Tea Party Budgeting: Everyone Doesn’t Deserve A Fair Shot
Three lessons I’ve learned from Tea Party budgeting:
1. Charles Lightroller was a chump.
Lightroller was the second mate on the Titanic. Legend holds that no one enforced the command to allow women and children to board the lifeboats first more rigorously than he did. Some call him a hero. But not me. That’s because I, like Rush Limbaugh, think Paul Ryan’s budget is “wonderful.”
And how could you not? Ryan surveys the budget battlefield and here’s what he sees: on one side, an onrushing horde of seniors, working people, and the disabled. On the other, defenseless corporations and their affluent compatriots prancing like happy kittens amongst the flowers. In the face of such forbidding odds some might duck, but Ryan strides onto the field of play and bravely interposes himself between the conflicting parties, prepared to defend the defenseless come what may.
Here’s what that looks like: Medicare, the health program relied on by millions of seniors, is replaced with a benefit guaranteed to fall further and further behind the actual cost of healthcare. Medicaid (healthcare for people with low-incomes) sustains deep cuts. But tax rates on corporations and the highest earners are lowered, while subsidies for oil companies remain untouched. Truly a profile in courage.
2. Pell Grants are destroying America.
I feel badly for not recognizing it, but it seems so obvious now. Freeloaders figured out how to get free food, free housing, and free electricity years ago, but they’ve never been able to reach the Holy Grail: free Biology of the East African Mud Turtle 101. Until now. “You can go to school,” warns Rep. Denny Rehberg of Montana, “collect your Pell Grants, get food stamps, low-income energy assistance, Section 8 housing, and all of a sudden we find ourselves subsidizing people that don’t have to graduate from college.”
Welfare cheats scheming to take the college courses of their dreams? (And then not graduate!) It’s an outrage. How many of them are sitting in a college cafeteria right now snickering over a steaming plate of American Chop Suey? (Purchased with food stamps, natch.) “It’s turning out to be the welfare of the 21st century,” Rehberg says. Talk about getting schooled: that’s got to be one of the smartest theories I’ve ever heard.
Of course, it’s not just Pell Grants that are so nefarious. It’s Head Start too, and Medicare, and Medicaid, and …(hence, Lesson 1 above).
3. Better than Government? Fairies.
A signal question in American political life today is: when things go wrong, what role, if any, should government play in trying to make things right?
We seem to have settled on some answers. When we’re to blame for the bad things that happen, we’re on our own. The same is true when we do our best but lose fair and square. But what about when people encounter difficulties through no fault of their own and in a way that offends our sense of fairness? A kid who’s born into a family without the means to send him to a good school, or a mother who works hard every day but loses her employment because global economic forces are moving manufacturing jobs to other countries? Should government lend a hand in those kinds of cases?
The Ryans and the Rehbergs conceive of a government that does so less and less. They say the benefit of helping the disadvantaged is outweighed by its expense. What they don’t say is what happens to people who no longer can rely on needed government assistance. Perhaps magical fairies come along, wave their magic wands, and everyone who used to get a Pell Grant can still go to college, only this one is taught by chocolate bunnies! And all those people who can’t afford healthcare anymore? It’s OK. They’re now living in a cottage made entirely of gingerbread!
Let me be clear: there’s every reason to be serious about reducing the budget deficit. Political leaders on both sides of the aisle should be open to good faith ideas that emanate from anywhere on the political spectrum. But it’s reasonable to ask whether using concern over the deficit as an excuse to accomplish purely ideological goals can be considered serious.
Democrats agree that the private sector should be the engine that drives our economy and that we need the discipline to cut government programs that aren’t working. But there’s something else we believe that sets us apart from the Tea Partyers: there’s a promise inherent to the American free market system that says everyone deserves a fair shot, and that promise goes unfulfilled when people are disadvantaged by forces beyond their control and we all stand by and do nothing about it.
In other words, bring back Charles Lightroller. Boy, do we need him.
By: Anson Kaye, U.S. News and World Report, April 7, 2011
The Budget Battles: Prosperity for Whom?
If the House Republican budget blueprint released on Tuesday is the “path to prosperity” that its title claims, it is hard to imagine what ruin would look like.
The plan would condemn millions to the ranks of the uninsured, raise health costs for seniors and renege on the obligation to keep poor children fed. It envisions lower taxes for the wealthy than even George W. Bush imagined: a permanent extension for his tax cuts, plus large permanent estate-tax cuts, a new business tax cut and a lower top income tax rate for the richest taxpayers.
Compared to current projections, spending on government programs would be cut by $4.3 trillion over 10 years, while tax revenues would go down by $4.2 trillion. So spending would be eviscerated, mainly to make room for continued tax cuts.
The deficit would be smaller, but at an unacceptable cost. Health care would be hardest hit, followed by nonsecurity discretionary spending — the sliver of the budget that encompasses annually appropriated programs. Those include education, scientific research, environmental preservation, investor protection, disease control, food safety, federal law enforcement and other areas that bear directly on the quality of Americans’ daily lives. The proposed cuts in such programs are $923 billion deeper than President Obama called for in his 2012 budget, which pushed the edge of what is politically possible.
Another big cut — $715 billion over 10 years — comes from mandatory spending other than Social Security and the big health care programs, a category that includes food stamps and federal retirement.
The blueprint does not call for any specific changes to Social Security, but, without explanation, it assumes a reduction of $1 trillion over 10 years in the program’s surplus. That would weaken the program by hastening the insolvency of Social Security.
When he unveiled this plan, Paul Ryan, a Republican of Wisconsin and the chairman of the House Budget Committee, declared, “This isn’t a budget. This is a cause.”
There is much truth in that. The blueprint is not a serious deficit reduction exercise for many reasons, the most important of which is that serious deficit reduction requires everything to be on the table, including tax increases. The plan released at the end of last year by the Obama deficit commission was one-third tax increases and two-thirds spending cuts. President Obama’s budget calls for a mix of tax cuts and tax increases, among the latter, letting high-end Bush tax cuts expire at the end of 2012. The Republican plan calls only for tax simplification. It would get rid of loopholes and reduce rates in a way that would not raise overall revenues but would invariably cut the tax bill of wealthy taxpayers for whom lower rates are more valuable than assorted loopholes.
The deficit is a serious problem, but the Ryan plan is not a serious answer. With its tax cuts above all, and spending cuts no matter the consequences, it is a recipe for more loud talk about the deficit but no real action.
By: Editorial, The New York Times, April 5, 2011
Congressional Budget Office Looks At “RyanCare” Rationing And It Ain’t Pretty
The Congressional Budget Office has released its preliminary analysis (PDF) of House Budget Committee Chairman Paul Ryan’s budget, and I wouldn’t say it’s pretty. According to the CBO, Medicare beneficiaries will be left paying more for less. The CBO goes about this in a bit of a confusing way, setting a “benchmark” that corresponds to the cost of purchasing a private plan equivalent to Medicare, and then seeing how much more that plan would cost than Medicare under two different scenarios. Compared with either scenario, RyanCare costs a lot more than Medicare:
Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, the CBO estimated the beneficiary’s spending on premiums and out-of-pocket expenditures as a share of a benchmark: what total health-care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary’s spending would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.
If Medicare’s beneficiaries are getting less for more, Medicaid’s are simply getting less, period:
Federal payments for Medicaid under the proposal would be substantially smaller than currently projected amounts. States would have additional flexibility to design and manage their Medicaid programs, and they might achieve greater efficiencies in the delivery of care than under current law. Even with additional flexibility, however, the large projected reduction in payments would probably require states to decrease payments to Medicaid providers, reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more themselves than would be the case under current law.
As the CBO recognizes, a lot of what Ryan is doing isn’t saving money so much as shifting costs. Poor people and seniors don’t need less health care because Medicare and Medicaid are providing less health care. They just have to pay for more of it on their own. And as the CBO says, it’s hard to imagine Congress simply ignoring their pleas for help:
Under the proposal analyzed here, debt would eventually shrink relative to the size of the economy — but the gradually increasing number of Medicare beneficiaries participating in the new premium support program would bear a much larger share of their health care costs than they would under the current program; payments to physicians and other providers for services provided under the traditional Medicare program would be restrained (as under the two scenarios); states would have to pay substantially more for their Medicaid programs or tightly constrain spending for those programs; and spending for federal programs other than Social Security and the major health care programs would be reduced far below historical levels relative to GDP. It is unclear whether and how future lawmakers would address the pressures resulting from the long-term scenarios or the proposal analyzed here.
By: Ezra Klein, The Washington Post, April 5, 2011
Cutting Through The Medicare Charade
In his Wall Street Journal op-ed today, House Budget Committee Chairman Paul Ryan (R-Wis.) said the Republican budget plan is focused on “saving Medicare.”
Of course, in this context, this is intended to strip the word “save” of all meaning. Even the Wall Street Journal yesterday noted that the GOP proposal “would essentially end Medicare,” which happens to be true.
Medicare is very easy to understand — it’s a popular system of socialized, single-payer health care for seniors. Beneficiaries love it, and the system works pretty well. The House Republican scheme for Medicare is a little more complicated, but still pretty straightforward — the GOP intends to privatize it. The resulting system would, ironically, look quite a bit like the Affordable Care Act, with seniors entering exchanges, where they would take a subsidy to purchase private insurance.
So, what’s the problem? Republicans intend to rig the game, scrapping the existing system and ending the guarantee of set benefits, while at the same giving beneficiaries a voucher that wouldn’t keep up with costs.
This isn’t “saving Medicare”; it’s ending Medicare and screwing over seniors.
Josh Marshall had a good piece on this yesterday, calling the plan “Medicare Phase-out legislation.”
The Ryan plan is to get rid of Medicare and in place of it give seniors a voucher to buy health care insurance from private insurers. Now, what if you can’t buy as much as insurance or as much care as you need? Well, start saving now or just too bad.
Now, by any reasonable standard, that’s getting rid of Medicare. Abolishing Medicare. Phasing it out. Whatever you want to call it. Medicare is this single payer program that guarantees seniors health care, as noted above. Ryan’s plan pushes seniors into the private markets and give them a voucher. That’s called getting rid of the program. There’s simply no ifs or caveats about. That’s not cuts or slowing of the growth. That’s abolishing the whole program. Saying anything else is a lie.
Yep.
I’d just add that some folks may have forgotten why Medicare was created in the first place. The nature of the human body is that ailments are more common as we get older, and profit-seeking insurance companies weren’t keen on covering those who cost so much more to cover. On average, folks who’ve lived more than six decades often have pre-existing conditions, and we know all too well what insurers think of those with pre-existing conditions.
Seniors relied on this system for many years, but it didn’t work. We created Medicare because relying on private insurers didn’t work.
And now Republicans want to roll back the clock.
By: Steve Benen, Washington Monthly, Political Animal, April 5, 2011
Cutting Medicaid Means Cutting Care For The Poor, Sick And Elderly
The part of Paul Ryan’s budget that’s going to get the most attention is his proposal to privatize and voucherize Medicare. But the part that worries me the most is his effort to slash Medicaid, with no real theory as to how to make up the cuts.
Ryan’s op-ed introducing his budget lists Medicaid under “welfare reform,” reflecting the widespread belief that Medicaid is a program for the poor. That belief is wrong, or at least incomplete. A full two-thirds of Medicaid’s spending goes to seniors and people with disabilities — even though seniors and the disabled are only a quarter of Medicaid’s members. Sharply cutting Medicaid means sharply cutting their benefits, as that’s where the bulk of Medicaid’s money goes. This is not just about the free health care given to some hypothetical class of undeserving and unemployed Medicaid queens.
But perhaps cutting it wouldn’t be so bad if there were a lot of waste in Medicaid. But there isn’t. Medicaid is cheap. Arguably too cheap. Its reimbursements are so low many doctors won’t accept Medicaid patients. Its costs grew less quickly than those of private insurance over the past decade, and at this point, a Medicaid plan is about 20 percent cheaper than an equivalent private-insurance plan. As it happens, I don’t think Medicaid is a great program, and I’d be perfectly happy to see it moved onto the exchanges once health-care reform is up and running. But the reason that’s unlikely to happen isn’t ideology. It’s money. Giving Medicaid members private insurance would cost many billions of dollars.
That’s why it’s well understood that converting Medicaid into block grants means cutting people off from using it, or limiting what they can use it for. You can see CBO director Doug Elmendorf say exactly the same thing here. There’s just not another way to cut costs in the program. You can, of course, work to cut costs outside of the program, either by helping people avoid becoming disabled or making it cheaper to treat patients once they become disabled or sick, but those sorts of health-system reforms are beyond the ambitions of Ryan’s budget.
To get around some of this, Ryan’s op-ed talks about state flexibility, with the implication being that states have some secret Medicaid policies they’ve been dying to try but that the federal government simply hasn’t let them attempt. But the truth is there’s been a tremendous amount of experimentation in Medicaid over recent decades. Indiana converted its Medicaid program into health savings accounts. Tennessee based its program around managed care. Massachusetts folded its Medicaid money into Mitt Romney’s health-care reforms. Oregon tried to rank treatments by value. Some of these reforms have worked well and some haven’t worked at all, but none have solved the basic problem that covering the sick and disabled costs money, and you can’t get around that by trying to redesign their insurance packages. For that reason, block-granting Medicaid ultimately means cutting health-care coverage to the poor, the elderly and the disabled, even as it doesn’t actually address the factors driving costs throughout the health-care system.
By: Ezra Klein, The Washington Post, April 5, 2011
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