“Laying It All Out On Medicare”: No Mistaking Paul Ryan’s Policy
The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year’s will be no different. Ryan’s budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes.
I’m sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he’d keep the tax increases and Medicare cuts that the bill included in order to pay for it all, which helps him achieve his “balanced” budget.
Yes, it’s true that when Ryan was running for vice president, he joined Mitt Romney in condemning those very Medicare savings. But nobody really believed he was doing anything at the time but being a team player. So we can give him credit for taking at least a step toward putting his money where his mouth is on Medicare. Sure, it may be couched in some misleading words (the document refers to “strengthening Medicare” no fewer than ten times), but there’s no mistaking the policy.
Because the rest of his party is, to put it kindly, of two minds when it comes to the program. On one hand, they will tell you, Medicare is unsustainable, a ravenous beast that will devour the entire nation’s financial well-being if we don’t find a way to suppress its appetite. In Washington-speak, this is translated as “doing something about entitlements.” We have to Do Something About Entitlements! If you don’t want to Do Something About Entitlements, you’re just not serious about our nation’s fiscal challenges.
On the other hand, Republicans believe that Medicare is utterly sacrosanct, a jewel whose every facet is so perfect that even the most modest attempt to curtail its costs should be met with howls of anguish and outrage. Or at least that’s what they believe at election time, when they’ll air one ad after another condemning Democrats for cutting the Medicare seniors so desperately need. Democrats all over the country have been subjected to ads saying, “Congressman Fnurbler voted to cut $716 billion from Medicare!” over a picture of an elderly couple sitting at the kitchen table, looking over their bills with an engulfing despair, then meeting each other’s eyes in a tragic look that says, “Thanks to Congressman Fnurbler, all is lost. If only we had been able to pay our gas bill so we could stick our heads in the oven and end it all right now.”
Republicans are so deeply opposed to the idea of cutting Medicare that they can’t even stomach anyone trying to see if Medicare is spending its money wisely. Mention the Independent Payment Advisory Board, a component of the ACA that was designed to restrain Medicare costs if they rose too fast, and steam will come out of their ears. (The IPAB would make recommendations to Congress on ways to save money, and Congress would have to act on them. But since Medicare spending has slowed dramatically in the last couple of years, the requirement has yet to kick in, and President Obama hasn’t bothered to appoint anyone to what is still a theoretical board.) They waged a virtual war on comparative effectiveness research, effectively saying that it was dangerous to even ask which competing treatments work well and which don’t.
In other words, most Republicans believe we must, must, must reduce the cost of Medicare—excuse me, Do Something About Entitlements—but are adamantly opposed to every step that has been taken to reduce the cost of Medicare. I’m sure that lots of them are sympathetic to Ryan’s vision, which is to essentially turn the program into a voucher system, in which the government helps you buy private insurance, and over time costs magically go down (and if you’re thinking that sounds a lot like what people are getting on the Obamacare exchanges, any Republican will tell you that it’s totally different because freedom).
So let’s give Paul Ryan some credit. Sure, his numbers might not add up. But when he puts out a budget, there’s no mystery about where he’s coming from and what he wants to do.
By: Paul Waldman, Contributing Editor, The American Prospect, April 1, 2014
“Calling The Republican’s Bluff”: Who Cares About The Value Of Work?
Finding a way out of our current political impasse requires some agreement on what problems we need to solve. If anything should unite left, center and right, it is the value of work and the idea, in Bill Clinton’s signature phrase, that those who “work hard and play by the rules” ought to be rewarded for their efforts.
This is why one of last week’s most important and least noted political events was the introduction of the 21st Century Worker Tax Cut Act by Sen. Patty Murray, D-Wash. Murray favors a minimum wage increase to $10.10 an hour, but she also has other ideas that would help Americans at the bottom of the income structure to earn more.
Let’s start with principles, and then move to specifics.
There’s a new vogue among conservatives: to talk less about entrepreneurs and to stop talking altogether about “makers” and “takers.” Instead, many of the wisest heads on the right are urging a focus on work. The new emphasis reflects a realization that President Obama won in 2012 in large part because Mitt Romney and his party failed to convey empathy for those who live on wages and salaries.
An early champion of this view was Ramesh Ponnuru, a writer for National Review. “The Republican story about how societies prosper — not just the Romney story — dwelt on the heroic entrepreneur stifled by taxes and regulations,” he wrote shortly after the election. It is, Ponnuru added, “an important story with which most people do not identify.”
Writing earlier this year in National Affairs magazine, Henry Olsen of the Ethics and Public Policy Center was more biting. “Modern conservatives,” he argued, “have tended to discount the moral value of the average person, focusing instead on extolling the moral superiority of the great.”
Two other conservative thinkers, Reihan Salam and Rich Lowry, say the antidote is for Republicans to become “the party of work.” As they see it, work “stands for a constellation of values and, like education, is universally honored.” The GOP, they said, “should extol work and demand it.”
Yes, that last phrase — “demand it” — could lead to a darker kind of politics involving the demonization of those who simply can’t find jobs. Thus did Rep. Paul Ryan, R-Wis., get into trouble for mourning “this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working.”
No matter what Ryan was trying to say, he seemed to be emphasizing the flaws of the unemployed themselves rather than the cost of economic injustice. My Post colleague Eugene Robinson captured this well: “Blaming poverty on the mysterious influence of ‘culture’ is a convenient excuse for doing nothing to address the problem.”
Nonetheless, many conservatives really do realize that they need to embrace hardworking Americans. But the question stands: What are they willing to do about it?
This is where Murray comes in. Her bill would rid the tax code of certain disincentives to work. She notes that “the second earner in a household often pays a higher tax rate on his or her earnings than the first.” Her plan would right this by offering a 20 percent deduction on the second earner’s income up to roughly $60,000 a year. (The benefit is focused on lower-income families, so it phases out at about $130,000 in joint annual income.) For a $25,000-a-year second earner in the 25 percent bracket, she says, this would mean $1,250 “back in their pocket for groceries, child care or retirement savings.”
She’d also expand the earned-income tax credit for workers without children and lower the eligibility age from 25 to 21. The changes would increase their maximum benefit from $487 to about $1,400 a year. It’s hardly nirvana. But it’s real money, especially for someone earning around $15,000 a year. The proposal would cover its roughly $15 billion annual cost by closing loopholes already identified as worthy of being scrapped by the GOP’s leading tax reformer, Rep. Dave Camp of Michigan.
You can, of course, look at what Murray is doing as a way of calling the conservatives’ bluff on the matter of work. But that will be true only if the right allows its bluff to be called.
In making their case, Salam and Lowry quoted Abraham Lincoln on the need “to advance the condition of the honest, struggling laboring man.” If conservatives are serious about this (and about the honest, laboring woman, too) they’ll join Murray in raising the minimum wage and in seeking a tax code more in harmony with the dignity of work.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, March 30, 2014
“In Addition To Honesty, It Requires Accountability”: Ryan Unsuited To Lead ‘Adult Conversation’ About Poverty
These days, a favorite talking point of Republican Congressman Paul Ryan’s is calling for an “adult conversation” about poverty.
“It’s time for an adult conversation,” he told The Washington Post.
“If we actually have an adult conversation,” he said in remarks at the Brookings Institution, “I think we can make a difference.”
The problem is that a prerequisite for any adult conversation is telling the truth and it is there the congressman falls monumentally short.
In addition to Rep. Ryan’s recent, racially-coded comments about “our inner cities” where “generations of men [are] not even thinking about working,” his rhetoric around policy should raise red flags for anyone — including the media — assessing his credibility.
A report from Emily Oshima Lee, policy analyst at the Center for American Progress Action Fund, examines the hatchet job Rep. Ryan did on Medicaid in his 204-page account of antipoverty programs that The Washington Post generously described as a “critique.” Indeed, Ryan’s report — which would have been flagged by my excellent 10th grade English teacher for misrepresenting and cherry-picking data — is a dangerous disservice to a public which has neither the time nor the staff that Ryan has at his disposal to delve into literature assessing antipoverty programs.
Lee notes that Ryan misuses research to imply that Medicaid coverage leads to poorer health — that people enrolled in Medicaid will have worse health than those with private insurance and the uninsured.
“The privately insured comparison is patently unfair because these people tend to be higher income and that comes with a whole host of health privileges,” said Lee.
She notes that Medicaid enrollees tend to struggle a lot more with chronic conditions and illnesses than other populations.
“A large body of literature identifies various social determinants of health, including socioeconomic status and living and work environments, as risk factors for poor health outcomes,” writes Lee, in my opinion admirably resisting the temptation to add, “duh.”
As for the uninsured being healthier — it would be one thing if Ryan were making an “apples to apples” comparison, but he’s not.
“The uninsured is a diverse group and doesn’t only include low-income individuals. It may include people who are high-income and don’t really want insurance but can afford health services, and lower-income people who may not have previously enrolled in insurance for a number of reasons — including cost and not having any real health issues,” Lee says. “But again, to imply that Medicaid is somehow making people worse off is absurd.”
Ryan also argues that Medicaid coverage has little positive effect on enrollees’ health. But as Lee points out, Ryan conveniently overlooks studies showing an association between Medicaid and lower mortality rates; reduced low-weight births and infant and child mortality; and lower mortality for HIV-positive patients, among other heath benefits.
“In general, we need more data to accurately assess the effect of Medicaid coverage on people’s health,” Lee continues. “But several studies do indicate positive health and non-health effects of coverage — such as increased use of preventive care and greater financial security.”
Rep. Ryan also plays on fears of low-income people abusing the welfare system when he asserts that Medicaid coverage improperly increases enrollees’ use of health care services, including preventive care and emergency department services. Ryan makes this case too by comparing Medicaid enrollees to uninsured people, who, as Lee writes, “are less likely to use health care services due to significant financial barriers.”
“Presenting data that Medicaid enrollees use more health services than the uninsured affirms that insurance coverage allows people who need care to seek it out,” writes Lee, “and that being uninsured is a major barrier to receiving important medical care.”
Further, one of the two studies Ryan references explicitly states that “neither theory nor existing evidence provides a definitive answer to… whether we should expect increases or decreases in emergency-department use when Medicaid expands.”
Despite Ryan’s shabby work when it comes to antipoverty policy, the media repeatedly seems willing to overlook it. That’s another strike against the prospects of a truly adult conversation about poverty — in addition to honesty, it requires accountability.
By: Greg Kaufmann, Moyers and Company, Bill Moyers Blog, March 29, 2014
“Hot Air Is Cheap”: Paul Ryan’s Culture Attack Is An Excuse To Do Nothing About Poverty
Blaming poverty on the mysterious influence of “culture” is a convenient excuse for doing nothing to address the problem.
That’s the real issue with what Rep. Paul Ryan (R-Wis.) said about distressed inner-city communities. Critics who accuse him of racism are missing the point. What he’s really guilty of is providing a reason for government to throw up its hands in mock helplessness.
The fundamental problem that poor people have, whether they live in decaying urban neighborhoods or depressed Appalachian valleys or small towns of the Deep South, is not enough money.
Alleviating stubborn poverty is difficult and expensive. Direct government aid — money, food stamps, Medicaid, housing assistance and the like — is not enough. Poor people need employment that offers a brighter future for themselves and their children. Which means they need job skills. Which means they need education. Which means they need good schools and safe streets.
The list of needs is dauntingly long, and it’s hard to know where to start — or where the money for all the needed interventions will come from. It’s much easier to say that culture is ultimately to blame. But since there’s no step-by-step procedure for changing a culture, we end up not doing anything.
This is what Ryan said in a radio interview: “We have got this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work, and so there is a real culture problem here that has to be dealt with.”
What exactly does he mean by culture? In the context of “our inner cities,” Ryan can’t be talking about rap music and baggy pants. If so, he ought to visit any high school in any affluent suburb, where he will find kids listening to the same music and wearing the same clothes — kids who will grow up to be doctors and lawyers.
Is he talking about the breakdown of family structure? To me, that’s looking suspiciously more like effect than cause. As President Obama has noted, the rise in out-of-wedlock births and single-parent households seen years ago among African Americans is now being seen among whites, especially in communities hit hard by economic dislocation.
Ryan surely can’t be talking about the use of illegal drugs, since most surveys indicate that young blacks and Hispanics are no more likely to be drug users than are young whites.
Ryan refers specifically to “the value and the culture of work,” and he may be onto something — almost. His description of “just generations of men not even thinking about working” is ridiculous. That would be like demanding to know what cultural shortcoming keeps me from spending time thinking about sailing my mega yacht to my private island.
In depressed urban and rural communities, there is an acute shortage of meaningful work. There was a time when young men who didn’t plan to go to college could anticipate finding blue-collar work at “the plant” nearby — maybe a steel mill, maybe an assembly line. There they could have job security, enough income to keep a roof over a family’s head, a pension when they retired. Their children, who would go to college, could expect lives of greater accomplishment and affluence.
This was how the “culture of work” functioned. How is it supposed to happen without work?
Confronting the devastation suffered by what used to be working-class communities is hard; adjusting to post-globalization economic realities is harder. Say the word culture and you sound erudite and concerned, especially if you drop the name of the Harvard scholar Samuel Huntington, who described world affairs as a clash of civilizations with different cultural values.
My problem is that when you identify something so amorphous as culture as the fundamental issue, you excuse yourself for not proposing concrete solutions.
As you might have gathered, I’m suspicious of the cultural hypothesis as a way to explain who succeeds and who doesn’t. I believe outcomes mostly depend on opportunities and that people are much less likely to engage in self-destructive behavior if they see opportunities that make sense to them.
If we had universal pre- kindergarten that fed all children into high-quality schools, if we had affordable higher education, if we incentivized industry to invest in troubled communities — if people had options for which they were prepared — culture would take care of itself.
But all of that is expensive. Hot air, as Paul Ryan knows, is cheap.
By: Eugene Robinson, Opinion Writer, The Washington Post, March 24, 2014
“The Real Cost Of Republican Cruelty”: Voters Should Know Who’s Holding Up Their Health Care
With one week remaining before the March 31 deadline for health coverage this year, a Republican filing a lawsuit against the Affordable Care Act has become a familiar, if tiresome, sight.
But Republicans filing a lawsuit against the law on the grounds of copyright infringement? That’s something new.
Yet that is effectively what happened this month in Louisiana. On March 14, the state’s lieutenant governor sued the progressive group MoveOn.org over a billboard criticizing Gov. Bobby Jindal’s refusal to expand Medicaid in the state. The billboard uses Louisiana’s tourism slogan — “Pick Your Passion!” — and adds: “But hope you don’t lose your health. Gov. Jindal’s denying Medicaid to 242,000 people.” The lawsuit claims that the MoveOn ad will “result in substantial and irreparable harm, injury, and damages” to the Louisiana tourism office — as if denying health insurance to the neediest will not cause the state “substantial and irreparable harm.”
Legal experts say Jindal’s ploy has no chance of succeeding, thanks to the First Amendment. (This would be the same First Amendment that the governor passionately invoked in defense of “Duck Dynasty” patriarch Phil Robertson’s right to spew racist and homophobic vitriol.)
Jindal’s reason for refusing to expand Medicaid is as specious as his reason for suing MoveOn. He claims, falsely, that the expansion would divert funds that now go to disabled individuals under traditional Medicaid. In reality, the health-care law doesn’t harm the existing program. It creates several programs to improve care for the disabled receiving Medicaid; Jindal enrolled Louisiana in three of them. But this hasn’t stopped him from blaming the ACA for his own bad policies, including cuts he made to state Medicaid funding for pregnant women.
Louisiana isn’t the only state where Republicans are preventing thousands of low-income Americans from receiving health care. In Virginia, where state lawmakers refuse to expand Medicaid, hospitals will face higher costs and reduced services as a result. One million Texans will be denied access to coverage if the state continues to reject the Medicaid expansion. Meanwhile, Mississippi Gov. Phil Bryant is willing to leave 300,000 of his neediest citizens uninsured. His reasoning? He’s afraid that the law might be repealed, leaving his state no way to meet its commitments — an ironic stance for a Republican to take, since they’re the ones trying to repeal it!
The 19 states that are refusing to expand Medicaid aren’t just leaving low-income Americans out to dry — they’re also leaving billions of health-care dollars on the table. While Bobby Jindal busies himself over a billboard, his state’s internal analysis found that Medicaid expansion would save Louisiana as much as $134 million in 2015 alone.
The real cost of Republican cruelty, however, cannot be measured in dollars and cents, but in people’s lives. Researchers at Harvard and the City University of New York concluded that without the Medicaid expansion, individuals will go without checkups, cancer screenings and treatment for diseases such as diabetes and depression — leading to thousands of premature and preventable deaths.
So much for compassionate or fiscal conservatism.
Amid the misinformation and fear-mongering, however, lies a real opportunity for Democrats to increase support for the ACA and win more races in November.
Consider the recent special election in Florida’s 13th Congressional District, where Republican David Jolly’s victory is being widely interpreted as a rebuke of the Affordable Care Act. Polls suggest that it wasn’t Obamacare that hurt Democrat Alex Sink but the same factor that often hurts Democrats in midterm elections: low turnout.
To combat this, what if Democrats organized a clear, concerted effort to demonstrate how Republicans are denying millions of Americans access to health insurance?
There are already signs that raising awareness is working. The Moral Monday movement, which favors expanding Medicaid, has been getting attention for its protests at public meetings in several southern states. Other states are considering following the lead of New Hampshire, where the state Senate voted, with Republican support, for a modified expansion.
At the same time, progressives should back MoveOn’s brilliant billboard campaign parodying the tourism slogans of not just Louisiana but also Texas, Florida, Nebraska, Virginia and Wisconsin — which are all blocking the Medicaid expansion.
The campaign might consider going to South Dakota, Alaska, Georgia, North Carolina, Mississippi and Maine, which have Republican governors, contested Senate races and huge numbers of residents who are being denied access to health care. They need to know who is at fault.
High-profile Democrats running for federal office this cycle should be similarly bold. Voters, especially low-income voters who are most hurt by the GOP’s cruel stance on health care, need to understand just what’s at stake. It’s time for Democrats to run on health-care reform, not away from it — and Medicaid expansion is a worthy place to start. If they need to know how far Republicans have gone to prevent it, there’s a billboard along Interstate 10 in Louisiana that’s a pretty good guide.
By: Katrina vanden Heuvel, Opinion Writer, The Washington Post, March 25, 2014
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