especially lends itself to such a pose. Pawlenty is merely the latest candidate to seize this meme.
But his candidacy runs squarely afoul of Robert’s 13th rule of politics: People like the idea of hard truths and hard-truth tellers much more than they like the reality of them. You can ask straight shooters like Walter Mondale (“Mr. Reagan will raise taxes, and so will I. He won’t tell you. I just did.”), Paul “I’m not Santa Claus” Tsongas, and John “Straight Talk” McCain. Winning the presidency requires an aspirational element at odds with the doom-and-gloom that comes with those self-consciously trying to speak hard truths.
So kudos to Pawlenty for standing up to big ethanol in little Iowa. But while some may take off their hats to him for traveling to Florida in order to call for overhauls (read: cuts) of Social Security and Medicare, it might be merely to scratch one’s head. As Hot Air blogger Allahpundit quipped after Pawlenty’s Florida performance, “Alternate headline: ‘Pawlenty now unelectable in not one but two early primary states.’ ”
Maybe this is actually deep strategy. Many conservatives and Tea Partyers in particular seem intent these days on—as Ronald Reagan used to complain of some of his more gung-ho supporters—going “off the cliff with all flags flying.” Perhaps this is a clever way for Pawlenty to appeal to that “I’d rather lose being right” instinct.
An additional problem for would-be hard-truth tellers is that in the telling, these so-called truths often become vehicles for an even harder ideology. The attempt to conflate serious problems with ideologically inflexible and partisan solutions can create political tensions and open deadly political rifts. See the political abyss House Budget Committee Chairman Paul Ryan has marched his colleagues into over his plan to repeal and replace Medicare.
With the future insolubility of Medicare as a starting point, Ryan and the GOP have embarked on an emphatically ideological course. They hailed themselves as seriously facing a tough issue, and they spin the plan as an attempt to save the program, but all it would save would be the name “Medicare.” A guarantee of healthcare would be replaced with a voucher of diminishing value. If it fails to cover seniors’ costs . . . tough luck. The view was perhaps best summed up by Georgia GOP Rep. Rob Woodall, who chastised a constituent at a town hall meeting last month when she asked how, after Ryan’s reforms eliminated the guarantee of Medicare, she could expect to get medical coverage since she worked for a company that doesn’t offer it in their retirement package. “Hear yourself, ma’am,” he said. “You want the government to take care of you, because your employer decided not to take care of you. My question is, ‘When do I decide I’m going to take care of me?’ ”
Woodall, like many conservatives, fails to grasp why programs like Medicare were created. They were a response to a market failure—specifically an inability of senior citizens to get or pay for healthcare. But in Woodall’s world there are apparently no market failures; if seniors can’t get healthcare it’s because they simply won’t take responsibility for themselves. Of course in 1964, 44 percent of senior citizens had no health coverage, and the cost of medical bills had driven more than one third of them below the poverty line. If only they had had the moral fiber to take care of themselves!
Safe in a heavily conservative district, Woodall can spout such nonsense. But roughly 60 House Republicans represent districts Barack Obama won in 2008 and virtually all voted for the Ryancare overhaul. In this case, the gap between hard truths and hard ideology may be big enough to swallow a House majority.
Just ask the pollsters employed by the House GOP, who warned that the bill was a ticking time bomb, Politico reported last week. Or ask Jane Corwin, that bomb’s first casualty. She is the Republican who lost May’s special election in a GOP-leaning New York district in which the Ryan plan was the defining issue. Or ask Sens. Olympia Snowe, Susan Collins, Lisa Murkowski, and Scott Brown, four of the five Senate Republicans who fled the plan last week (the fifth, Rand Paul, opposed it as not being conservative enough).
Or ask Gingrich, the former House speaker who drew party-wide opprobrium when he dismissed the Ryan plan as being so much “right-wing social engineering.” Pity poor Newt: He was just trying to tell a hard truth.
By: Robert Schlesinger, U. S. News and World Report, June 3, 2011
Walking Away From The Truth: GOP Playing With Matches On The Debt
Just ignore Tuesday’s vote against raising the debt ceiling, House Republican leaders whispered to Wall Street. We didn’t really vote against it, members suggested; we just sent another of our endless symbolic messages, pretending to take the nation’s credit to the brink of collapse in order to extract the maximum concessions from President Obama.
Once he caves, members said, the debt limit will be raised and the credit scare will end. And the business world apparently got the message. It’s just a “joke,” said a leader of the United States Chamber of Commerce, and Wall Street is in on it. Not everyone found it funny.
No matter how they tried to spin it, 318 House members actually voted against paying the country’s bills and keeping the promise made to federal bondholders. That’s an incredibly dangerous message to send in a softening global economy. Among the jokesters were 236 Republicans playing the politics of extortion, and 82 feckless Democrats who fret that Republicans could transform a courageous vote into a foul-smelling advertisement.
The games that now pass for governing in an increasingly embarrassing 112th Congress are menacing the nation’s future. It was bad enough when Republicans threatened to shut down the government to achieve their extreme and extremely misguided spending cuts, but that threat would have caused temporary damage. The debt limit is something else altogether. If the global credit markets decide that the debt of the United States will regularly be held hostage to ideological demands, it could cause significant harm to investment in long-term bonds and other obligations. That, in turn, could damage domestic credit markets and easily spark another recession.
To prevent this from happening, 114 Democrats in April asked for a “clean” vote without conditions. But Republicans were not about to set their hostage free. Knowing that the clean vote would not pass — and imposing a two-thirds majority requirement to ensure its failure — House Republicans gave the Democrats what they requested. They then voted it down, sending their reckless message to the world.
But there was no excuse for so many Democrats to go along with that message, including the leadership. Steny Hoyer, the minority whip, urged his members to vote no so they would not “subject themselves to a political 30-second ad attack” with all Republicans voting no. Apparently Mr. Hoyer did not trust voters to understand what a dangerous and dishonest game the Republicans are playing.
The exercise has prompted the White House to convene talks to discuss the Republicans’ scattershot demands, which have ranged from trillions in spending cuts to the outright dismantling of vital safety-net programs like Medicare and Medicaid. Democrats have hoped to get an increase in revenues out of any deal, but House Republican leaders emerged from a White House meeting on Wednesday spouting the usual discredited claims that higher taxes on the rich would impede job growth.
What Republicans seem unwilling to acknowledge is that the debt-limit debate is not about future spending. It is about paying for a deficit already incurred because of two wars and tax cuts approved by both Republicans and Democrats at the behest of a Republican president. Tuesday’s vote was a chance to do the right thing and educate the public on why it was necessary. Instead, too many lawmakers walked away from the truth.
House GOP Scoffs At The Fact That Taxes Are Lower Under Obama Than Under Reagan
President Obama met with House Republicans today at the White House to discuss ways to move forward on negotiations regarding the nation’s debt ceiling and the budget. During the discussion, talk evidently turned to taxes, and when Obama noted that taxes today are lower than they were under President Reagan, the GOP, according to The Hill, “engaged in a lot of ‘eye-rolling’“:
Republicans attending a White House meeting on Wednesday didn’t take kindly to President Obama telling them tax rates were higher during the Reagan administration. GOP members engaged in a lot of “eye-rolling,” according to a member who was on hand to hear Obama, who invited House Republicans to the White House for discussions on the debt ceiling. […]
“[The President] made a comment like the tax rate is the lightest, even more than (under former President) Reagan,” Rep. Lee Terry (R-Neb.) told The Hill following the meeting. House Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) joked that during the meeting, “We learned we had the lowest tax rates in history … lower than Reagan!”
That House Republicans find this preposterous is symptomatic of the hold Reagan mythology has over them. After all, for seven of Regan’s eight years in office, the top tax rate was higher than the current 35 percent. In six of those years, it was 50 percent or more. And every year that Regan was in office, the bottom tax bracket was higher than the current ten percent.
For a family of four, the “average income tax rate under Reagan in 1983 was 11.06 percent. Under Clinton in 1992, it was 9.18 percent. And under Obama in 2010, it was 4.68 percent.” During Reagan’s time, income tax revenue ranged from 7.8 to 9.4 percent of GDP. Last year, it was 6.2 percent and is not projected to climb back to 9 percent until 2016. In fact, in 2009, Americans paid their lowest taxes in 60 years.
Republicans are very fond of saying that the U.S. has “a spending problem, not a revenue problem.” But the truth is that revenue has plunged due to the recession and to continued misguided tax cuts, and revenue needs to be raised to eventually bring the budget into balance. And Reagan knew that taxes were an important part of the budget equation. After all, he “raised taxes in seven of his eight years in office,” including four times in just two years.
By: Pat Garofalo, Think Progress, June 1, 2011
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GOP And Media Alert: Vouchercare Is Not Medicare
What’s in a name? A lot, the National Republican Congressional Committee obviously believes. Last week, the committee sent a letter demanding that a TV station stop running an ad declaring that the House Republican budget plan would “end Medicare.” This, the letter insisted, was a false claim: the plan would simply install a “new, sustainable version of Medicare.”
But Comcast, the station’s owner, rejected the demand — and rightly so. For Republicans are indeed seeking to dismantle Medicare as we know it, replacing it with a much worse program.
I’m seeing many attempts to shout down anyone making this obvious point, and not just from Republican politicians. For some reason, many commentators seem to believe that accurately describing what the G.O.P. is actually proposing amounts to demagoguery. But there’s nothing demagogic about telling the truth.
Start with the claim that the G.O.P. plan simply reforms Medicare rather than ending it. I’ll just quote the blogger Duncan Black, who summarizes this as saying that “when we replace the Marines with a pizza, we’ll call the pizza the Marines.” The point is that you can name the new program Medicare, but it’s an entirely different program — call it Vouchercare — that would offer nothing like the coverage that the elderly now receive. (Republicans get huffy when you call their plan a voucher scheme, but that’s exactly what it is.)
Medicare is a government-run insurance system that directly pays health-care providers. Vouchercare would cut checks to insurance companies instead. Specifically, the program would pay a fixed amount toward private health insurance — higher for the poor, lower for the rich, but not varying at all with the actual level of premiums. If you couldn’t afford a policy adequate for your needs, even with the voucher, that would be your problem.
And most seniors wouldn’t be able to afford adequate coverage. A Congressional Budget Office analysis found that to get coverage equivalent to what they have now, older Americans would have to pay vastly more out of pocket under the Paul Ryan plan than they would if Medicare as we know it was preserved. Based on the budget office estimates, the typical senior would end up paying around $6,000 more out of pocket in the plan’s first year of operation.
By the way, defenders of the G.O.P. plan often assert that it resembles other, less unpopular programs. For a while they claimed, falsely, that Vouchercare would be just like the coverage federal employees get. More recently, I’ve been seeing claims that Vouchercare would be just like the system created for Americans under 65 by last year’s health care reform — a fairly remarkable defense from a party that has denounced that reform as evil incarnate.
So let me make two points. First, Obamacare was very much a second-best plan, conditioned by perceived political realities. Most of the health reformers I know would have greatly preferred simply expanding Medicare to cover all Americans. Second, the Affordable Care Act is all about making health care, well, affordable, offering subsidies whose size is determined by the need to limit the share of their income that families spend on medical costs. Vouchercare, by contrast, would simply hand out vouchers of a fixed size, regardless of the actual cost of insurance. And these vouchers would be grossly inadequate.
But what about the claim that none of this matters, because Medicare as we know it is unsustainable? Nonsense.
Yes, Medicare has to get serious about cost control; it has to start saying no to expensive procedures with little or no medical benefits, it has to change the way it pays doctors and hospitals, and so on. And a number of reforms of that kind are, in fact, included in the Affordable Care Act. But with these changes it should be entirely possible to maintain a system that provides all older Americans with guaranteed essential health care.
Consider Canada, which has a national health insurance program, actually called Medicare, that is similar to the program we have for the elderly, but less open-ended and more cost-conscious. In 1970, Canada and the United States both spent about 7 percent of their G.D.P. on health care. Since then, as United States health spending has soared to 16 percent of G.D.P., Canadian spending has risen much more modestly, to only 10.5 percent of G.D.P. And while Canadian health care isn’t perfect, it’s not bad.
Canadian Medicare, then, looks sustainable; why can’t we do the same thing here? Well, you know the answer in the case of the Republicans: They don’t want to make Medicare sustainable, they want to destroy it under the guise of saving it.
So in voting for the House budget plan, Republicans voted to end Medicare. Saying that isn’t demagoguery, it’s just pointing out the truth.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 5, 2011
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June 6, 2011 Posted by raemd95 | Affordable Care Act, Budget, Conservatives, Consumers, Elections, GOP, Government, Health Care Costs, Health Reform, Ideologues, Ideology, Journalists, Lawmakers, Media, Medicare, Politics, Pundits, Republicans, Right Wing, Seniors, Under Insured, Uninsured, Voters | Canada, Canadian Health Care, Canadian Medicare, CBO, Comcast, Commentators, Demagoguery, Elderly, Government Health Insurance, House Republicans, Insurance Companies, Low Income, Medicare Vouchers, Out of Pocket xpenses, Politicians, Poor, Private Health Insurance, VoucherCare | Leave a comment