“Rejecting Their Own Ideas”: Republicans Are Creating Needless Difficulties For Themselves And The Country
We know that the House of Representatives has been unable to reach a sensible deal to avoid unnecessary fiscal trouble at the first of the year because of right-wing Republicans’ aversion to tax increases.
But there is another issue on which conservatives are creating needless difficulties for themselves and the country: It’s harder and harder for politicians on the right to think straight about health care.
Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective.
Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law. The mechanisms would allow more than 20 million Americans to buy coverage. They were originally a conservative idea for large, trustworthy marketplaces where individuals and families could buy plans of their choice.
Many liberals preferred a national exchange, in which the federal government could institute strong rules to protect consumers and offer broader options. This was the path the House took, but the final Senate-passed law went with state-level exchanges in deference to Republican sensibilities.
To ensure that governors could not just prevent their residents from having access to the new marketplaces, the bill required the federal government to run them if states defaulted. So, irony of ironies, in declining to set up state exchanges, conservative governors are undermining states’ rights and giving liberals something far closer to the national system they hoped for. As Robert Laszewski, an industry critic of Obamacare, told The Post’s N.C. Aizenman, conservative governors are engaging in “cut-off-your-nose-to-spite-your-face” behavior.
This is one of many forms of conservative health-care unreason. The “fiscal cliff” debate has been distorted because the problems confronting federal finances are consistently misdescribed. We do not have “an entitlement problem.” We have a giant health-care cost problem.
Our major non-military fiscal challenges lie in Medicare and Medicaid. In principle, conservatives should seek to find ways of holding down health-care inflation in both the private and public sectors. In practice, they see most efforts to take on this issue system-wide as examples of big government run wild. They seem to have a vague idea that markets can yet solve a problem that markets have not been very good at solving.
The result is that conservatives would either let government get bigger, or they’d save money by throwing ever more risk onto individuals by undercutting core government guarantees.
Their most outrageous move was the big lie that the original health-care bill included “death panels.” This would have been laughable if it had not been so pernicious. The provision in question would simply have paid for consultations by terminally ill patients — if they wanted them — with their physicians on their best options for their care. Few things are more important to the future of health care than thinking straight about the costs and benefits (to patients and not just the system) of end-of-life treatments. For those of us who oppose physician-assisted suicide, it’s urgent to promote, rather than block, serious, moral and compassionate discussions of the difficult issues raised by high-tech medicine.
Or take the health-care law’s creation of the Independent Payment Advisory Board, known as IPAB. It’s a 15-member body charged with finding ways of cutting the costs of treatment under Medicare. Congress would have the final say, but through a fast-track process. Yet the ink was barely dry on Obama’s signature of the Affordable Care Act (ACA) when a group of Republican senators introduced what they called the Health Care Bureaucrats Elimination Act, to get rid of IPAB. Thus did an innovative effort to save money meet with a slap in the face. Conservatives barely acknowledge other cost-saving experiments in the ACA.
Is it any wonder that our fiscal politics are so dysfunctional? Yes, we liberals are very reluctant to cut access to various government health-insurance programs. With so many Americans still uninsured, we are wary of depriving more people of coverage. But we fully accept the need to contain government health spending.
Yet given the conservatives’ habit of walking away even from their own ideas (the exchanges, for example) and of rejecting progressive efforts to save money, is it any wonder that liberals suspect them of greater interest in dismantling programs than in making them more efficient? We won’t find genuine common ground on deficits until we resolve this dilemma.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, December 26, 2012
“Laying Out The Best Options”: The Progressive Case For The Chained Consumer Price Index
Liberals are going to have to decide if they’ll stick with the president if the plan he floated this week to cut Social Security benefits by switching to the so-called chained CPI becomes a reality, and it’s not an easy choice. Progressive pressure groups and lawmakers are furious with Obama for proposing the cuts, as I noted yesterday, but House Democratic Leader Nancy Pelosi said she’s confident that her caucus would ultimately support the plan if the president asks them too.
The case against moving to the chained CPI is easy to make: It represents a real cut to seniors’ Social Security benefits, which has so far been a non-starter. Even advocates of the switch acknowledge this. But since we may have to swallow it, it’s worth laying out the best progressive argument possible in favor of the chained CPI. We’re not saying it’s right, but it’s a case that should be made.
And the argument does exist. The Center for Budget and Policy Priorities, one of the most well-respected liberal think tanks on policy analysis, has endorsed the change. As has the Center for American Progress, Washington’s most powerful liberal think tank, which recommended the chained CPI in its comprehensive Social Security reform plan.
The key question is this: Do you believe Obama can get a deal without cutting anything from social safety entitlement programs, or is he going to have to do something? If you fall in the former camp, then the chained CPI is dead on arrival. But, if you think we’re going to have to cut entitlements at some point, then the chained CPI is probably the least bad option of a menu of bad possibilities, including raising the Medicare retirement age, which is the most likely alternative and would be far more harmful.
On its own, the chained CPI is unquestionably bad, but as part of a deal to raise taxes, extend unemployment benefits and do the other good things Obama wants to do, and if it includes major mitigating tweaks, it can be made almost palatable.
First of all, it’s important to note that the CPI formula doesn’t affect just Social Security. Rather, it appears in hundreds of different places on both the revenue and spending side of government. Almost every government retirement, disability and income-support program pays annual cost of living adjustments that are linked to the CPI. On the tax side, dozens of elements, from the standard deduction to limits on contributions to 401K plans to the earned income and child tax credits, are adjusted every year based on the CPI.
The whole point of the CPI is make sure benefits keep pace with inflation on the one hand, and to ensure that people are paying enough taxes as inflation changes on the other hand. So while the chained CPI cuts benefits, it also raises revenues in a way that’s palatable to Republicans. The change is estimated to save about $220 billion over 10 years, $72 billion of which would come from increased tax revenue.
Moreover, both CBPP and CAP, along with many independent economists, believe the chained CPI is a more accurate measure of inflation than the current index, called the CPI-W. The CPI is calculated by measuring price changes in a basket of 250 common consumer goods, but only the chained CPI takes into account that people shift their buying habits in response to price changes. Adjusting for that, the chained CPI grows about .3 percent slower than the current rate.
Liberals rightly note that this substitution effect isn’t really true for the very poor and very old, who spend a disproportionate amount of their income on non-substitutable goods like healthcare and housing. That’s why the only acceptable way to shift to the chained CPI is to include exemptions for some of the most vulnerable groups.
There are two major changes necessary. First, add a bump in benefits to the very old, who are more likely to have high healthcare bills and to have exhausted their savings that supplemented their Social Security income. Second, exempt Supplemental Security Income, which serves the poorest, disabled and blind but still often leaves people below the poverty line. SSI benefits should actually be increased, but that would require a different effort, so it should at the minimum be exempted from the CPI change.
Obama has indicated that he will demand these changes. The Simpson-Bowles and Rivlin-Domenici deficit reduction plans, which both included a move to the chained CPI, also included similar caveats. Nancy Pelosi said the changes would be included in a final deal: “The details of this are not all ironed out, but they all mitigate for helping the poorest and neediest in our society, whether they’re Supplemental Security Income recipients, whether they’re 80 and older or whether they’re truly needy in-between.”
With the changes, CBPP says, “we believe that the chained CPI is a reasonable component of a comprehensive package to put the budget on a sustainable course.”
But wait, aren’t there more progressive ways to change Social Security? Yes, but.
Dylan Matthews yesterday laid out three alternative ways to cut the plan that is far progressive in the economic sense and appealing to progressives in the political sense. Two of the plans are different ways to reduce benefits for the wealthy, while the third option would be to raise or eliminate the tax cap, which prevents any income over about $110,000 from being taxed. These plans would all save far more money than the chained CPI, and do it all by hurting only the rich, unlike the CPI change. Great, right?
There are two major political problems with either approach. The first is in the short term: Republicans will never support raising or eliminating the tax cap as it would be a huge tax increase. Even Democrats would have trouble embracing it, since it would mean raising taxes on people who make under $250,000 a year, whose taxes they’ve promised not to hike.
The second problem is in the long term. Social Security was designed to be not a welfare program but a social insurance program. You get out what you paid into it over many years of working, with only marginal changes to redistribute income downward. Making it a welfare program would undermine the programs long-term political strength.
This was a cornerstone of FDR’s vision for the plan. He had to defend the plan from attacks from the populist left, which called for more aggressive redistribution from general taxation. Some means testing may be possible without transforming the perception of the program into a welfare plan, but it’s a potentially dangerous precedent.
Perhaps the best argument against the chained CPI is that even if it is a more accurate measure of inflation, Congress should not cut benefits because it would be almost impossible to restore or raise them (which is probably what actually needs to happen) through a change in the benefit structure. This would require an enormous congressional fight and Republicans would almost surely kill it, so the current CPI should be preserved, the thinking goes. This is convincing. The only plausible response is a good government argument that the CPI should be used to calculate inflation, not monkey with benefits in a backdoor way.
To Paul Krugman, the plan put forward by Obama is barely acceptable, and anything more would be unacceptable, but he’s not convinced the chained CPI is an outright deal killer.
Since the chained CPI may become a reality, liberals should at least begin thinking critically about it, even if just to decide once again that it is unacceptable.
By: Alex Seitz-Wald, Salon, December 19, 2012
“The Austerity Trap”: What Raising The Medicare Eligibility Age Really Means
After a campaign in which Republicans attempted to pillory Barack Obama for finding $716 billion in savings from Medicare (via cuts in payments to insurance companies and providers but not cuts to benefits), those same Republicans now seem to be demanding that Obama agree to cuts in Medicare benefits as the price of saving the country from the Austerity Trap, a.k.a. fiscal cliff. Oh, the irony! You’d almost think that they weren’t really the stalwart defenders of Medicare they pretended to be.
And there are some hints that the Obama administration is seriously considering agreeing to raise the Medicare eligibility age from 65 to 67 as part of this deal. It’s a dreadful idea, and as we discuss this possibility, there’s one really important thing to keep in mind: Medicare is the least expensive way to insure these people. Or anybody, for that matter. In all this talk of the bloated entitlement system, you’d be forgiven for thinking Medicare was some kind of inefficient, overpriced big government program. But the opposite is true, and that’s why raising the eligibility age is such a dreadful idea.
Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
What we’d be doing is taking people off Medicare, the most efficient and inexpensive option for them to have insurance, and putting them into the individual market, which works less well and costs more. When we start talking about this in more detail, that’s what Republicans should really be forced to address.
If you want more details on the implications of raising the eligibility age, you should be reading Jonathan Cohn and Sarah Kliff. But it’s important that we keep the big picture in view as the Austerity Trap deal takes shape. If anything, we should be putting more people on Medicare—that would save money and improve health in the system overall (you may recall that when the ACA was being debated one of the proposals was to allow people over 50 to buy in to Medicare, an idea we should bring back). There’s an argument being made that raising the eligibility age may not be a good idea, but the administration has to give Republicans something, and it’s not that big a deal. If that’s the case that wins the day, we should be clear about exactly what it means: a more expensive health care system, exactly the opposite of what everybody says they want.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2012
“Republicans Need To Wise Up”: It’s Not Their Uninspiring Candidates Or Unsound Tactics, It’s Their Unpopular Ideas
The biggest problem the Republican Party faces is not uninspiring candidates or unsound tactics. It is unpopular ideas.
This reality was brought home in last month’s election. It’s playing out in the struggle over how to avoid the “fiscal cliff.” And we’ll see it again in coming fights over immigration, entitlements, inequality and a host of other issues. Here’s the sad thing: Republicans get this stuff so wrong that Democrats aren’t even forced to go to the trouble of getting it right.
There will be those who doubt the sincerity of my advice to the GOP, since my standing as a conservative is — justifiably — less than zero. But I’ve always believed in competition, if only to prevent liberals from becoming lazy and unimaginative. One could argue that this is already happening.
Take the question of what to do about undocumented immigrants. The Republican Party takes an uncompromising line against anything that could be construed as amnesty — any solution that provides “illegal” immigrants with a path to citizenship. Much has been made of the impact the immigration issue had in the election, as Latinos voted for President Obama over Mitt Romney by nearly 3-1.
It is obvious to sentient Republicans why the party cannot afford to so thoroughly alienate the nation’s largest minority group. What the GOP seems not to grasp is that the party’s “send ’em all home” stance is way out of line with much of the rest of the electorate as well.
A Politico-George Washington University poll released Monday asked voters whether they favored “an immigration reform proposal that allows illegal or undocumented immigrants to earn citizenship over a period of several years.” That would be amnesty, pure and simple — and a whopping 62 percent said they were in favor, compared to 35 percent who said they were opposed.
You might expect Democrats, then, to be pushing hard for a straightforward amnesty bill. But they don’t have to. Because Republicans are so far out in right field on the issue, Democrats haven’t actually had to do anything to reap substantial political benefits. They’ve just had to sound more reasonable, and less hostile, than Republicans, which has not required breaking a sweat.
On the central fiscal-cliff question, the GOP is similarly out of step. The Politico poll found that 60 percent of respondents favor raising income taxes on households that earn more than $250,000 a year. The Republican Party says no — and thus allows itself to be portrayed as willing to sink the economic recovery, if necessary, to ensure that tycoons can keep their pantries stocked with caviar.
Where is the incentive for Democrats to get serious about fiscal matters? As long as the GOP remains adamant on what many Americans see as a no-brainer question of basic fairness, those who believe in progressive solutions get a pass.
The truth is that raising top marginal rates for the wealthy is probably as far as we should go on the tax front right now, given the fragility of the recovery. The best thing we could do for the country’s long-term fiscal health is spur the economy into faster growth, which will shrink deficits and the debt as a percentage of gross domestic product.
That said, it’s hard to imagine long-term solutions that don’t eventually require more tax revenue from the middle class as well as the rich. But why should Democrats mention this inconvenient fact when Republicans, out of ideological stubbornness, are keeping the focus on the upper crust?
The same basic dynamic plays out in the question of reforming entitlements. Republicans proposed turning Medicare into a voucher program; polls show that voters disagree. The GOP seems to be falling back to the position that the eligibility age for the program should be raised. Trust me, voters aren’t going to like that, either.
Nor, for that matter, do voters like the GOP’s solution for the millions of Americans who lack health insurance, which Romney summarized as, essentially, go to the emergency room. A smart Republican Party would stop focusing exclusively on how government can pay less for health care and, instead, begin to seriously explore ways to reduce health-care costs. A smart GOP would acknowledge the fact that Americans simply don’t want to privatize everything, which means we need new ideas about how to pay for what we want.
Faced with an opposition that verges on self-parody, progressive thinkers are mostly just phoning it in. This won’t change until somebody defibrillates the GOP, and we detect a pulse.
By: Eugene Robinson, Opinion Writer, The Washington Post, December 10, 2012
“Something To Talk About”: The Deep, Real Spending Cuts Already Passed
The prospect of cutting Medicare benefits in a “fiscal cliff” deal has prompted an outcry from concerned liberals. But whether or not legislators actually end up raising the Medicare age or paring back Social Security payments, domestic benefits and services—ranging from veterans’ health care and low-income housing to Head Start programs—are going to get squeezed over the next 10 years.
Last year’s debt-ceiling agreement included $1.5 trillion in cuts to discretionary programs through 10-year spending caps that are already in effect. According to a new analysis by the Center on Budget and Policy Priorities, the domestic programs subject to the spending caps will face a $615 billion shortfall if they keep their benefits and services at 2012 levels. If such, they’ll be forced to scale back unless Congress decides otherwise—and right now, the Republicans want even less money spent on these domestic programs, not more.
The Center on Budget and Policy Priorities’s Richard Kogan breaks down the impact of the new spending caps:
We estimate that, with the funds available under the caps, the federal government will fall about $350 billion short over the next ten years of delivering the same level of benefits and services for NDD programs as it did in 2012. This is because: (1) the costs of a number of key programs, especially VA medical care, are projected to grow substantially, and (2) Congress relied on certain temporary savings measures to meet the 2012 caps that it cannot repeat in the future. Furthermore, it would take an additional $265 billion over the next ten years to account for general population growth, which affects NDD programs ranging from Head Start to home-delivered meals for the elderly. In total, it would require $615 billion above what the caps allow to maintain the same level of benefits and servicesper person as in 2012.
It’s a good reminder of the trade-offs that we have already made in the name of deficit reduction, which have received little attention amid the hand-wringing over the fiscal cliff. And, as Kogan points out, these domestic programs still remain vulnerable to further cutting. House Speaker Boehner (R-Ohio) has already proposed $300 billion in further cuts to discretionary programs, though he hasn’t specified how they’d be carried out. And unlike the defense programs that face big cuts, these domestic programs don’t have deep-pocketed industry lobbyists to help shield them.
By: Suzy Khimm, The Washington Post Wonkblog, December 9, 2012
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