“Confronting Health Care Reform”: What Romney Won’t Do On Health Care
He has awful plans that he’ll probably never implement.
Despite what the average voter probably thinks, presidential candidates keep the overwhelming majority of the promises they make. And most of the ones they don’t keep aren’t because they were just lying, but because circumstances changed or they tried to keep the promise and failed. But that’s in the big, broad strokes, while the details are another matter. It’s easy to put out a plan for, say, tax reform, but even if you achieve tax reform, it’s Congress that has to pass it, and they will inevitably shape it to their own ends. This happened to a degree with President Obama’s health care reform: it largely resembles what he proposed during the 2008 campaign, but not entirely. He had said he wanted a public option, for instance, but eventually jettisoned that, and had rejected an individual mandate, but eventually embraced it as unavoidable.
Which brings us to Mitt Romney’s health care plan. In its details, it’s quite horrifying. Jonathan Cohn has done us the service of giving it a close read, and explains: “He wants to scale back health insurance, so that it reaches less people and provides less protection from medical bills. In theory, this transformation will unleash market forces that restrain the cost of medical care. In practice, it will cause serious hardship, by exposing tens of millions of Americans to crushing medical bills or forcing some of them to go without necessary, even life-saving care.” Estimates are that under Romney’s plan—which repeals the Affordable Care Act, makes Medicaid a block grant (leading almost inevitably to fewer people getting covered), eliminates the tax advantage for employer-sponsored coverage (leading to more employers dropping coverage) and turns Medicare into a voucher, as many as 58 million fewer Americans could have health insurance than will once the ACA fully takes effect. Wow.
So the question is, is Mitt Romney really going to do this? I’m guessing the answer is no, and here’s why. If he becomes president, he’ll confront health care under one of two scenarios. The first is one in which the Supreme Court has upheld the ACA. In that case, conservatives are still mad, and will want to repeal it. But as long as there are more than 40 Democrats in the Senate to mount a filibuster, they won’t let repeal happen. So faced with the inability to achieve great big things on health care, Romney will probably settle for some smaller bills, probably including malpractice reform. One year into his presidency, the ACA will take full effect, and at that point, implementing his plan would mean not just preventing people who don’t have insurance from getting it, but actually tossing people who have insurance off their plans. Which just isn’t going to happen.
The second scenario is that the Supreme Court overturns the ACA, in which case they will have largely done Romney’s job for him. The elements of his plan that don’t relate to the ACA—block granting Medicaid, ending the tax exemption for employer benefits—will still run into unified opposition from Democrats, and as far as congressional Republicans will be concerned, the battle over health care will be over, and they’ll move on to other things.
In any discussion of health care, it’s important to remember that Republicans don’t really care about the issue, except insofar as it’s a bludgeon they can use to beat Democrats with. They just don’t. They care about taxes, and regulation, and defense, and many other things, but they’re happy not to worry about health care unless they have to. So chances are that whatever the Supreme Court decides, big, dramatic changes to the health care system during a Romney presidency are going to be talked about briefly, then put on the back burner permanently.
By: Paul Waldman, Contributing Editor, The American Prospect, May 24, 2012
“Right Wing Social Engineering”: What Romney’s Medicare Plan Actually Does
DC journos have spent much of the 2012 election trying to answer the question of how exactly a President Romney would govern. On one side, there are the skeptics who never bought into Romney’s rhetoric during the Republican nomination. They argue Romney is, at heart, still a moderate northeastern governor, a businessman unsuited for the extremism that has come to dominate his party. Others are equally convinced that Romney must be taken at face value. Sure he might have positioned himself in the middle while he governed a state dominated by Democrats, but he has spent the past five years running for president full-time, aligning himself with every right-wing whim over the course of his two campaigns. He’s the Republican who sought the endorsement of Ted Nugent, discarded a gay spokesman, and calls corporations people. Lest we forget, it was Romney who was poised to run as the right-wing challenger to John McCain and Rudy Giuliani in 2008 before Mike Huckabee swooped in to steal the evangelical vote.
The best measure to get at the real Romney is to read his actual proposals and ignore the standard posturing at campaign stops or TV interviews. These are the documents directed primarily at the obsessive political class, barely noticed by your average voter, thus freeing Romney to be closer to his true self. They’re probably the most important piece of evidence for any politician before an election. As Jonathan Bernstein has convincingly argued, presidential pledges should be taken at face value, as newly elected presidents are almost always constrained by the commitments they made during the campaign.
When weighed by this measure, Romney is undoubtably aligned with the far right-wing vision of his policy, particularly on budgetary and fiscal matters. He’s advocated not only for the extension of the Bush tax cuts, but has suggested even further reductions in the U.S. tax rate that would heavily benefit the wealthy. He’s endorsed the Paul Ryan budget wholesale, an Ayn Randian vision of the limited government that even Newt Gingrich termed “right wing social engineering” when it was initially introduced.
One of the key elements of the Ryan/Romney overlapping vision is how the government should handle the exploding costs of Medicare. The New York Times delved into Romney’s proposals in contrast with Obama’s in an article Tuesday. The piece unfortunately falls into the pitfalls of equivocating newspaper journalism, weighing both plans largely by the attacks poised by the opponent rather than independent descriptions of what each candidate is suggesting. Romney’s plan is introduced as “ending Medicare as we know it” in Obama’s words, while the article introduces the Affordable Care Act as such:
The president’s 2010 health care law, Mr. Romney says, “could lead to the rationing or denial of care for seniors,” as it will squeeze nearly a half-trillion dollars from the growth of Medicare over 10 years while putting the program’s future “in the hands of 15 unelected bureaucrats.”
Either side of the political divide can agree that Medicare is on a perilous path. Health care expenditures as a whole are eating up an increasingly large share of the country’s GDP, and the number of Medicare enrollees is set to jump as the Baby Boomers start to retire. The government has projected that by 2024 the Medicare fund will no longer be able to match the full cost of expected benefits.
This concern is one of the primary reasons Obama pushed health care reform early in his administration. Alongside the measures that make it easier for low and middle income Americans to purchase health insurance, the Affordable Care Act takes a first stab at tackling the looming problem. The bill included a variety of measures to incentivize cheaper, more effective health care to bring down costs throughout the health care market, along with a medical advisory board that will suggest best practices to keep the tab lower on Medicare.
Meanwhile, Romney and Ryan’s strategy is to largely ignore the general growing cost of health care, instead focusing on Medicare itself. They would turn Medicare into a premium support plan—essentially a voucher program that would shift the burden of health spending off the government ledger by forcing future retirees to spend far more of their own funds on health services. These vouchers would initially meet the value of buying insurance on the private market, but they would soon fall behind the actual cost for consumers if the general price of health care continues to rise unabated.
Romney has not yet released a proposal with all of the details, but it is safe to assume that his premium support plan would largely follow the model set forth by Ryan. Under that plan—which has already passed the Republican controlled House before it was blocked by Democrats in the Senate—all Medicare enrollees who enter the program beginning in 2023 would have to enter the voucher program, and, as the Center for Budget and Policy Priorities has highlighted, by 2050 Medicare expenditures would be 35 to 42 percent lower for each participant, primarily by shifting the cost burden onto enrollees rather than lowering the overall cost of the care they consume.
Yes, Medicare expenditures would be lowered—but on enrollees’ dime.
By: Patrick Caldwell, The American Prospect, May 15, 2012
“A Window Into The Future”: Mitt Romney Won’t Enroll In Medicare And Doesn’t Want Anybody Else To Either
Mitt Romney hasn’t explained his announcement yesterday that he won’t be enrolling in Medicare despite turning 65, but as Jonathan Cohn points out, Romney is at least practicing what he preaches. Romney supports Paul Ryan’s plan to turn Medicare into a voucher program, a plan that would effectively end Medicare as we know it, and Romney is putting his money where his mouth is by deciding against enrolling.
Romney’s decision is a window into the future that he promises to deliver. Instead of a Medicare program that directly provides coverage, Romney wants seniors to obtain coverage from private insurers. Depending on their income and personal wealth, a portion of that coverage would be subsidized, but the guaranteed coverage of Medicare would be eliminated.
The fact that Romney was able to forego the Medicare system without penalty or punishment puts the lie to the notion that government health care programs are tyrannical. That’s an important fact to point out, because even though any senior who doesn’t want Medicare coverage could walk away from the system, just like Mitt Romney did, the overwhelming majority of them don’t—and that’s a testament to the effectiveness of Medicare.
But even though Medicare works, Mitt Romney wants to end the program as we know it. He wants Medicare to be transformed into a voucher provider, subsidizing private insurance plans instead of directly covering medical care. For 99 percent of Americans, it would be a radical overhaul, raising costs and making it difficult if not impossible to find insurance. Given his means, Romney would do fine in such a system. That’s basically the system he’s living in now, but it doesn’t take a rocket scientist to realize most people can’t afford what he can afford. And if Medicare were privatized as he proposes, that’s exactly what he would force every American senior to do.
If you’re only concerned about personal benefit, Medicare might not turn out to be the best deal in the world for someone like Mitt Romney, who is fabulously wealthy and doesn’t need the coverage. But even the Mitt Romneys of the world are better off living in a society where senior citizens have the security of health care coverage that Medicare provides. If we were to adopt Mitt Romney’s proposal to turn it into a voucher system, Medicare would no longer provide it’s greatest benefit of all: the peace of mind that comes with knowing that every single senior citizen has the health care coverage they need.
By: Jed Lewison, Daily Kos, March 13, 2012
“Sowing Confusion”: Is There Any Limit To Mitt Romney’s Dishonesty?
The other day, David Bernstein argued that there’s been an “important tipping point” where many national media figures have come to understand that “in the Romney campaign, they are dealing with something unlike the normal spin and hyperbole.” Bernstein suggested they are realizing Romney has crossed into groundbreaking levels of dishonesty.
I wish I were as optimistic. I’d argue that much of the national media is still treating Romney’s nonstop distortions, dissembling, and outright lying as par for the course, as business as usual.
Here’s a test case: The debate over Medicare — and Romney’s embrace of the Paul Ryan plan — is about to dominate the conversation. Romney is moving to get ahead of the story by accusing Obama of being the one who would “end Medicare as we know it.” Here’s the Romney campaign’s statement this morning:
“There are two proposals on the table for addressing the nation’s entitlement crisis. Mitt Romney — along with a bipartisan group of leaders — has offered a solution that would introduce competition and choice into Medicare, control costs, and strengthen the program for future generations. President Obama has cut $500 billion from Medicare to fund Obamacare and created an unaccountable board with rationing power — all while America’s debt is spiraling out of control and we continue to run trillion-dollar deficits.
“If President Obama’s plan is to end Medicare as we know it, he should say so. If he has another plan, he should have the courage to put it forward.”
The claim that Romney supports a solution favored by a “bipartisan group of leaders” is a reference to the plan authored by Ryan and Dem Senator Ron Wyden. The idea that this represents “bipartisan” suppport is laughable. But this type of claim is made on both sides, so put it aside.
More interesting is the assertion that Obama has “cut $500 billion from Medicare” and created an “unaccountable board with rationing power” even as the deficit is “spiraling out of control.” That’s a reference to Obamacare’s efforts to curb spending with $500 billion in savings that are actually wrung from health care providers, not Medicare beneficiaries. That “unaccountable board,” meanwhile, is a reference to the Independent Payment Advisory Board, which is designed to make recommendations for reducing Medicare costs, and explicitly cannot recommend rationing.
Get the trick here? The Romney campaign is accusing Obama of slashing Medicare, and hence “ending Medicare as we know it,” while simultaneously accusing him of failing to curb entitlement spending in ways that pose grave danger to the nation’s finances. This, even as Romney has endorsed a plan that would quasi-voucherize Medicare and end the program as we know it.
This is all about muddying the waters in advance of a debate that could cut badly against Romney. The GOP primary forced him to embrace Ryancare; Dems are going to hammer him over it. So the Romney camp is trying to get out front by blurring lines and sowing confusion over who actually is defending traditional Medicare and who would end the program’s fundamental mission as we know it. The question is whether this, too, will be treated as just part of the game.
By: Greg Sargent, The Washington Post, The Plum Line, March 12, 2012
“Enumerated Powers” And The Radicalism of The GOP Thought Process
Republican presidential hopeful Rick Perry chatted with The Daily Beast yesterday, and was asked about his understanding of “general welfare” under the Constitution. The left, the Texas governor was told, would defend Social Security and Medicare as constitutional under this clause, and asked Perry to explain his own approach. He replied:
“I don’t think our founding fathers, when they were putting the term ‘general welfare’ in there, were thinking about a federally operated program of pensions nor a federally operated program of health care. What they clearly said was that those were issues that the states need to address. Not the federal government. I stand very clear on that. From my perspective, the states could substantially better operate those programs if that’s what those states decided to do.”
It’s worth pausing to appreciate the radicalism of this position. When congressional Republicans, for example, push to end Medicare and replace it with a privatized voucher scheme, they make a fiscal argument — the GOP prefers to push the costs away from the government and onto individuals and families as a way of reducing the deficit.
But Perry is arguing programs like Medicare and Social Security aren’t just too expensive; he’s also saying they shouldn’t exist in the first place because he perceives them as unconstitutional. Indeed, when pressed on what “general welfare” might include if Medicare and Social Security don’t make the cut, the Texas governor literally didn’t say a word.
Now, this far-right extremism may not come as too big a surprise to those familiar with Perry’s worldview. He’s rather obsessed with the 10th Amendment — unless we’re talking about gays or abortion — and George Will recently touted him as a “10th Amendment conservative.” Perry’s radicalism is largely expected.
It’s worth noting, then, that Mitt Romney seems to be in a similar boat. He was asked in last night’s debate about his hard-to-describe approach to health care policy, and the extent to which his state-based law served as a model for the Affordable Care Act. Romney argued:
“There are some similarities between what we did in Massachusetts and what President Obama did, but there are some big differences. And one is, I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people.”
What I’d really like to know is whether Romney means this, and if so, how much. Because if he’s serious about this interpretation of the law, and he intends to govern under the assumption that powers not specifically granted to the federal government are reserved by the states and the people, then a Romney administration would be every bit as radical as a Perry administration.
After all, the power to extend health care coverage to seniors obviously isn’t a power specifically granted to the federal government, so by Romney’s reasoning, like Perry’s, Medicare shouldn’t exist. Neither should Social Security, the Civil Rights Act, the Clean Air Act, student loans, FEMA, or many other benchmarks of modern American life.
And if Romney doesn’t believe this, and he’s comfortable with Medicare’s constitutionality, maybe he could explain why the federal government has the constitutional authority to bring health care coverage to a 65-year-old American, but not a 64-year-old American.
By: Steve Benen, Contributing Writer, Washington Monthly-Political Animal, August 12, 2011
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