“The Real Referendum”: The Legacy Of The New Deal, The Great Society And Obamacare
Republicans came into this campaign believing that it would be a referendum on President Obama, and that still-high unemployment would hand them victory on a silver platter. But given the usual caveats — a month can be a long time in politics, it’s not over until the votes are actually counted, and so on — it doesn’t seem to be turning out that way.
Yet there is a sense in which the election is indeed a referendum, but of a different kind. Voters are, in effect, being asked to deliver a verdict on the legacy of the New Deal and the Great Society, on Social Security, Medicare and, yes, Obamacare, which represents an extension of that legacy. Will they vote for politicians who want to replace Medicare with Vouchercare, who denounce Social Security as “collectivist” (as Paul Ryan once did), who dismiss those who turn to social insurance programs as people unwilling to take responsibility for their lives?
If the polls are any indication, the result of that referendum will be a clear reassertion of support for the safety net, and a clear rejection of politicians who want to return us to the Gilded Age. But here’s the question: Will that election result be honored?
I ask that question because we already know what Mr. Obama will face if re-elected: a clamor from Beltway insiders demanding that he immediately return to his failed political strategy of 2011, in which he made a Grand Bargain over the budget deficit his overriding priority. Now is the time, he’ll be told, to fix America’s entitlement problem once and for all. There will be calls — as there were at the time of the Democratic National Convention — for him to officially endorse Simpson-Bowles, the budget proposal issued by the co-chairmen of his deficit commission (although never accepted by the commission as a whole).
And Mr. Obama should just say no, for three reasons.
First, despite years of dire warnings from people like, well, Alan Simpson and Erskine Bowles, we are not facing any kind of fiscal crisis. Indeed, U.S. borrowing costs are at historic lows, with investors actually willing to pay the government for the privilege of owning inflation-protected bonds. So reducing the budget deficit just isn’t the top priority for America at the moment; creating jobs is. For now, the administration’s political capital should be devoted to passing something like last year’s American Jobs Act and providing effective mortgage debt relief.
Second, contrary to Beltway conventional wisdom, America does not have an “entitlements problem.” Mainly, it has a health cost problem, private as well as public, which must be addressed (and which the Affordable Care Act at least starts to address). It’s true that there’s also, even aside from health care, a gap between the services we’re promising and the taxes we’re collecting — but to call that gap an “entitlements” issue is already to accept the very right-wing frame that voters appear to be in the process of rejecting.
Finally, despite the bizarre reverence it inspires in Beltway insiders — the same people, by the way, who assured us that Paul Ryan was a brave truth-teller — the fact is that Simpson-Bowles is a really bad plan, one that would undermine some key pieces of our safety net. And if a re-elected president were to endorse it, he would be betraying the trust of the voters who returned him to office.
Consider, in particular, the proposal to raise the Social Security retirement age, supposedly to reflect rising life expectancy. This is an idea Washington loves — but it’s also totally at odds with the reality of an America in which rising inequality is reflected not just in the quality of life but in its duration. For while average life expectancy has indeed risen, that increase is confined to the relatively well-off and well-educated — the very people who need Social Security least. Meanwhile, life expectancy is actually falling for a substantial part of the nation.
Now, there’s no mystery about why Simpson-Bowles looks the way it does. It was put together in a political environment in which progressives, and even supporters of the safety net as we know it, were very much on the defensive — an environment in which conservatives were presumed to be in the ascendant, and in which bipartisanship was effectively defined as the effort to broker deals between the center-right and the hard right.
Barring an upset, however, that environment will come to an end on Nov. 6. This election is, as I said, shaping up as a referendum on our social insurance system, and it looks as if Mr. Obama will emerge with a clear mandate for preserving and extending that system. It would be a terrible mistake, both politically and for the nation’s future, for him to let himself be talked into snatching defeat from the jaws of victory.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 1, 2012
“New Wrapping, Same Contents”: Re-Packaging Mitt Romney As A Compassionate Conservative
“My heart aches for the people I’ve seen,” Mitt Romney said, on the second day of his Ohio bus tour. He’s now telling stories of economic hardship among the people he’s met.
Up until now, Romney’s stories on the campaign trail have been about business successes – people who started businesses in garages and grew their companies into global giants, entrepreneurs who succeeded because of grit and determination, millionaires who began poor. Horatio Alger updated.
Curiously absent from these narratives have been the stories of ordinary Americans caught in an economy over which they have no control. That is, most of us.
At least until now.
“I was yesterday with a woman who was emotional,” Romney recounts, “and she said, ‘Look, I’ve been out of work since May.’ She was in her 50s. She said, ‘I don’t see any prospects. Can you help me?’”
Could it be Romney is finally getting the message that many Americans need help through no fault of their own?
“There are so many people in our country that are hurting right now,” Romney says. “I want to help them.”
Later in the day, Romney told NBC that because of his efforts as governor of Massachusetts, “one hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”
But the repackaging of Mitt as a compassionate conservative won’t work. The good citizens of Ohio — as elsewhere — have reason to be skeptical.
This is, after all, the same Mitt Romney who told his backers in Boca Raton that 47 percent of Americans are dependent on government and unwilling to take care of themselves.
It’s the same Romney who was against bailing out GM and Chrysler. One in eight jobs in Ohio is dependent on the automobile industry. Had GM and Chrysler gone under, unemployment in Ohio would be closer to the national average of 8.1 percent than the 7.2 percent it is today.
This is the same Romney who has been against extending unemployment benefits. Or providing food stamps or housing benefits for families that have fallen into poverty. Or medical benefits. To the contrary, Romney wants to repeal Obamacare, turn Medicare into vouchers, and turn Medicaid over to cash-starved states.
This is the same Mitt Romney who doesn’t worry that Wall Street financiers — including his own Bain Capital — have put so much pressure on companies for short-term profits that they’re still laying off workers and reluctant to take on any more.
And the same Mitt who doesn’t want government to spend money repairing our crumbling infrastructure, rebuilding our schools, or rehiring police and firefighters and teachers.
Romney says he feels their pain but his policy prescriptions would create more pain.
Mitt Romney’s real compassion is for people like himself, whom he believes are America’s “job creators.” He aims to cut taxes on the rich, in the belief that the rich create jobs — and the benefits of such a tax cut trickle down to everyone else.
Trickle-down economics is the core of Romney’s economics, and it’s bunk. George W. Bush cut taxes — mostly for the wealthy — and we ended up with fewer jobs, lower wages, and an economy that fell off a cliff in 2008.
In Ohio Romney is repeating his claim that, under his tax proposal, the rich would end up paying as much as before even at a lower tax rate because he’d limit their ability to manipulate the tax code. “Don’t be expecting a huge cut in taxes because I’m also going to be closing loopholes and deductions,” he promises.
But Romney still refuses to say which loopholes and deductions he’ll close. He doesn’t even mention the “carried interest” loophole that has allowed him and other private-equity managers to treat their incomes as capital gains, taxed at 15 percent.
What we’re seeing in Ohio isn’t a new Mitt Romney. It’s a newly-packaged Mitt Romney. The real Mitt Romney is the one we saw on the videotape last week. And no amount of re-taping can disguise the package’s true contents.
By: Robert Reich, Robert Reich Blog, September 26, 2012
“The Red Flags Are Flying”: Senate Candidate Tommie Thompson Wants To “Do Away With Medicare And Medicaid”
Paul Ryan admits that he’s an “end Medicare as we know it” candidate.
But, somehow, we are not supposed to think that he would actually end the popular and successful healthcare program for the elderly, as well as related Medicaid programs for the poor and people with disabilities.
The “as we know it” part provides a sort of cover, at least in the eyes of a media that is more inclined toward stenography than journalism.
Never mind that Ryan, a rabid reader of government-can-do-no-good fanatic Ayn Rand, goes positively wide-eyed when he starts talking about how desperately he wants to downsize government—and shift control of healthcare and retirement programs to the insurance and Wall Street interests that so generously fund his campaigns. We’re not supposed to talk about the long-term crony-capitalist scheme of certain Republicans to do away with government programs that work so that private sector profiteers can come in and create programs that don’t work—except for private sector profiteers.
Never mind that the Republican nominee for vice president has a long history of decrying Social Security, Medicare and Medicaid in Randian terms such as “collectivist” and “socialistic.”
Never mind that Ryan has griped that “Social Security right now is a collectivist system. It’s a welfare transfer system.”
Never mind that, as recently as 2010, Ryan dismissed Medicare and Medicaid as part of a “socialist based system” that needs to be replaced.
The red flags are not supposed to go up until someone actually says they want to, you know, “do away with Medicaid and Medicare.”
Never mind that, even now, Ryan complains about how America is being overwhelmed by “takers” (citizens who claim benefits to which they are entitled) and the “welfare state” (Social Security, Medicare and Medicaid).
Only when a candidate starts talking about ending entitlement programs—as in “doing away” with them—can we be serious about the immediate threat those programs actually face.
Meet Tommy Thompson, former Republican governor of Wisconsin, former Bush-Cheney administration secretary of health and human services, former candidate for the Republican nomination for president and mentor to Paul Ryan.
Speaking to a Tea Party group while campaigning for Wisconsin’s open US Senate seat, Thompson recounted how he “reformed” welfare in Wisconsin.
Back in the 1990s, Thompson said he wanted to “end welfare as we know it.” In fact, he replaced the program with a classic combination of high-government spending, lots of patronage appointments and rising poverty.
Now, Thompson has dropped the “end welfare as we know it” pretense. He brags that he finished off “one of the entitlement program.”
And he’s gunning for a couple of other entitlement programs.
Which ones?
You guessed it: Medicaid and Medicare.
Declaring that he wants to “change Medicare and Medicaid like I did welfare,” Thompson asked a May gathering of the Lake Country Area Defenders Of Liberty in Oconomowoc, Wisconsin: “Who better to and who better than me, who’s already finished one of the entitlement programs, to come up with programs to do away with Medicaid and Medicare?”
The video has only now surfaced and its a blockbuster—especially in the aftermath of the release last week of a similar video that saw Republican presidential nominee Mitt Romney dismissing 47 percent of Americans as a “dependent” class unworthy of Republican consideration.
Just to repeat: a top Republican Senate candidate has been caught on video talking about how he would “DO AWAY WITH MEDICAID, AND MEDICARE.”
Just to repeat: “DO AWAY WITH MEDICAID, AND MEDICARE.”
It should be understood that Thompson is no fringe-dwelling Todd Akin. As the longtime Republican governor of a swing state, he’s worked with every GOP president since Ronald Reagan, and he oversaw social programs for the Bush-Cheney administration. This year, he’s one of his party’s premier recruits in the fight to retake the Senate. Indeed, the race between Thompson and Democratic Congresswoman Tammy Baldwin could decide which party controls the chamber.
Thompson is, as well, closely aligned with Paul Ryan. The Senate candidate’s ties to Ryan’s politically connected family go back to when the Republican vice presidential nominee was a child. Thompson has been a Ryan booster from the very beginning of the younger Wisconsinite’s career in electoral politics—when Thompson was the powerful governor of the state and Ryan was organizing his first Congressional bid.
When Thompson joined the Bush-Cheney Cabinet, he and Ryan kept regular company in Washington. They look forward to working together when Thompson becomes the point man on entitlement debates in a Republican-controlled Senate and Ryan is the Romney White House’s chief liaison to Capitol Hill.
The voters will have something to say about that, however.
If they want to preserve Medicaid and Medicare, they will remember that, while Ryan may add the “as we know it” spin, Thompson gets to the heart of the matter when he says it is the intention of these “reformers” to “do away with Medicaid and Medicare.”
By: John Nichols, The Nation, September 24, 2012
“Eddie Haskell Maintains His Mask”: Paul Ryan’s Presence On The Romney Ticket Has Become An Actual Irritant
The day Mitt Romney put Paul Ryan on the ticket, my immediate reaction was to speculate that this was a definite effort to get conservative activists off Mitt’s back and liberate him to run whatever kind of campaign he wanted: “Here you go! Now STFU!”
If that was the idea, the memo didn’t seem to get around, because Ryan’s presence on the ticket has become an actual irritant to many of the Wisconsin’s fans who are increasingly agitated that this isn’t the Randian anti-entitlement firebrand they know and love. WaPo’s Felicia Sonmez and David A. Fahrenthold have the low-down:
Conservatives had hoped that Mitt Romney’s choice of House Budget Committee Chairman Paul Ryan (Wis.) as his running mate would make Romney act more like Ryan — bold, specific, confident.
Instead, in the six weeks since Ryan became the GOP vice presidential nominee — and particularly in the three weeks since the Republican National Convention in Tampa — there has been mounting concern among Republicans that the pick has made Ryan look more like Romney — vague, cautious and limited to pre-set talking points….
“I was wrong. When Paul Ryan was picked, I really thought this meant that the Romney campaign was shifting gears and was going to have a debate about big issues,” said Michael Tanner, an expert on health care and the budget at the libertarian Cato Institute.
He said that Romney’s campaign had previously cast the race as a referendum on Obama instead of as a choice between two clear visions. That hasn’t changed, Tanner said.
“Why do you pick somebody like Paul Ryan if you’re going to run a referendum, Obama’s-done-a-bad-job campaign?” Tanner asked.
That’s the question being raised by all sorts of people on the Right who weren’t informed or didn’t accept that the gift of the vice-presidential nomination was the last gift the Romney campaign intended to give them before November 6.
So the Eddie Haskell persona Ryan’s put on from the moment he was chosen–reassuring old folks he’s not the Social-Security-and-Medicare hater his record would suggest, and is instead actually their very best friend, determined to protect their benefits from mean old Barack Obama–is upsetting those who are fond of the smart-and-snarky Eddie who emerges when Mrs. Cleaver isn’t around. Indeed, Team Mitt is in serious danger of falling between two stools here, picking a vulnerable running mate whose downside can’t be made to go away even as his upside is obscured.
Before it’s over, Tim Pawlenty may look better than ever in the rear-view mirror.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, September 24, 2012
“Promoting Untrue Choice”: Paul Ryan’s Health Care Proposal Would Shrink The Medicare Doctor Pool
The federal budget proposed by Representative Paul Ryan, the Republican vice-presidential nominee, extols the benefits of “promoting true choice” for Medicare beneficiaries.
In truth, though, the Ryan plan would substantially reduce choice for many people on Medicare — by cutting them off from their current doctors.
Doctors see Medicare patients, despite the relatively low payments they receive for doing so, partly because Medicare represents such a large share of the health-care market.
If a substantial number of beneficiaries moved out of Medicare and into private plans, as Ryan proposes, doctors would have much less incentive to see Medicare patients. And the elderly who want to remain in traditional Medicare would risk being stranded.
The evidence suggests that, in time, this problem could well affect a large share of Medicare beneficiaries. To put that evidence in context, though, it helps to first review the history of the Ryan plan.
The proposal has changed since it was presented in 2011. In the original version, traditional Medicare was eventually to be replaced in its entirety by private plans. The Congressional Budget Office found that this shift would raise health-care costs drastically because the private plans wouldn’t be large enough to enjoy Medicare’s leverage in negotiating prices with hospitals and other large providers. The savings that private plans could achieve because beneficiaries would share more of the costs, and therefore economize more, would be more than offset by that loss of leverage — and by the private plans’ higher overhead and need to turn a profit.
Ryan Revision
In response to the devastating CBO report, Ryan revised his proposal. Under Ryan 2.0, private plans would co-exist with traditional Medicare. (The CBO hasn’t fully evaluated the revised plan yet.)
Many supporters argue that the new plan can’t be as big a problem as the old one, since beneficiaries could always choose to remain in traditional Medicare. In health care, however, choice isn’t always innocuous — and can sometimes be harmful.
I have previously described two downsides to expanding private plans in Medicare. First, it would undercut Medicare’s ability to help move the payment system away from fee-for- service reimbursement and toward payments based on value, because no private plan is large enough to accomplish that shift by itself. Second, the mechanism for adjusting premiums to even out the health risks of individual beneficiaries is far from perfect, so plans can easily game the system, raising total costs. In effect, the plans would end up being overpaid.
The reduced choice of doctors for those who remain in traditional Medicare is a third adverse consequence of moving beneficiaries out of the program.
Currently, Medicare beneficiaries almost universally enjoy excellent access to doctors. And the great majority of beneficiaries never have to wait long for a routine appointment, the Medicare Payment Advisory Commission has found. Roughly 90 percent of doctors accept new Medicare patients.
Doctors provide this access even though they are reimbursed by Medicare at rates that are only about 80 percent of commercial rates — partly because Medicare is such a large share of the market. Which brings us to the concern about the Ryan plan.
Medicare Doctors
How important is Medicare’s market share in influencing physician participation? The evidence is limited, but the best study to date suggests it is significant. In the 1990s, Peter Damiano, Elizabeth Momany, Jean Willard and Gerald Jogerst, all associated with the University of Iowa, surveyed Iowa physicians and examined variation among counties. They found that for each percentage-point increase in the share of Medicare beneficiaries in a county’s population, doctors were 16 percent more likely to accept patients on Medicare. The only other study I know of on this topic, an unpublished analysis by Matthew Eisenberg of Carnegie Mellon University, also found an effect from Medicare’s market share, albeit one that was substantially smaller than the one Damiano and his colleagues found.
About 10 percent of the U.S. population is now enrolled in traditional Medicare, and an additional 5 percent has private Medicare plans. Let’s assume, for the sake of argument, that the Ryan plan would cause another 5 percent of the population to shift, and to be conservative let’s cut in half the Damiano estimate of the impact from that reduction in Medicare’s market share. Then the chance that a doctor is willing to see traditional Medicare patients would be expected to decline by a whopping 40 percent. The share of doctors accepting Medicare would fall from about 90 percent to 54 percent.
To be even more conservative, let’s average the reduced Damiano estimate (already been cut in half and applied only to today’s market share rather than the higher one that will exist in the future when more people are on Medicare) with the Eisenberg estimate. Still, about 20 percent of doctors would be expected to stop accepting Medicare patients.
Supporters of the Ryan approach might argue that fewer people would shift into the private plans, so the impact would not be that great. After all, the existing Medicare program already offers Medicare Advantage plans, so perhaps anyone who wants private insurance already has it. But then, what is the point of Ryan’s Medicare reform?
Another defense might be that the government could simply raise doctor-reimbursement rates to encourage providers to continue treating a shrinking population of traditional Medicare patients. And that’s true. However, Ryan has not included the extra cost in his budget.
So, which is it, Mr. Ryan? Will your plan cause Medicare beneficiaries to lose access to their doctors, or are your budget numbers too rosy because you haven’t counted the extra payments needed to keep doctors in the program?
By: Peter Orszag, Council on Foreign Policy, Business Insider, September 24, 2012
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