“Privatization Of Medicare”: Jeb Bush Now Says He Wouldn’t ‘Phase Out’ Medicare. What He Would Do Is Just As Wrong
It had to happen sooner or later: a Republican presidential candidate says something suggesting he’d destroy Medicare, the Democrats jump all over him, and he backtracks, saying that’s not what he meant and in fact he only wants to strengthen it. This time it’s Jeb Bush, who said the other day that though we can keep Medicare around for the people who are currently on it, “we need to figure out a way to phase out this program for others and move to a new system that allows them to have something – because they’re not going to have anything.”
This is an old argument from Republicans, one they also use to justify attacks on Social Security: the program is doomed anyway, so we should go ahead and privatize it. The argument is completely wrong with regard to Social Security, and the truth about Medicare is that the program’s future is looking brighter and brighter — in no small part because of the Affordable Care Act. The argument Bush is making is ten years out of date.
Bush did try to walk back his statement a bit, saying the “phase out” part was taken out of context and he’s only talking about how we “reform our entitlement system.” Here’s his follow-up, which doesn’t change the essence of what he was arguing:
“It’s an actuarially unsound health care system,” said Bush, who said something must be done before the system burdens future generations with $50 billion of debt. “Social Security is an underfunded retirement system; people have put money into it, for sure.
“The people that are receiving these benefits, I don’t think that we should touch that; but your children and grandchildren are not going to get the benefit of this that they believe they’re going to get, or that you think they’re going to get, because the amount of money put in compared to the amount of money the system costs is wrong.”
Bush hasn’t yet released his plan to phase out/reform Medicare, but given these comments it seems likely he’ll embrace something like what Paul Ryan has been advocating for years. It involves changing Medicare from a guaranteed single-payer government insurance plan into a voucher plan, in which the government gives senior citizens a set amount of money with which they can go out and get private health insurance. It saves money by limiting the value of that voucher, so if it’s less than what coverage actually costs, well, tough luck. In that way, it eliminates the central promise of Medicare, which is that every American senior citizen will have health coverage.
We’ll await Jeb’s particulars, but I promise you that most of the GOP candidates will embrace some version of this plan, because that’s what the Republican consensus on Medicare is these days. And it’s always justified with the argument Jeb gives: because of skyrocketing costs the program is doomed, so privatization is the only way to make sure it’s there for your kids. But don’t worry, current seniors, we won’t touch your Medicare! Which is one of the ironies of their argument: the free market is supposed to make everything wonderful, but they fall all over themselves to promise senior citizens that they won’t disturb the big-government, socialist program that seniors love.
Now on to the cost question. As it happens, the Medicare Trustees just released their annual report on the future of the program. And as Kevin Drum noted, things are looking a lot sunnier than they were a few years ago:
Ten years ago, Medicare was a runaway freight train. Spending was projected to increase indefinitely, rising to 13 percent of GDP by 2080. This year, spending is projected to slow down around 2040, and reaches only 6 percent of GDP by 2090. Six percent! That’s half what we thought a mere decade ago. If that isn’t spectacular, I don’t know what is.
Those are projections for what’s going to happen decades from now, so things are doubtless going to change. But the presumption of the Republican argument is that Medicare is eventually going to eat the entire federal budget, and so we have no choice but to fundamentally alter it. And that’s just not true.
The other assumption they make is that the way to alter Medicare is simple: privatize it. But they’re wrong about this, too. Medicare is expensive, but that’s not because it’s an inefficient big-government program. In fact, Medicare is remarkably efficient, more so than private insurance. That’s because it benefits from economies of scale, and because it doesn’t have to spend money on things like marketing, underwriting, and big salaries for executives. The reason Medicare is expensive is that American health care is expensive, and it serves a lot of people. The retirement of the large Baby Boom generation is what’s producing its current funding challenges.
Let’s not forget that at the same time Republicans cry that Medicare is unaffordable and so must be dismantled, they fight any effort to actually lower costs in a rational way. For instance, they’re adamantly opposed to comparative effectiveness research, which involves looking at competing treatments and seeing which ones actually work better. That this isn’t something Medicare already takes into account sounds ridiculous, but it’s true. If there are two medications for a particular ailment that are equally effective, but one costs $100 a year and one costs $100,000 a year, wouldn’t it make sense for Medicare to 1) find that out, and 2) make coverage decisions accordingly? But Republicans have said no — Medicare should just pay for both, no matter what it costs.
Republicans also oppose the most significant effort to reduce Medicare costs in decades, something called the Affordable Care Act, which included all kinds of provisions meant to achieve this goal. Perhaps most critically, the law starts a move away from the fee-for-service model, in which doctors and hospitals make more money the more procedures they do, to a model where they get paid a single rate for treating a patient. Under the fee-for-service model, if your hospital screws up, you get an infection, and you have to get re-admitted, they make more money; the ACA actually punishes them for that, giving them a greater incentive to provide better and less expensive care.
But Republicans not only want to repeal the ACA, which means repealing all those kinds of payment provisions, they have nothing much to say about how, specifically, we might save money in Medicare. Their only answer is that if we privatize it, the magic of the market will produce savings. Of course, if that were true America would have the cheapest health care system in the advanced world, since ours is already more private than in any other similar country. And yet we don’t — ours is far and away the most expensive, and that’s precisely because the market has failed.
So to sum up, this is the Republican argument on Medicare: We absolutely can’t do anything in particular that would bring down the cost of Medicare, but the cost of Medicare is so outrageous that we have no choice but to privatize it.
When Jeb Bush and the other candidates talk about this subject, pay close attention to what they say. They’ll use the word “strengthen” a lot — we want to strengthen Medicare! They’ll tell seniors, who vote in great numbers, that they aren’t going to touch their precious Medicare. And they’ll ignore what we’ve learned in the last few years, talking as though things look just as bad as they did before the Affordable Care Act was passed and health care spending slowed. But the truth is that their solution is no solution at all.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, July 24, 2015
“Greece’s Economy Is A Lesson For Republicans In The U.S.”: The Toxic Combination Of Austerity With Hard Money
Greece is a faraway country with an economy roughly the size of greater Miami, so America has very little direct stake in its ongoing disaster. To the extent that Greece matters to us, it’s mainly about geopolitics: By poisoning relations among Europe’s democracies, the Greek crisis risks depriving the United States of crucial allies.
But Greece has nonetheless played an outsized role in U.S. political debate, as a symbol of the terrible things that will supposedly happen — any day now — unless we stop helping the less fortunate and printing money to fight unemployment. And Greece does indeed offer important lessons to the rest of us. But they’re not the lessons you think, and the people most likely to deliver a Greek-style economic disaster here in America are the very people who love to use Greece as a boogeyman.
To understand the real lessons of Greece, you need to be aware of two crucial points.
The first is that the “We’re Greece!” crowd has a truly remarkable track record when it comes to economic forecasting: They’ve been wrong about everything, year after year, but refuse to learn from their mistakes. The people now saying that Greece offers an object lesson in the dangers of government debt, and that America is headed down the same road, are the same people who predicted soaring interest rates and runaway inflation in 2010; then, when it didn’t happen, they predicted soaring rates and runaway inflation in 2011; then, well, you get the picture.
The second is that the story you’ve heard about Greece — that it borrowed too much, and its excessive debt led to the current crisis — is seriously incomplete. Greece did indeed run up too much debt (with a lot of help from irresponsible lenders). But its debt, while high, wasn’t that high by historical standards. What turned Greek debt troubles into catastrophe was Greece’s inability, thanks to the euro, to do what countries with large debts usually do: impose fiscal austerity, yes, but offset it with easy money.
Consider Greece’s situation at the end of 2009, when its debt crisis burst into the open. At that point Greek government debt was near 130 percent of gross domestic product, which is definitely a big number. But it’s by no means unprecedented. As it happens, Greece’s debt ratio in 2009 was about the same as America’s in 1946, just after the war. And Britain’s debt ratio in 1946 was twice as high.
Today, however, Greek debt is over 170 percent of G.D.P. and still rising. Is that because Greece just kept on borrowing? Actually, no — Greek debt is up only 6 percent since 2009, although that’s partly because it received some debt relief in 2012. The main point, however, is that the ratio of debt to G.D.P. is up because G.D.P. is down by more than 20 percent. And why is GDP down? Largely because of the austerity measures Greece’s creditors forced it to impose.
Does this mean that austerity is always self-defeating? No, there are cases — for example, Canada in the 1990s — of countries that slashed their debt while maintaining growth and reducing unemployment. But if you look at how they managed this, it involved combining fiscal austerity with easy money: Canada in the ’90s drastically reduced interest rates, encouraging private spending, while allowing its currency to depreciate, encouraging exports.
Greece, unfortunately, no longer had its own currency when it was forced into drastic fiscal retrenchment. The result was an economic implosion that ended up making the debt problem even worse. Greece’s formula for disaster, in other words, didn’t just involve austerity; it involved the toxic combination of austerity with hard money.
So who wants to impose that kind of toxic policy mix on America? The answer is, most of the Republican Party.
On one side, just about everyone in the G.O.P. demands that we reduce government spending, especially aid to lower-income families. (They also, of course, want to reduce taxes on the rich — but that wouldn’t do much to boost demand for U.S. products.)
On the other side, leading Republicans like Representative Paul Ryan incessantly attack the Federal Reserve for its efforts to boost the economy, delivering solemn lectures on the evils of “debasing” the dollar — when the main difference between the effects of austerity in Canada and in Greece was precisely that Canada could “debase” its currency, while Greece couldn’t. Oh, and many Republicans hanker for a return to the gold standard, which would effectively put us into a euro-like straitjacket.
The point is that if you really worry that the U.S. might turn into Greece, you should focus your concern on America’s right. Because if the right gets its way on economic policy — slashing spending while blocking any offsetting monetary easing — it will, in effect, bring the policies behind the Greek disaster to America.
By: Paul Krugman, Op-Ed Columnist, The New York Times, July 10, 2015
“An Insurgency By Any Other Name”: Republicans Only Believe In Democracy Insofar As It Achieves Their Desired Ends
In my very first post here at Political Animal, I described the possible threat from a Confederate insurgency. In his review of Charles Murray’s latest book, By the People: Rebuilding Liberty Without Permission, Ian Millhiser basically describes it as an insurgency by another name.
Before he gets to the book, Millhiser reminds us of a couple of things. First of all, he points to the fact that it was not that long ago that Majority Leader Mitch McConnell suggested that democracy wasn’t working.
At the height of 2011’s debt ceiling crisis, then-Senate Minority Leader Mitch McConnell (R-KY) offered a candid explanation of why his party was willing to threaten permanent harm to the U.S. economy unless Congress agreed to change our founding document. “The Constitution must be amended to keep the government in check,” McConnell alleged. “We’ve tried persuasion. We’ve tried negotiations. We’ve tried elections. Nothing has worked.”…
Few politicians are willing to admit what McConnell admitted when he confessed that elections have not “worked” to bring about the policy Republicans tried to impose on the nation in 2011. Elected officials, after all, only hold their jobs at the sufferance of the voters, and a politician who openly admits that they only believe in democracy insofar as it achieves their desired ends gives the middle finger to those voters and to the very process that allows those voters to have a say in how they are governed.
Secondly, he reminds us that, even though an entire industry has risen to debunk Murray, he is still revered by powerful Republicans.
Dr. Murray’s pre-Bell Curve work shaped the welfare reforms enacted in the 1990s. Former Republican vice presidential candidate Paul Ryan cited Murray in 2014 to claim that there is a culture of laziness “in our inner cities in particular.” Last April, when Jeb Bush was asked what he liked to read, he replied “I like Charles Murray books to be honest with you, which means I’m a total nerd I guess.”
So when Murray speaks, powerful and influential men (and his acolytes are, almost invariably, men) listen, including men who shape our nation’s fiscal policy and men who could be president someday.
Millhiser then does a thorough job of explaining what Murray proposes in this book. It’s important to note that it’s title “By the People” is the exact opposite of what he recommends. Basically what Murray wants to see is an ultra-rich benefactor who would be willing to pay for a legal defense fund that would subvert the work of the federal government.
To impose these limits on society, Murray claims that his Madison Fund can essentially harass the government into compliance. The federal government, Murray claims, cannot enforce the entirety of federal law “without voluntary public compliance.” Federal resources are limited, and only a small fraction of these limited resources have been directed towards enforcement. Thus, Murray argues, by simply refusing to comply with the law and contesting every enforcement action in court, regulated entities can effectively drain the government’s resources and prevent it from engaging in meaningful enforcement.
These are not merely the ravings of a lunatic right-winger. I was immediately reminded of the fact that Majority Leader Mitch McConnell has advised states to disregard the recent EPA rulings on coal plant emissions while various entities challenge them in court.
For a while now I have been suggesting that this form of Republicanism is best described as a beast in it’s final death throes. That beast is now a minority in this country and as it lashes out, one of the only remaining possibilities for survival is to subvert our democratic process.
I hope that by now you know that I am not one given to hyperbole and conspiracy theories. I don’t say all this to ramp up a fevered reaction. But it’s important to see what is happening here with clear eyes and name it for what it is…a call to insurgency.
By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, May 27, 2015
“Boehner Rejects Amtrak Question As ‘Stupid'”: U.S. Investment In Infrastructure Has Become A National Embarrassment
It became clear yesterday that congressional Republicans came up with one talking point in response to the deadly Amtrak derailment in Philadelphia: “human error.”
The point, of course, is obvious. If the Amtrak 188 tragedy was the result of a person making a mistake, then there’s no need for federal policymakers to act, there’s no need for Congress to make additional investments in infrastructure, and there’s no need for Republicans to be embarrassed by slashing Amtrak’s budget just hours after the accident.
This morning, as National Journal noted, House Speaker John Boehner (R-Ohio) didn’t hold back on this point.
Boehner downright dismissed claims that underfunding for the rail system was responsible for the derailment in Philadelphia that killed at least seven people and injured 200 on Tuesday night.
“Are you really gonna ask such a stupid question?” Boehner said during his Thursday morning press conference when a reporter began to ask about Democratic concerns that Amtrak was underfunded because of Republicans. “They started this yesterday: ‘It’s all about funding. It’s all about funding.’ Well, obviously it is not about funding. The train was going twice the speed limit.”
House Ways and Means Chairman Paul Ryan (R-Wis.) sounded a similar note on Fox News this morning, dismissing those who want to increase “the size of government programs,” all in response to an accident he said was “human error.”
The congressman added that he hopes “people won’t seize on political opportunities out of tragedies like this” to spend more money.
Let’s set the record straight.
Just on a surface level, even without consideration of the tragedy in Philadelphia, U.S. investment in infrastructure has become a national embarrassment. The United States used to lead the world in infrastructure innovation and development, and the more Republicans decided public investment in “government programs” is necessarily bad, the more other countries have surpassed us.
But specifically on this week’s Amtrak disaster, to dismiss this as nothing more than a tragic case of “human error” is to overlook the relevant details.
According to Boehner, “obviously it is not about funding.” In reality, it’s also obvious that a Positive Train Control system could have prevented the accident.
It’s equally obvious that PTC is not free. If Congress wanted to invest in the system, it could have. Indeed, it can make those investments now. At least for now, however, Boehner and his party don’t see it as a priority.
This might make the Speaker uncomfortable, but it’s anything but “a stupid question.”
By: Steve Benen, The Maddow Blog, May 14, 2015
“He’s Not A Reformer He’s A Fraud”: Marco Rubio Is The Most Disingenuous Republican Running For President
Most of the Republican Party’s primary candidates have internalized something that was blindingly obvious to everyone who watched the 2012 elections unfold. So long as traditional turnout patterns hold, Republicans can’t keep up with Democrats in presidential contests. To win, they need to alter the turnout pattern, and to alter the turnout pattern, they need to break with GOP orthodoxy in some way.
Jeb Bush is jilting the conservative movement by swearing off red meat, hoping an even temperament will appeal to uncommitted voters. Senator Rand Paul is courting young and minority voters by promising to challenge the surveillance and carceral states.
Senator Marco Rubio, who will announce his candidacy for president on Monday, was supposed to lead a GOP breakaway faction in support of comprehensive immigration reform, but was unable to persuade House Republicans to ignore the nativist right, and the whole thing blew up in his face. In regrouping, he’s determined that the key to restoring Republican viability in presidential elections is to woo middle class voters with fiscal policies that challenge conservative orthodoxy.
His new basic insight is correct. The GOP’s obsession with distributing resources up the income scale is the single biggest factor impeding it from reaching new constituencies, both because it reflects unpopular values and because it makes them unable to address emerging national needs that require spending money.
It also happens to be the raison d’être of the conservative establishment. Challenging the right’s commitment to lowering taxes on high earners, and reducing transfers to the poor and working classes, will encounter vast resistance. Where Paul can appeal to the moral and religious sensibilities of elderly whites who might otherwise oppose criminal justice reforms, a real challenge to GOP fiscal orthodoxy will get no quarter from GOP donors.
If Rubio were both serious and talented enough to move his party away from its most inhibiting orthodoxy, in defiance of those donors, his candidacy would represent a watershed. His appeal to constituencies outside of the GOP base would be both sincere and persuasive.
But Rubio is not that politician. He is no likelier to succeed at persuading Republican supply-siders to reimagine their fiscal priorities than he was at persuading nativists to support a citizenship guarantee for unauthorized immigrants. In fact, nobody understands the obstacles facing Marco Rubio better than Marco Rubio. But rather than abandon his reformist pretensions, or advance them knowing he will ultimately lose, Rubio has chosen to claim the mantle of reform and surrender to the right simultaneously—to make promises to nontraditional voters he knows he can’t keep. My colleague Danny Vinik proposes that Rubio wants to “improve the lives of poor Americans” but he must “tailor [his] solutions to gain substantial support in the GOP, and those compromises would cause more harm to the poor.” I think this makes Rubio the most disingenuous candidate in the field.
Nothing captures Rubio’s irreconcilable commitments quite like the evolution of his plan to reform the tax code. From the outset, Rubio never intended to sideline the interests of the wealthy. As originally conceived, his tax plan would’ve paired modest middle class benefits with very large tax cuts for high earners, much like George W. Bush’s first big tax cut in 2001. But when conservatives voiced dissatisfaction with that particular distribution, Rubio responded not by telling them to buzz off, or by eliminating the middle-income benefits and plying the savings into further high-end tax cuts. He kept the benefits, and layered hugely regressive additional tax cuts for the wealthy on top of an already unaffordable plan. What once would have increased deficits by $2.4 trillion over a decade, according to the Tax Policy Center, would now increase them by trillions more. The beneficiaries would be investors, who would no longer pay any tax on capital gains and dividends, and wealthy families, whose enormous bequests would be subject to no tax either.
Unbelievably, this play to have it both ways still doesn’t satisfy supply-siders. “This business side of the plan is pretty darn good and I like it,” Larry Kudlow told Politico’s Ben White. “The personal side of it is a mess and will be politically and economically indefensible and he is going to take tremendous criticism for it and my guess is he will have to back off it very fast.”
That a Republican’s tax math doesn’t add up is nothing new in politics. But most Republicans brush off the shortfalls with vague promises to make huge reductions in social spending. That’s what Mitt Romney did, and what Paul Ryan did back when he chaired the House budget committee. This didn’t put them on the level, but it helped complete a picture—that cutting taxes was a higher priority to them than supporting lower and middle class incomes. Rubio, by contrast, says he will hold anti-poverty spending flat. Now that Ryan is no longer responsible for writing Republican budgets, and doesn’t have to reconcile his incompatible priorities, he also claims he wants to hold anti-poverty spending flat. Rubio isn’t so lucky. As a presidential candidate, he, unlike Ryan, will be held to account for all of his tax and spending proposals.
Either Rubio is promising to run up bigger deficits than any president in history, or he’s swindling someone. Upper income tax cuts, middle class tax credits, anti-poverty spending—at least one of these will have to give. The experience of watching his tax plan evolve tells us a great deal about which one won’t.
By: Brian Beutler, The New Republic, April 13, 2015
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