“37 Pages Of Talking Points”: The Republican Healthcare Plan Isn’t Actually A Healthcare Plan
Rep. Billy Long (R-Mo.) boasted on Twitter yesterday, “You’ve asked for it and tomorrow, House Republicans will release our plan to replace Obamacare.” Whether or not this actually constitutes a “plan,” however, is open to some debate.
After six years of vague talk about a conservative alternative to the Affordable Care Act, House Republicans on Tuesday finally laid out the replacement for a repealed health law – a package of proposals that they said would slow the growth of health spending and relax federal rules for health insurance. […]
In finally presenting one, Speaker Paul D. Ryan of Wisconsin and his Republican team did not provide a cost estimate or legislative language. But they did issue a 20,000-word plan that provides the most extensive description of their health care alternative to date.
Perhaps, but let’s not grade on a curve. It was seven years ago this month that House Republican leaders began promising to unveil a GOP health-care-reform plan, and for seven years, the party has done nothing except offer vague soundbites and vote several dozen times to repeal the Affordable Care Act, replacing it with nothing.
Or put another way, we’ve seen seven years of posturing on health care policy, but no actual governing.
The New York Times is correct that we now have an “extensive description” of the House Republican vision on the issue, but an “extensive description” does not a plan make. There’s still no legislation; there are still no numbers; there’s still no substance to score and scrutinize.
The Huffington Post summarized the problem nicely: “Speaker Paul Ryan wants to replace 20 million people’s health insurance with 37 pages of talking points.”
The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.
It’s difficult to be certain, because the proposal, which House Speaker Paul Ryan (R-Wis.) will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage.
The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.
As for the outline itself, the “plan” includes exactly what we’d expect it to include: tax credits, health savings accounts, high-risk pools that Republicans don’t want to finance, transitioning Medicare into a voucher/coupon system, and the ability to buy insurance across state lines without necessary consumer safeguards and protections.
After seven years of study, GOP lawmakers are stuck with the same collection of ineffective ideas they’ve been pushing to no avail all along.
When House Speaker Paul Ryan (R-Wis.) announced plans to unveil a six-part “Better Way” governing agenda, he vowed, “We’re not talking about principles here. This is substance.” That may have been the goal, but as of this morning, we’re still left with “a starting point” and “a broad outline” on health care that will ostensibly help Republicans to work out the details later.
There’s no great mystery here. Republicans haven’t been able to come up with a credible reform package for some pretty obvious reasons: (1) they’re a post-policy party with no real interest in governing; (2) health care reform has never really been a priority for the party, which would prefer to leave this in the hands of the private sector and free-market forces; and (3) trying to improve the system requires a lot of government spending and regulations, which contemporary GOP policymakers find ideologically abhorrent.
On this last point, New York’s Jon Chait explained a while back, “The reason the dog keeps eating the Republicans’ health-care homework is very simple: It is impossible to design a health-care plan that is both consistent with conservative ideology and acceptable to the broader public. People who can’t afford health insurance are either unusually sick (meaning their health-care costs are high), unusually poor (their incomes are low), or both. Covering them means finding the money to pay for the cost of their medical treatment. You can cover poor people by giving them money. And you can cover sick people by requiring insurers to sell plans to people regardless of age or preexisting conditions. Obamacare uses both of these methods. But Republicans oppose spending more money on the poor, and they oppose regulation, which means they don’t want to do either of them.”
A Republican Hill staffer famously put it this way in 2014: “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act…. To make something like that work, you have to move in the direction of the ACA.”
Which, of course, Republicans can’t bring themselves to do. The result is a shell of a plan, like the one Paul Ryan is rolling out today.
By: Steve Benen, The Maddow Blog, June 22, 2016
“Why Republicans Are Hell-Bent On Destroying Medicare”: Belief’s That Spring From Ideological Faith, Not Facts
One way you can identify politicians’ sincere convictions is by looking at the things they do even when they know they’re unpopular. There are few better examples than the half-century-long quest by Republicans to destroy Medicare.
As we move towards the 2016 presidential election, it’s something we’re hearing about yet again. Conservatives know the Democrats will attack them for it mercilessly, and they know those attacks are probably going to work — yet Republicans keeps trying. Which is why it’s clear that they just can’t stand this program.
When Medicare was being debated in the early 1960s, one of its most prominent opponents was a certain future president, who recorded a spoken word album called Ronald Reagan Speaks Out Against Socialized Medicine. In it, he said that if the bill were to pass, “We are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” He failed in that crusade, and ever since, conservatives have watched in pain as the program became more entrenched and more popular.
That popularity didn’t happen by accident. Medicare is popular because it gives seniors something they crave: security. Every American over 65 knows that they can get Medicare, it will be accepted by almost every health care provider, their premiums will be modest, and it won’t be taken away. On the policy level, the program is expensive, but that’s because providing health care for the elderly is expensive. It’s not because the program is inefficient; in fact, Medicare does an excellent job of keeping costs down. Its expenses for overhead (basically everything except health care) are extremely low, somewhere between 1 percent and 5 percent of what it takes in, compared to private insurance costs that can run from 10 percent to 20 percent and, in some cases, even higher. (See here for a good explanation of these figures.)
That’s not to say there’s nothing about the program that could be improved, because there certainly is. The Affordable Care Act tried to institute some Medicare reforms, including moving away from the fee-for-service model (which encourages doctors and hospitals to do as many procedures as possible) and toward a model that creates incentives for keeping patients healthy. It’s still too early to say how great an impact those changes will have. But Medicare is still in most ways the most successful part of the American health insurance system. And if you care about empirical truth, it’s impossible to argue that it’s a failure because it involves too much government.
But Republicans do argue that, and it’s a belief that springs from ideological faith, not facts. In Wednesday’s debate, Rand Paul was asked whether Reagan was right about Medicare, and he responded, “The question always is, what works better, the private marketplace or government? And what distributes goods better? It always seems to be the private marketplace does a better job. Is there an area for a safety net? Can you have Medicare or Social Security? Yes. But you ought to acknowledge the government doesn’t do a very good job at it.” Paul’s ambivalence is obvious — he grudgingly acknowledges that you can have a “safety net,” including Medicare, even as he says it’s terrible. But if that’s so, why not get rid of it entirely?
The presidential candidates who have said anything specific about Medicare all want to move in the direction of privatization, which isn’t too surprising. After all, they believe that it’s impossible for government to do anything better than the private sector, and if you can take a government program and privatize it, that’s what you should do. That’s also what new Speaker of the House Paul Ryan believes: For years he’s been touting a plan to privatize Medicare by essentially turning it into a voucher program. Instead of being an insurer for seniors as it is now, the government would give you a voucher that you could spend to buy yourself private insurance. And if the voucher didn’t cover the cost of the insurance you could find? Tough luck.
When you ask Paul Ryan about this, the first thing he’ll say is that he wants a slow transition to privatizing Medicare, one that won’t affect today’s seniors at all, so they don’t need to worry. In Wednesday’s debate, Marco Rubio made the same argument. “Everyone up here tonight that’s talking about reforms, I think and I know for myself I speak to this, we’re all talking about reforms for future generations,” he said. “Nothing has to change for current beneficiaries. My mother is on Medicare and Social Security. I’m against anything that’s bad for my mother.”
In other words: Medicare is a disaster, but we would never change it for the people who are on it and love it so much. They don’t have to fear the horror of being subject to our plan for Medicare’s future. Which is going to be great.
That contradiction is the essence of the Republicans’ Medicare problem. It’s one of the most successful and beloved social programs America has ever created, and to mess with it is to court political disaster, particularly among seniors who vote at such high rates. And its success is particularly galling, standing as it does as a living rebuke to their fervent belief that there can never be any area in which government might outperform the private sector.
But grant Republicans this: A less ideologically committed group might say, “We don’t like this program, but it’s too politically dangerous to try to undo it. So we’ll just learn to live with it.”
Republicans won’t give up. They want to undermine Medicare, to privatize it, to try in whatever way they can come up with to hasten the day when it disappears. And no matter how often they fail, they keep trying.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, October 30, 2015
“Kinder, Gentler, Not In Substance, But In Tone”: Maybe Jeb Bush Doesn’t Have To Pander To The Right Wing After All
When Jeb Bush said last December that the Republican nominee would have to be willing to “lose the primary to win the general without violating your principles,” it sounded like either a starkly realistic assessment of the dynamics of Republican presidential politics or an awfully naïve statement of what was actually possible for a Republican candidate. Most observers — myself included — thought that he’d have no choice but to mirror the anger of committed Republican voters. As the candidate perceived by base voters and the most moderate of the contenders, he’d have to go through the same ritual that Mitt Romney did — genuflection to the right.
But so far, it doesn’t seem to be happening. Bush is offering a kinder, gentler conservatism than the other candidates — not in substance, but in tone. And even though he’s trailing Donald Trump in the polls, at this point it looks like his strategy might just pay off.
Let’s be clear about one thing: Jeb Bush is very, very conservative. His answers to almost every policy question are firmly within today’s Republican consensus. He wants a belligerent foreign policy, tax cuts and slashing of regulations, a repeal of the Affordable Care Act, raising the eligibility age for Medicare and possibly voucherizing the program, and so on. Even on immigration, Bush favors a path to “legal status” that would allow the 11 million undocumented immigrants in this country to stay, but wouldn’t allow them to become citizens.
But Bush isn’t trying to sound mad, and he doesn’t seem particularly spooked by the Trump candidacy. He was candid in condemning Trump’s remarks about Mexican immigrants, and just did an interview with Telemundo — in Spanish — where he talked about how his family speaks Spanish at home, and about bigotry his children have faced. In an interview published today, he admits that human activity contributes to climate change, though like any good Republican he doesn’t actually want to do anything about it.
What this all adds up to is a candidate who in substance is almost indistinguishable from other Republicans, but sounds very different in tone. And what are the results? One way to look at it is that Bush can’t seem to break out. He’s been surpassed in the polls by Donald Trump, but he hasn’t really fallen — the Huffpost Pollster average has him at 13.9 percent, about where he’s been since people started polling this race.
But none of the other candidates have broken out, either. Trump, Bush, and Scott Walker are the only ones who ever score in double digits. Candidates who at various times were thought to have great potential, like Marco Rubio, Rand Paul, and Ted Cruz, don’t seem to be going anywhere. They’re trying desperately to find ways to get noticed — Paul takes a chainsaw to the tax code, Cruz calls Mitch McConnell a liar, Mike Huckabee compares President Obama to Hitler — but none of it seems to work.
If you’re Bush, your path to victory looks like this: Trump soaks up all the attention for a while, but eventually gets bored (and hasn’t bothered to mount an actual campaign that can deliver votes), and either fades or just packs it in. Meanwhile, the conservative vote is split. Once the voting starts, the failing candidates will begin to fall away one by one. But by the time most of them are gone and their supporters have coalesced around a single candidate like Scott Walker, it’s too late — Jeb has built his lead and is piling up delegates, has all the money in the world, and can vanquish that last opponent on his way to the convention in Cleveland.
It sounds perfectly plausible. And if it happens that way, the party’s conservatives will have the next chapter in their long narrative of betrayal already written. Once again, they’ll say, the establishment foisted a moderate on a party that didn’t want him, and the result was disaster. If only they had nominated a true conservative, then victory would have been theirs.
Unless, of course, Bush’s entire theory about winning the general by being prepared to lose the primary is correct, and he ends up gaining the White House. Either way — at least for the moment — it doesn’t seem like such a bad idea for Jeb Bush to keep sounding like a nice guy, and keep a lid on the most embarrassing pandering to the right wing.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 30, 2015
“Zombies Against Medicare”: The Right Has Never Abandoned Its Dream Of Killing The Program
Medicare turns 50 this week, and it has been a very good half-century. Before the program went into effect, Ronald Reagan warned that it would destroy American freedom; it didn’t, as far as anyone can tell. What it did do was provide a huge improvement in financial security for seniors and their families, and in many cases it has literally been a lifesaver as well.
But the right has never abandoned its dream of killing the program. So it’s really no surprise that Jeb Bush recently declared that while he wants to let those already on Medicare keep their benefits, “We need to figure out a way to phase out this program for others.”
What is somewhat surprising, however, is the argument he chose to use, which might have sounded plausible five years ago, but now looks completely out of touch. In this, as in other spheres, Mr. Bush often seems like a Rip Van Winkle who slept through everything that has happened since he left the governor’s office — after all, he’s still boasting about Florida’s housing-bubble boom.
Actually, before I get to Mr. Bush’s argument, I guess I need to acknowledge that a Bush spokesman claims that the candidate wasn’t actually calling for an end to Medicare, he was just talking about things like raising the age of eligibility. There are two things to say about this claim. First, it’s clearly false: in context, Mr. Bush was obviously talking about converting Medicare into a voucher system, along the lines proposed by Paul Ryan.
And second, while raising the Medicare age has long been a favorite idea of Washington’s Very Serious People, a couple of years ago the Congressional Budget Office did a careful study and discovered that it would hardly save any money. That is, at this point raising the Medicare age is a zombie idea, which should have been killed by analysis and evidence, but is still out there eating some people’s brains.
But then, Mr. Bush’s real argument, as opposed to his campaign’s lame attempt at a rewrite, is just a bigger zombie.
The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful. But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.
What Medicare’s would-be killers usually argue, instead, is that the program as we know it is unaffordable — that we must destroy the system in order to save it, that, as Mr. Bush put it, we must “move to a new system that allows [seniors] to have something — because they’re not going to have anything.” And the new system they usually advocate is, as I said, vouchers that can be applied to the purchase of private insurance.
The underlying premise here is that Medicare as we know it is incapable of controlling costs, that only the only way to keep health care affordable going forward is to rely on the magic of privatization.
Now, this was always a dubious claim. It’s true that for most of Medicare’s history its spending has grown faster than the economy as a whole — but this is true of health spending in general. In fact, Medicare costs per beneficiary have consistently grown more slowly than private insurance premiums, suggesting that Medicare is, if anything, better than private insurers at cost control. Furthermore, other wealthy countries with government-provided health insurance spend much less than we do, again suggesting that Medicare-type programs can indeed control costs.
Still, conservatives scoffed at the cost-control measures included in the Affordable Care Act, insisting that nothing short of privatization would work.
And then a funny thing happened: the act’s passage was immediately followed by an unprecedented pause in Medicare cost growth. Indeed, Medicare spending keeps coming in ever further below expectations, to an extent that has revolutionized our views about the sustainability of the program and of government spending as a whole.
Right now is, in other words, a very odd time to be going on about the impossibility of preserving Medicare, a program whose finances will be strained by an aging population but no longer look disastrous. One can only guess that Mr. Bush is unaware of all this, that he’s living inside the conservative information bubble, whose impervious shield blocks all positive news about health reform.
Meanwhile, what the rest of us need to know is that Medicare at 50 still looks very good. It needs to keep working on costs, it will need some additional resources, but it looks eminently sustainable. The only real threat it faces is that of attack by right-wing zombies.
By: Paul Waldman, Op-Ed Columnist, The New York Times, July 27, 2015
“Privatization Of Medicare”: Jeb Bush Now Says He Wouldn’t ‘Phase Out’ Medicare. What He Would Do Is Just As Wrong
It had to happen sooner or later: a Republican presidential candidate says something suggesting he’d destroy Medicare, the Democrats jump all over him, and he backtracks, saying that’s not what he meant and in fact he only wants to strengthen it. This time it’s Jeb Bush, who said the other day that though we can keep Medicare around for the people who are currently on it, “we need to figure out a way to phase out this program for others and move to a new system that allows them to have something – because they’re not going to have anything.”
This is an old argument from Republicans, one they also use to justify attacks on Social Security: the program is doomed anyway, so we should go ahead and privatize it. The argument is completely wrong with regard to Social Security, and the truth about Medicare is that the program’s future is looking brighter and brighter — in no small part because of the Affordable Care Act. The argument Bush is making is ten years out of date.
Bush did try to walk back his statement a bit, saying the “phase out” part was taken out of context and he’s only talking about how we “reform our entitlement system.” Here’s his follow-up, which doesn’t change the essence of what he was arguing:
“It’s an actuarially unsound health care system,” said Bush, who said something must be done before the system burdens future generations with $50 billion of debt. “Social Security is an underfunded retirement system; people have put money into it, for sure.
“The people that are receiving these benefits, I don’t think that we should touch that; but your children and grandchildren are not going to get the benefit of this that they believe they’re going to get, or that you think they’re going to get, because the amount of money put in compared to the amount of money the system costs is wrong.”
Bush hasn’t yet released his plan to phase out/reform Medicare, but given these comments it seems likely he’ll embrace something like what Paul Ryan has been advocating for years. It involves changing Medicare from a guaranteed single-payer government insurance plan into a voucher plan, in which the government gives senior citizens a set amount of money with which they can go out and get private health insurance. It saves money by limiting the value of that voucher, so if it’s less than what coverage actually costs, well, tough luck. In that way, it eliminates the central promise of Medicare, which is that every American senior citizen will have health coverage.
We’ll await Jeb’s particulars, but I promise you that most of the GOP candidates will embrace some version of this plan, because that’s what the Republican consensus on Medicare is these days. And it’s always justified with the argument Jeb gives: because of skyrocketing costs the program is doomed, so privatization is the only way to make sure it’s there for your kids. But don’t worry, current seniors, we won’t touch your Medicare! Which is one of the ironies of their argument: the free market is supposed to make everything wonderful, but they fall all over themselves to promise senior citizens that they won’t disturb the big-government, socialist program that seniors love.
Now on to the cost question. As it happens, the Medicare Trustees just released their annual report on the future of the program. And as Kevin Drum noted, things are looking a lot sunnier than they were a few years ago:
Ten years ago, Medicare was a runaway freight train. Spending was projected to increase indefinitely, rising to 13 percent of GDP by 2080. This year, spending is projected to slow down around 2040, and reaches only 6 percent of GDP by 2090. Six percent! That’s half what we thought a mere decade ago. If that isn’t spectacular, I don’t know what is.
Those are projections for what’s going to happen decades from now, so things are doubtless going to change. But the presumption of the Republican argument is that Medicare is eventually going to eat the entire federal budget, and so we have no choice but to fundamentally alter it. And that’s just not true.
The other assumption they make is that the way to alter Medicare is simple: privatize it. But they’re wrong about this, too. Medicare is expensive, but that’s not because it’s an inefficient big-government program. In fact, Medicare is remarkably efficient, more so than private insurance. That’s because it benefits from economies of scale, and because it doesn’t have to spend money on things like marketing, underwriting, and big salaries for executives. The reason Medicare is expensive is that American health care is expensive, and it serves a lot of people. The retirement of the large Baby Boom generation is what’s producing its current funding challenges.
Let’s not forget that at the same time Republicans cry that Medicare is unaffordable and so must be dismantled, they fight any effort to actually lower costs in a rational way. For instance, they’re adamantly opposed to comparative effectiveness research, which involves looking at competing treatments and seeing which ones actually work better. That this isn’t something Medicare already takes into account sounds ridiculous, but it’s true. If there are two medications for a particular ailment that are equally effective, but one costs $100 a year and one costs $100,000 a year, wouldn’t it make sense for Medicare to 1) find that out, and 2) make coverage decisions accordingly? But Republicans have said no — Medicare should just pay for both, no matter what it costs.
Republicans also oppose the most significant effort to reduce Medicare costs in decades, something called the Affordable Care Act, which included all kinds of provisions meant to achieve this goal. Perhaps most critically, the law starts a move away from the fee-for-service model, in which doctors and hospitals make more money the more procedures they do, to a model where they get paid a single rate for treating a patient. Under the fee-for-service model, if your hospital screws up, you get an infection, and you have to get re-admitted, they make more money; the ACA actually punishes them for that, giving them a greater incentive to provide better and less expensive care.
But Republicans not only want to repeal the ACA, which means repealing all those kinds of payment provisions, they have nothing much to say about how, specifically, we might save money in Medicare. Their only answer is that if we privatize it, the magic of the market will produce savings. Of course, if that were true America would have the cheapest health care system in the advanced world, since ours is already more private than in any other similar country. And yet we don’t — ours is far and away the most expensive, and that’s precisely because the market has failed.
So to sum up, this is the Republican argument on Medicare: We absolutely can’t do anything in particular that would bring down the cost of Medicare, but the cost of Medicare is so outrageous that we have no choice but to privatize it.
When Jeb Bush and the other candidates talk about this subject, pay close attention to what they say. They’ll use the word “strengthen” a lot — we want to strengthen Medicare! They’ll tell seniors, who vote in great numbers, that they aren’t going to touch their precious Medicare. And they’ll ignore what we’ve learned in the last few years, talking as though things look just as bad as they did before the Affordable Care Act was passed and health care spending slowed. But the truth is that their solution is no solution at all.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 24, 2015
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