“Common Ground Is Not Always Common”: Beware Of Paul Ryan’s Lose-A-Battle, Win-A-War Strategy
The conventional wisdom is that the Republicans got nothing—except some historic disapproval numbers and a lot of internal backbiting—from the whole shutdown showdown.
But there are different Republicans, with different intentions, and not all of them were frowning as the week of their party’s public shame came to a conclusion.
It is certainly true that Texas Senator Ted Cruz has become a political punch line—the Canadian-born Republican whom Democrats would most like to see the Grand Old Party nominate for president. House Speaker John Boehner’s name is likely to enter the lexicon as an antonym for “leadership.” Senate minority leader Mitch McConnell is going to be spending an inordinate amount of time discussing the term “Kentucky kickback.” And it may even be dawning on the Tea Partisans that the whole “defund Obamacare” gambit was a charade.
The real point of the exercise in chaos that the country was just dragged through was the chaos itself.
And the beneficiary of it all is the Republican who has suddenly stepped back into the limelight after laying low through most of the shutdown: House Budget Committee chairman Paul Ryan, R-Wisconsin.
Fully aware that the American people have no taste for a “grand bargain” that might see the implementation of at least some of his Ayn Rand–inspired “survival-of-the-fittest” proposals for means-testing earned-benefit programs, for taking the first steps toward privatization of Social Security, for turning Medicare and Medicaid into voucher programs, Ryan has for years been looking for an opening that makes his proposals seem “necessary.”
The 2012 election, when he was his party’s “big ideas” guy, and its nominee for vice president, confirmed that there was no electoral route to advance his agenda. Americans rejected Ryan, overwhelmingly. He could not even carry his home state for the Romney-Ryan ticket, which was defeated by a 5 million popular-vote margin and a 332-206 Electoral College blowout. Ryan knew that it would take more to get his opening. And the crisis of the past several weeks in Washington provided it.
Some analysts were surprised when Ryan voted against the deal to temporarily end the shutdown and raise the debt ceiling. They shouldn’t have been. While it’s true that Ryan—an enthusiastic backer of the 2008 bank bailout—is a reliable vote for the agenda of the Wall Street speculators who fund his campaigns, he wasn’t going against his political patrons when he joined 143 other House Republicans in voting “no.” Rather, the Budget Committee chairman—who just reported raising more than $1 million in fresh campaign funds in the third quarter of 2013—was voting to strengthen his own hand as he steps into the ring for the next stage of an inside-the-Beltway fight that is far from finished.
The deal that ended the shutdown set up a high-stakes conference committee on budget issues. If there is to be a “grand bargain,” this is where it will be generated. And Ryan—the most prominent of the fourteen Democrats, fourteen Republicans and two independents on the committee—is in the thick of it.
The Budget Committee chairman says it would be “premature to get into exactly how we’re going to” sort out budget issues.
But no one should have any doubts about the hard bargain he will drive for. In the midst of the shutdown, Ryan jumped the gun by penning a Wall Street Journal op-ed that proposed: “Reforms to entitlement programs and the tax code…”
“Here are just a few ideas to get the conversation started,” Ryan wrote. “We could ask the better off to pay higher premiums for Medicare. We could reform Medigap plans to encourage efficiency and cut costs. And we could ask federal employees to contribute more to their own retirement.”
Translation: Get ready for the radical reshaping of Medicare so that it is no longer a universal program. Make way for more price-gouging by the private companies that sell supplemental insurance. Launch a new assault on public employees who have already been hit with wage freezes and furloughs.
And Ryan will not stop there.
He never does.
That’s why the Democrats on the conference committee—led by Senate Budget Committee chairman Patty Murray, D-Washington—must be exceptionally wary.
“Chairman Ryan knows I’m not going to vote for his budget, and I know he’s not going to vote for mine,” says Murray. “We’re going to find the common ground between our two budgets that we both can vote on and that’s our goal.”
The thing to remember that Ryan is working to get cuts to earned-benefit programs onto that common ground.
Ryan cast his “no” vote on the deal that set up the conference committee in order to begin organizing his troops for a fight that will set up the next shutdown and debt-ceiling struggles. The committee has a deadline of December 13. That makes its report—or the lack of one—the first deadline on a schedule that proceeds toward new continuing resolution and debt-ceiling votes in January and February. That creates tremendous pressure for a deal, and Ryan’s at the ready.
That answer to his supplications must be a firm “No.”
That’s what Senator Bernie Sanders, I-Vermont, is proposing. Sanders, one of a member of the conference committee says: “it is imperative that this new budget helps us create the millions of jobs we desperately need and does not balance the budget on the backs of working people, the elderly, the children, the sick and the poor…”
Sanders’ office notes: “The Senate budget protects Medicare while the House version would end Medicare as we know it by providing coupons for private health insurance. Unlike the House budget, the Senate resolution does not repeal the Affordable Care Act, which would prevent more than 20 million Americans from getting health insurance. The House version would eliminate grants for up to 1 million college students while the Senate plan protects Pell grants. The House version would kick up to 24 million Americans off of Medicaid while the Senate budget would protect their benefits. The Senate budget calls for new revenue while the House version would provide trillions of dollars in tax breaks mainly for the wealthiest Americans and profitable corporations offset by increased taxes on the middle class.”
Ryan would be more than happy to settle for a “common ground” agreement that opens the way for a little bit of privatization, a little bit of movement toward vouchers, a little bit of means testing, a little bit of an increase in the retirement age. But if he gets that, the big “blink” that everyone was talking about during the shutdown fight will have happened.
If that is where this thing ends, it might not be the Democrats who get the last laugh.
It might yet be a Republican named Paul Ryan.
By: John Nichols, The Nation, October 18, 2013
“Cloaked In Secrecy”: The Myth Of The Medical-Device Tax
In the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign — even garnering the support of many Democrats who favored the law — arguing that the tax would stifle innovation and increase health care costs.
This argument is doubly disingenuous. Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.
The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.
Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.
Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.
There are several ways policy makers could lower device costs. The first step would be to end the anticompetitive practices that prevent hospitals from getting the best deals. Senator Charles E. Grassley, Republican of Iowa, has sponsored legislation that would foster transparency by posting online price information for implantable medical devices.
In addition, instead of simply paying hospitals based in part on what they have spent on devices, Medicare should force manufacturers to compete for business based on a product’s price and quality.
Medicare should also pay hospitals a single lump sum for all of the associated costs of a given procedure (like a hip replacement). This approach, known as “bundling” the costs, would create incentives for hospitals to lower device costs. Savings should be shared with the physicians, so that their incentives are aligned with the hospital’s.
Bundling has been used successfully in pilot programs. Under Medicare’s Acute Care Episode Program — which bundled payments for cardiac and orthopedic procedures — physicians worked together to choose high-quality, cost-effective devices. Baptist Health System in Texas, which participated in the program, used clinical evidence to choose devices and negotiated lower prices for both Medicare and non-Medicare patients.
States could adopt similar payment reforms for private insurance and their Medicaid programs. In Arkansas, the Medicaid program and private payers — including Walmart — have collaborated to adopt bundled payments for several procedures, including hip and knee replacements.
To complement these efforts, the new Patient-Centered Outcomes Research Institute, a nongovernmental body created by the Affordable Care Act, should pay for research that compares the effectiveness of devices so physicians can make informed choices. (Three years into its existence, the institute has initiated few, if any, studies of medical devices.) Medicare or the Food and Drug Administration should also require the use of registries that track when devices fail.
Currently, medical-device manufacturers allocate only a sliver of profits to research and development and often focus on “tweaks” to existing devices, without providing any evidence that they are of better quality. Competitive pressures from public and private payers would provide incentives for the industry to become more innovative, producing technologies that actually lowered costs and offered truly advanced breakthroughs.
Instead of using its clout to lobby against the device tax — which helped foment opposition to the Affordable Care Act — the medical-device industry needs to share the responsibility of lowering costs for patients, businesses and taxpayers.
By: Topher Spiro, Op-Ed Contributor, The New York Times, October 16, 2013
“Lessons Learned”: Why Giving Republican Bullies A Bloody Nose Isn’t Enough
Now is the time to lance the boil of Republican extremism once and for all.
Since Barack Obama became president, the extremists who have taken over the Republican Party have escalated their demands every time he’s caved, using the entire government of the United States as their bargaining chit.
In 2010 he agreed to extend all of the Bush tax cuts through the end of 2012. Were they satisfied? Of course not.
In the summer of 2011, goaded by an influx of Tea Partiers, they demanded huge spending cuts in return for raising the debt ceiling. In response, the President offered an overly-generous $4 trillion “Grand Bargain,” including cuts in Social Security and Medicare and whopping cuts in domestic spending (bringing it to its lowest level as a share of gross domestic product in over half a century).
Were Republicans content? No. When they demanded more, Obama agreed to a Super Committee to find bigger cuts, and if the Super Committee failed, a “sequester” that would automatically and indiscriminately slice everything in the federal budget except Social Security and Medicare.
Not even Obama’s re-election put a damper on their increasing demands. By the end of 2012, they insisted that the Bush tax cuts be permanently extended or the nation would go over the “fiscal cliff.” Once again, Obama caved, agreeing to permanently extend the Bush tax cuts for incomes up to $400,000.
Early this year, after the sequester went into effect, Republicans demanded even bigger spending cuts. Obama offered more cuts in Medicare and a “chained CPI” to reduce Social Security payments, in exchange for Republican concessions on taxes.
Refusing the offer, and seemingly delirious with their power to hold the nation hostage, they demanded that the Affordable Care Act be repealed as a condition for funding the government and again raising the debt ceiling.
This time, though, Obama didn’t cave — at least, not yet.
The government is shuttered and the nation is on the verge of defaulting on its debts. But public opinion has turned sharply against the Republican Party. And the GOP’s corporate and Wall Street backers are threatening to de-fund it.
Suddenly the Republicans are acting like the school-yard bully who terrorized the playground but finally got punched in the face. They’re in shock. They’re humiliated. They’re trying to come up with ways of saving face.
With bloodied nose, House Republicans are running home. They’ve abruptly turned negotiations over to their Senate colleagues.
And just as suddenly, their demand to repeal or delay the Affordable Care Act has vanished. (An email from the group Tea Party Express says: “Are you like us wondering where the fight against Obamacare went?”) At a lunch meeting in the Capitol, Senator John McCain asked a roomful of Republican senators if they still believed it was possible to reverse parts of the program. According to someone briefed on the meeting, no one raised a hand — not even Ted Cruz.
It appears that negotiations over the federal budget deficit are about to begin once again, and presumably Senate Republicans will insist that Obama and the Democrats give way on taxes and spending in exchange for reopening the government and raising the debt ceiling for at least another year.
But keeping the government running and paying the nation’s bills should never have been bargaining chits in the first place, and the President and Democrats shouldn’t begin to negotiate over future budgets until they’re taken off the table.
The question is how thoroughly President Obama has learned that extortionist demands escalate if you give in to them.
By: Robert Reich, The Robert Reich Blog, October 12, 2013
“GOP Fully Succumbs To Its Cultural Rage”: The Day The Mad Dogs Took Over The Republican Party
It was a head-spinning day in Washington, yesterday was, as the story seemed to change from hour to hour in terms of who was proposing or accepting or refusing what and who seemed up and who seemed down. But through it all, one constant did not change and doesn’t seem likely to change: The Republicans are wrecking themselves.
Indeed, historically so. This is one of those turning points in American political history, the kind you’ll tell your grandkids you were around to see: a once-respectable party that finally was eaten alive by the cultural rage it had so long used to its advantage but held in check in order to win elections. It was a long time coming and it’s a grand thing to watch, provided they don’t wreck the country along with themselves.
First, a quick recap. Thursday morning, John Boehner finally picked up on the signals the White House had been sending and offered a “clean” but short-term debt-limit increase. Since Boehner clearly knew that such a measure wouldn’t get votes from his loony-tunes caucus, he was aiming for something that might pass with a combination of Republican and Democratic votes. That was admirable. But there was a problem: He proposed to do nothing about the government shutdown until Nov. 22, and that was something most Democrats wouldn’t have gone for.
Still, the Obama administration signaled that it would play ball. This angered Harry Reid, who was at work trying to round up a few Republican votes for his own one-year increase of the debt limit. The afternoon skirmishing was intense, featuring a few Republican senators (Roy Blount, Susan Collins, and, most interestingly of all, John Cornyn) undercutting Boehner, saying they would like to alter his proposal to include a provision to allow the government to open back up. Then, late in the day, the Not-So-Magic Bus of 20 Republicans rolled up to the White House, and Boehner put… well, put something on the table to Obama, something involving a six-week increase in the debt limit but who knows what else, and Obama said: not yet.
It is true that Obama drew back from the signals his people had been sending for a couple of days. But it’s also true that we don’t know exactly what happened in that room and what was proposed. One of the various crazy things about the GOP position now is that we don’t even know what they’re negotiating for. “America’s pressing problems,” they kept saying. But what exactly are those? I guess now Obamacare isn’t one of them, since it’s off the table. Or maybe the medical-device tax is. So higher taxes on prostheses is the crisis that the country must solve yesterday?
They mean, of course, Social Security, Medicare, and Medicaid. They want cuts. But they just want Obama to give in on those without giving him anything on revenues. This would be the normal way of what we call “negotiating.”
But the thing is this. People who have specific policy goals engage in negotiation. But these Republicans don’t have specific policy goals. They have what we might call emotional policy goals. They want to wipe Obamacare, and Obama’s desires on taxation, and the entire Obama record, really, from the face of the earth, like Pharoah wanted to wipe Moses’s name from the obelisks. They don’t even really know what they want to win, as Indiana GOP Congressman Martin Stutzman famously said last week. But if it humiliates Obama, it’s a win. Bad for the country? That doesn’t matter either. To them, by definition, if it’s bad for Obama, it’s good for the country. They actually think this.
And so, through a combination of a critical mass of anti-thought people in their caucus who won’t govern at all if it means seeing Obama come out OK, and a “leader” who can now plainly be called the weakest speaker since America became a country of consequence, the Republican Party has finally and fully succumbed to its cultural rage. It has used that rage mostly effectively for nigh on 50 years now, since Barry Goldwater. That rage has served it well on balance. It helped elect Nixon. It certainly helped elect Reagan, and even though it could be argued that once in office Reagan didn’t do that much to stoke it, he understood that he needed it to win, which is why he opened his 1980 campaign down in Mississippi, to say to his America that it was all right to resent black people, he understood you.
The rage kept the base galvanized. It kept the enemy, or enemies—liberal and the media, often one and the same—in the gun sights. But it could also be controlled, the way Reagan controlled it. And even Dubya controlled it. The rich didn’t really share the rage, or most of them. Even the Koch Brothers probably don’t, what with all the froufrou artsy-fartsy outfits up in New York they help sustain.
But all of them have used it. And they have tolerated it, the casual racism, the hatred of gay people, and the rest. They tolerated it because the booboisie voted the right way, and because they, the elites, remained in charge. Well, they’re not in charge now. The snarling dog they kept in a pen for decades has just escaped and bitten their hand off.
The Republicans still might pull it back together. They were also at a historic low after Nixon resigned. They won three of the next four elections. But that was just one man’s megalomania. This is the psychosis of one-quarter of the nation. That quarter is now leading the elites around by the nose. And the Red Sea just might swallow them all. It’s certainly what they deserve.
By: Michael Tomasky, The Daily Beast, October 11, 2013
“Dealing With Default”: Let’s Hope We Don’t Find Out What Will Happen If We Hit The Debt Ceiling
So Republicans may have decided to raise the debt ceiling without conditions attached — the details still aren’t clear. Maybe that’s the end of that particular extortion tactic, but maybe not, because, at best, we’re only looking at a very short-term extension. The threat of hitting the ceiling remains, especially if the politics of the shutdown continue to go against the G.O.P.
So what are the choices if we do hit the ceiling? As you might guess, they’re all bad, so the question is which bad choice would do the least harm.
Now, the administration insists that there are no choices, that if we hit the debt limit the U.S. government will go into general default. Many people, even those sympathetic to the administration, suspect that this is simply what officials have to say at this point, that they can’t give Republicans any excuse to downplay the seriousness of what they’re doing. But suppose that it’s true. What would a general default look like?
A report last year from the Treasury Department suggested that hitting the debt ceiling would lead to a “delayed payment regime”: bills, including bills for interest due on federal debt, would be paid in the order received, as cash became available. Since the bills coming in each day would exceed cash receipts, this would mean falling further and further behind. And this could create an immediate financial crisis, because U.S. debt — heretofore considered the ultimate safe asset — would be reclassified as an asset in default, possibly forcing financial institutions to sell off their U.S. bonds and seek other forms of collateral.
That’s a scary prospect. So many people — especially, but not only, Republican-leaning economists — have suggested that the Treasury Department could instead “prioritize”: It could pay off bonds in full, so that the whole burden of the cash shortage fell on other things. And by “other things,” we largely mean Social Security, Medicare, and Medicaid, which account for the majority of federal spending other than defense and interest.
Some advocates of prioritization seem to believe that everything will be O.K. as long as we keep making our interest payments. Let me give four reasons they’re wrong.
First, the U.S. government would still be going into default, failing to meet its legal obligations to pay. You may say that things like Social Security checks aren’t the same as interest due on bonds because Congress can’t repudiate debt, but it can, if it chooses, pass a law reducing benefits. But Congress hasn’t passed such a law, and until or unless it does, Social Security benefits have the same inviolable legal status as payments to investors.
Second, prioritizing interest payments would reinforce the terrible precedent we set after the 2008 crisis, when Wall Street was bailed out but distressed workers and homeowners got little or nothing. We would, once again, be signaling that the financial industry gets special treatment because it can threaten to shut down the economy if it doesn’t.
Third, the spending cuts would create great hardship if they go on for any length of time. Think Medicare recipients turned away from hospitals because the government isn’t paying claims.
Finally, while prioritizing might avoid an immediate financial crisis, it would still have devastating economic effects. We’d be looking at an immediate spending cut roughly comparable to the plunge in housing investment after the bubble burst, a plunge that was the most important cause of the Great Recession of 2007-9. That by itself would surely be enough to push us into recession.
And it wouldn’t end there. As the U.S. economy went into recession, tax receipts would fall sharply, and the government, unable to borrow, would be forced into a second round of spending cuts, worsening the economic downturn, reducing receipts even more, and so on. So even if we avoid a Lehman Brothers-style financial meltdown, we could still be looking at a slump worse than the Great Recession.
So are there any other choices? Many legal experts think there is another option: One way or another, the president could simply choose to defy Congress and ignore the debt ceiling.
Wouldn’t this be breaking the law? Maybe, maybe not — opinions differ. But not making good on federal obligations is also breaking the law. And if House Republicans are pushing the president into a situation where he must break the law no matter what he does, why not choose the version that hurts America least?
There would, of course, be an uproar, and probably many legal challenges — although if I were a Republican, I’d worry about, in effect, filing suit to stop the government from paying seniors’ hospital bills. Still, as I said, there are no good choices here.
So what will happen if and when we hit the debt ceiling? Let’s hope we don’t find out.
By: Paul Krugman, Op-Ed Columnist, the New York Times, October 10, 2013
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 