Paul Ryan’s Moral Barbarism
Karl Rove’s column the other day joined the many conservatives expressing their hurt and anger that President Obama would depict Paul Ryan’s budget as harming sick and vulnerable citizens:
Mr. Obama likes campaigning more than governing. And for this president, campaigning means knocking down straw men and delivering a steady stream of misleading attacks. It means depicting opponents as indecent, heartless people who take special delight in targeting seniors and autistic children.
In fact, Obama has never accused Ryan, or anybody, of having a “special delight” in targetting seniors and autistic children. But he has accused them of pursuing policies that would harm, among others, seniors and autistic children. That’s because it’s incontrovertably true. The Center on Budget and Policy Priorities delves into the details of Ryan’s plan to slash Medicaid by more than a third over the next decade, and in half over the next two decades:
- Seniors: An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage. Because the Ryan plan would require such deep cuts in federal Medicaid funding, it would inevitably result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families. A sharp reduction in the quality of nursing home care would be virtually inevitable, due to the large reduction that would occur in the resources made available to pay for such care.
- People with disabilities: These individuals constitute 15 percent of Medicaid beneficiaries but account for 42 percent of all Medicaid expenditures, mostly because of their extensive health and long-term care needs. Capping federal Medicaid funding would place significant financial pressure on states to scale back eligibility and coverage for this high-cost population, many of whom would be unable to obtain coverage elsewhere because of their medical conditions.
- Children: Currently, state Medicaid programs must provide children with health care services and treatments they need for their healthy development through the Early Periodic Screening, Diagnostic and Treatment (EPSDT) aspect of Medicaid, which provides regular preventive care for children and all follow-up diagnostic and treatment services that children are found to need. A block grant would likely permit states to drop EPSDT coverage, meaning that children, particularly those with special health care needs, would not be able to access some care that medical professionals find they need (because Medicaid would no longer cover certain health services and treatments for children, and their parents wouldn’t be able to afford to pay for that care on their own).
- Working parents and pregnant women: Many state Medicaid programs already have extremely restrictive eligibility criteria for parents. In the typical state, working parents are ineligible for Medicaid if their income exceeds 64 percent of the poverty line (or $14,304 a year for a family of four), and unemployed parents are ineligible if their income exceeds 37 percent of the poverty line ($8,270 a year for a family of four). Under a block grant, states could cut these already low eligibility levels even further, cap enrollment, and/or require low-income parents to pay more for health services. States could do the same for low-income pregnant women who rely on Medicaid for their prenatal care, resulting in them forgoing services that are critical to ensuring a healthy pregnancy.
Now, Rove appears to be a pathological liar, or at least so deeply enmeshed in partisan spin it’s not clear that a distinction exists in his mind between objective truth and claims that are useful to his side. But many other conservatives have likewise expressed what has the ring of genuine outrage that Obama would accuse Ryan of snatching medical care away from people in nursing homes, very poor families, special needs children, and so on. I think it reflects, in part, an inability or lack of desire to think with any specificty about the concrete ramifications of imposing extremely deep cuts to Medicaid. Who do they think is on Medicaid? Prosperous, healthy people?
No, Medicaid is a bare-bones program throwing a lifeline to people who are in bad shape. Cutting Medicaid may be the politically easiest way for Ryan to clear budget room to preserve Bush-era revenue levels, as Medicaid patients have little political clout. But it is, well, deeply immoral. I’m actually surprised that conservatives not only can’t seem to imagine (or care about) the consequences of such policies, but they can’t even imagine that people like Obama would actually feel moral outrage at their plan. They can’t imagine a liberal objection as representing anything other than an attempt to score political points. It’s bizarre. I mean, of course Obama finds it morally objectionable to take away medical care to people in nursing homes and children with special needs. That’s why he’s a Democrat.
By: Jonathan Chait, The New Republic, May 3, 2011
A Catastrophe For America: Liberals Should’t Even Consider Gloating About Donald Trump
Now that Donald Trump appears on the verge of launching a presidential campaign, it is worth reflecting on the meaning of this low moment in American political history. Trump is a clown and a buffoon, and the odds of him winning even one Republican caucus or primary appear slim. But there is no denying that Trump has managed to tap into something genuinely worrisome in American politics. Democrats may be tempted to take pleasure in the fact that Trump will likely push the GOP presidential field to the right, and thereby help Obama in 2012. But this would be sheer myopia, and any delight over Trump’s arrival on the political scene is entirely misplaced. The Trump ascendancy calls not for glee, but for serious concern about the state of our country.
It’s true that the media erred in awarding Trump such a large spotlight—did all the cable news networks really have to cover his press conference on Wednesday?—but, at this point, the Trump phenomenon does not seem to be a mere media creation. His popularity (he currently leads in several polls) can no longer be denied. So what is Trump’s appeal? Why do his message and vulgar personality resonate with such a significant percentage of Americans? Trump’s embrace of birtherism has been the most widely discussed aspect of his rise. But this only scratches the surface of the Trump phenomenon.
What Trump actually stands for is an exaggerated sense of victimhood. This is the theme that unites his personal style with the political views he has thus far expressed. Are you tired of being pushed around? Are you tired of our country being pushed around? Trump’s political acuity lies in his ability to take these grievances and turn them into politics. His foreign policy views in essence consist of a pledge to bully other nations.Chinais “decimating our country.” OPEC is imperiling the economy. And ungrateful Libyans and Iraqis are trying to build a society from oil that is rightfully ours. (“We won the war. We take over the oil fields. We use the oil.”) When Bill O’Reilly, in an interview with Trump, seemed taken aback by the idea that we could simply force OPEC orChinato do our bidding, Trump appeared surprised that anyone could view international relations as anything more than a contest of machismo. “The messenger is the key,” Trump told O’Reilly. “If you have the right messenger and they know how to deliver the message … you’re going to scare them, absolutely.”
Trump’s thinly veiled accusation that President Obama benefited from affirmative action when he applied to college derives from the same theme. This time the victims aren’t Americans as a whole, they are white Americans; but the message—of anger, resentment, and victimhood—is identical.
Americais currently engaged in three wars. The country faces major economic challenges. Global warming is continuing apace. There is no chance any of these issues can be solved by yelling at foreign countries, or stirring up anger at Iraqis or Libyans or minority applicants to elite colleges. Donald Trump has appointed himself spokesman for some of the nastiest impulses in American politics, and he seems to have a following. The sooner the Republican mainstream rejects him, the better. And we liberals should be cheering them along as they do.
By: The Editors, The New Republic, April 29, 2011
Why Are People Acting Like Health Care Reform Never Happened?
Ezra Klein, responding to the widespread perception that Paul Ryan has a plan to tackle medical cost inflation and Democrats don’t, points out that this is the opposite of the truth:
The Affordable Care Act’s central hope is that Medicare can lead the health-care system to pay for value, cut down on overtreatment, and cut out treatments that simply don’t work. The law develops Accountable Care Organizations, in which Medicare pays one provider to coordinate all of your care successfully, rather than paying many doctors and providers to add to your care no matter the cost or outcome, as is the current practice. It also begins experimenting with bundled payments, in which Medicare pays one lump-sum for all care related to the successful treatment of a condition rather than paying for every piece of care separately. To help these reforms succeed, and to help all doctors make more cost-effective treatment decisions, the law accelerates research on which drugs and treatments are most effective, and creates and funds the Patient-Centered Outcomes Research Institute to disseminate the data.
If those initiatives work, they head over to the Independent Payment Advisory Board (IPAB), which can implement cost-controlling reforms across Medicare without congressional approval — an effort to make continuous reform the default for Medicare, even if Congress is gridlocked or focused on other matters. And if they don’t work, then it’s up to the Center for Medicare and Medicaid Innovation, a funded body that will be continually testing payment and practice reforms, to keep searching and experimenting, and when it hits on successful ideas, handing them to the IPAB to implement throughout the system.
The law also goes after bad and wasted care: It cuts payments to hospitals with high rates of re-admission, as that tends to signal care isn’t being delivered well, or isn’t being follow up on effectively. It cuts payments to hospitals for care related to infections caught in the hospitals. It develops new plans to help Medicare base its purchasing decisions on value, and new programs to help Medicaid move patients with chronic illnesses into systems that rely on the sort of maintenance-based care that’s been shown to successfully lower costs and improve outcomes.
Keep in mind that the Congressional Budget Office made the very conservative decision not to assign savings to these measures, on the assumption that since they had never been tried before, there was no way of measuring how well they would work, so it gave them no financial savings value. And the Affordable Care Act also included a limit on the tax deduction for expensive health insurance, a powerful cost-saving tool that the CBO did score.
But to zoom out for a second, what Klein’s identifying here is part of a larger phenomenon. It’s not just that the debate about health care costs seems to take place as if the ACA never happened. The entire political debate seems to take place as if the ACA never happened. Moderate liberal Jacob Weisberg lamented liberal opposition to Paul Ryan as advocating government health care for the old but nobody else — when of course we now have government-provided health insurance for everybody else (except illegal immigrants.)
The deficit hawks embrace Paul Ryan’s plan as a starting point of a debate about deficit. (David Brooks today: “Because he had the courage to take the initiative, Paul Ryan’s budget plan will be the starting point for future discussions.”) But of course the ACA was not just a starting point but an enormous stride forward. Ryan proposes to undo much of it. Yet he is the courageous leader, and his critics passive observers.
What happened? The details of the ACA’s cost-containment are wonky, and few people paid attention to them. Staunch liberals either didn’t care about cost containment, or devoted their energy to agitating for more sweeping alternatives. Moderate liberals supported the measure, but, taking their cue from policy wonks, took the very honest posture of conceding that some parts might not work as planned, and thus contributed to a massive asymmetry of passion. Centrists simply assumed that any deficit plan that wasn’t a grand bipartisan deal could not be a real deficit plan, since their fundamental premise is that a grand bipartisan deal is the only way to address the deficit. And the whole health care issue was sucked into the vortex of an unhinged debate, so that millions of conservatives understand the whole package as nothing more than an assault on freedom, with little or no grasp of the particulars.
The end result of all this is a debate around an issue with a peculiar backwards character.
By: Jonathan Chait, The New Republic, April 4, 2011
Mangled Mandate: How Paul Ryan And The GOP Are Misreading The American People
As with any election, there are competing narratives about what message the voters were sending last November when Democrats got routed in the mid-terms. Each party has offered a view on the meaning of the election. In the Democrats’ view, an economically anxious electorate was focused on jobs and repudiated Obama’s party for not delivering on job growth. In this telling, voters did not reject a liberal agenda but saw health care and other issues as diversions from their immediate pressing economic concerns. And there is some evidence to support this view: Nearly two out of three voters picked the economy as the single most important issue in deciding their vote, and Republicans won that vote. Republicans, on the other hand, argue that voters threw out Democrats in record numbers because they recoiled at incredible levels of government spending. And, indeed, some exit polling showed that voters registered their opposition to a more activist federal government: 56 percent said the government is doing too much, while only 38 percent said the government should do more to solve problems. Meanwhile, 40 percent of voters favored deficit-reduction.
Now, Republicans are intent on using their interpretation of the election to achieve their policy goals. They are offering a budget blueprint that slashes spending on Medicare and Medicaid and other government programs. Representative Paul Ryan’s plan dramatically cuts services to the middle class. As my colleague Jonathan Chait has pointed out, these cuts would be made by lowering taxes on the wealthy and corporations. The whole proposal, in other words, represents a giant redistribution of wealth away from the middle class toward the rich. As the Congressional Budget Office notes about Ryan’s plan for Medicare, for example, “most elderly people would pay more for their health care than they would pay under the current Medicare system.” What Ryan is really saying, then, is in the middle of this recession, after a decade of declining wages, the real problem in our country is that middle-class Americans have too many services and the rich have been too put upon. And he seems to think he has public support to back him up.
But are Ryan and other Republicans about to walk over quicksand, fooled by the illusion of firm ground beneath their feet after the November elections? Do Americans really want slashes to programs that serve them? Evidence suggests not—meaning Paul Ryan is teetering on the edge of a cliff, threatening to take all House Republicans down with him.
Even the Tea Party movement, whose momentum was built on outrage at government spending, seems to be waning somewhat; the movement’s rallies that once boasted huge numbers now bring only hundreds to the Capitol. As poll analyst Charlie Cook has pointed out, independents have also shifted to being more neutral toward government intervention in the economy over the last few months—from 60 percent saying the government was trying to do too much in October to only 47 percent agreeing with that idea now. (Or, seen from another angle, in the same time frame, people saying the government should do more has risen from 38 percent to 51 percent). And, perhaps even more ominous for Republicans, according to a recent Kaiser poll, 56 percent of Americans do not support any Medicare reductions, 35 percent support minor reductions, and only 8 percent support major reductions. The story is the same with Medicaid: 47 percent do not support Medicaid reductions, 39 percent support minor reductions and 13 percent support major reductions.
Dress it up as he likes, Paul Ryan is proposing to do just what polls show the American people don’t want—to shift more costs shift to individuals, including middle-class Americans. And many House Republicans agree with him, although, already, a few members are refusing to embrace the Ryan budget proposal. Politico has reported that several more vulnerable Republican members, including Blake Farenthold, Sean Duffy, and Ann Marie Buerkle, have called the plan bold, yet not embraced the details.
After every election, the victors try to define and act on their mandate. As Ryan and other Republicans rush through their effort to slash spending, however, they would do well to ask themselves whether it’s what the public really wants—or whether they’re woefully misreading the voters, and setting themselves up for disaster in the next election.
By: Neera Tanden, The New Republic, April 7, 2011
KSM Decision: Place The Blame Where Blame Is Due
Many in the media, and many more of President Obama’s detractors from the left, are hitting his administration pretty hard today for this reversal. The development is obviously disappointing, but if we’re assigning blame, let’s at least direct at those responsible.
In a major reversal, the Obama administration has decided to try Khalid Sheikh Mohammed for his role in the attacks of Sept. 11 before a military commission at Guantanamo Bay, Cuba, and not in a civilian courtroom.
Attorney General Eric H. Holder Jr. is expected to announce on Monday afternoon that Mr. Mohammed, the self-described mastermind of the attacks, and four other accused conspirators will face charges before a panel of military officers, a law enforcement official said. The Justice Department has scheduled a press conference for 2 p.m. Eastern time.
Mr. Holder, who had wanted to prosecute Mr. Mohammed before a regular civilian court in New York City, changed his mind after Congress imposed a series of restrictions barring the transfer of Guantanamo detainees into the United States, making such a trial impossible for now, the official said.
Even that last sentence is awkward — the Attorney General “changed his mind” after Congress “imposed a series of restrictions”? That’s a bit like saying I changed my mind about getting up after I was tied to my chair.
Holder told reporters this afternoon that his original decision was still the right one, but blamed Congress for “tying our hands.”
He happens to be right. Even today, Holder wants to do the right thing, and so does President Obama. And yet, Gitmo is open today, and KSM will be subjected to a military commission in the near future, not because of an administration that backed down in the face of far-right whining, but because congressional Republicans orchestrated a massive, choreographed freak-out, and scared the bejesus out of congressional Democrats. Together, they limited the White House’s options to, in effect, not having any choice at all.
There’s plenty of room for criticism of the administration, but those slamming Obama for “breaking his word” on this are blaming the wrong end of Pennsylvania Avenue.
By: Steve Benen, Political Animal, Washington Monthly, April 4, 2011
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