Budget and health issues

SUMMARY

The Republicans, so far, seem to be doubling down on their very dangerous bet, the proposition that they can convince the American people to give up Medicare in exchange for health-care vouchers. They even seem to be making it a litmus-test issue for presidential candidates, as Newt Gingrich found out the hard way. They are trying to avoid the wrath of seniors by pointing out that the cuts won’t apply to them – only their kids and grandkids. Democrats, already angry that the GOP won the 2010 midterms by accusing them of being the Medicare-killers, are attacking Republicans on this, particularly the GOP presidential hopefuls, who like the Republicans in the Senate wanted desperately to waffle on the Ryan Medicare plan. While Washington is fight this battle, they will also be fighting the debt-ceiling battle, which exposes a rift between the tea-party and the Wall Street Republicans who are terrified of a default, and also fighting the battle to repeal Obama’s health reform package, which Obama must do better to sell to the voters. Five sections in the article:

The backlash against the Ryan plan
The Republicans double down on the Ryan plan
The Democrats attack
The debt ceiling
Obamacare

DETAILS

The backlash against the Ryan plan

The Republicans have been trying to kill government programs like Medicare for decades. Here’s Reagan’s apocalyptic and wildly inaccurate warning from 1961: "First you [the government] decide that the doctor can have so many patients. ... So a doctor decides he wants to practice in one town, and the government has to say to him, "You can't live in that town, they already have enough doctors, you have to go live somewhere else. And from here it's only a short step to dictating where he will go. Pretty soon your son won't decide when he's in school where he will go or what he will do for a living, but will wait for the government to tell him where he will go to work and what he will do. ...And if you don't [stop Medicare] and I don't do it, one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free."

…And then they will sap your precious bodily fluids. Needless to say Reagan was dead wrong, but Republicans have been trying to wreck Medicare for decades, so trying to deny it now is silly. Not only is Medicare so wildly popular that the GOP is taking a serious beating just for threatening it: it actually saves money. Let’s look at some numbers: Medicaid covers 49 million people for $208 billion; Medicare covers 43 million people for $440 billion, and the VA covers 26 million vets for $87 billion. So those three programs cover 118 million people for $735 billion, about $6000 per person. This is thousands of dollars less than the rest of us are paying the private insurers: the government programs are cheaper that the private companies.

Also, the private companies are overwhelming covering healthy people in the prime of life: the government programs are overwhelmingly covering the young, old and poor, in other words the people who cost the most to cover. In other words, the government outperforms the private sector.

Along comes Paul Ryan, whose plan would destroy Medicare (as even the Wall Street Journal admitted), add 30-40 million new uninsured including more than a million children within five years, and add crippling financial burdens for the sick, disabled and elderly. And the aim is not to tackle the debt, but to give tax breaks to millionaires, which makes all of the debt-ceiling brinksmanship silly. The plan was so obviously unsound that Republicans privately chastised Ryan for being so explicit about the damage it would do: they said he should have just inserted some vague language into that part of the budget. All the same, almost all of them voted for it, even though they knew it would never pass. Mass suicide almost on a Jonestown scale. All while complaining that it's Obama who's the radical.

Another dangerous gambit the Republicans are trying: assuring seniors that the Medicare cuts won’t apply to them, only to their kids and grandkids. The plan would keep Medicare for everyone over 55, but everyone else gets the private system. So how many grandparents really want to hear that? Pawlenty tried something similar, promising to cut Social Security benefits, but not for today's seniors. And the worst thing is that the claim isn't even true: Ryan's plan would hurt today's seniors immediately, by jacking up costs for prescriptions and probably long-term care and other phases of coverage.

The Republicans also tried out "where is the Democratic plan for Medicare?" Whereupon Pelosi shot back that their plan is called Medicare. And as for the budget itself, Obama put out his plan back in April. It cut the debt by $4 trillion. This line of attack is particularly ironic since the Republicans promised a plan to replace Obamacare and then never delivered; even the House GOP rank and file complained that their own leadership didn't follow through.

Ryan got one ringing endorsement from a big-name Republican: “I worship the ground the Paul Ryan walks on". Unfortunately it was the incredibly toxic Dick Cheney, fresh off his "Torture Is Good" publicity tour. Thanks for the help!

(Footnote: when Ryan wasn’t plotting to destroy Medicare, he was working with might and main to destroy the economy by screaming at the Fed chair to tighten the money supply, right in the middle of a recession. Fortunately the Fed ignored him; this is exactly why the Fed is supposed to be immune to political pressure from economic illiterates with gavels. This Ryan rube was the Republican party’s choice to be their top budget expert in the House. And for anyone trying to get him to run for President, know that in 12 years in Congress, about all he has accomplished is to propose a series of doomed, wildly irresponsible budget proposals just like the one he is now famous for.)

Congressional Republicans saw the reactions to the plan, and they panicked: 61 House Republicans come from districts which Obama won in 2008 and the effort to destroy Medicare could kill them in 2012.

One must wonder: are the Republicans really terrified that their base will insist on trashing Medicare? Isn’t their base the same bunch of elderly coots who screamed “keep your hands off my Medicare” in those town halls a year ago?

The Republicans double down on the Ryan plan

But then a strange thing happened. The GOP leadership decided that rather than run from the Ryan fiasco, the smart thing to do was double down on their bet. They have now made the Ryan bill a litmus test: support the Ryan plan or you will be shunned like an Amish prostitute. Not only must congressional candidates go back to their districts and suicidally promise to cut Medicare, which is already creating those very lively town-hall meetings, but presidential candidates must toe the line as well.

Newt Gingrich found this out the hard way. All he was trying to do was tell the truth and position himself with a relatively moderate position for the general election: “look at me, saving your Medicare!” And the wrath of the entire party establishment fell upon him: Ryan himself, Jim DeMint, Cantor, Nikki Haley in South Carolina, Pat Buchanan, Newsmax, the Wall Street Journal, Limbaugh, Krauthammer, Rasmussen. One of Newt’s own allies blamed it on both Newt and the extremist primary voters: "Why doesn't [Newt] know that these issues have become the Holy Grail for GOP primary voters?"

The other potential presidential nominees, seeing Newt’s bleeding body on the ground, decided to say nice things about Ryan’s plan, but mostly they were careful to endorse it as is. Huntsman did endorse it and Palin called it a good plan. Pawlenty said his own plan would be similar when he unveiled it; then he was cornered by the press and waffled on whether he would have signed the Ryan plan as President, and then he said he would have signed it. Romney also promised his own plan later on, but he also claimed Ryan's plan saved Medicare for future generations: characteristically Romney is trying to have it both ways. Paul said the Ryan plan is a move in the right direction; Daniels called it “serious”. Bachmann supported it but urged caution about Medicare and added some vague blather to qualify her comments: if even Michele “Damn-The-Torpedoes” Bachmann is being cautious, it really must be a dangerous issue. Gingrich himself had half a dozen positions on it within a week.

There are more signs that the Republicans are indeed going to double down on this. Senate Republicans voted almost unanimously to back the Ryan plan; Mitch McConnell was working to have it both ways by trying to spin the Ryan plan as an effort to “empower” grandma to shop in the private market, but also admitting that he wouldn’t whip support for the Ryan plan, and that there were a number of other Republican plans, none of which was going to even become law anyway.

Key tea-party leader Dick Armey is still sticking with Ryan, and the Wall Street Journal still calls entitlement "reform" a key building block of the party agenda, which is no great surprise since Newt tried to attack Medicare in the 1990s and Bush attacked Social Security a decade later. Americans For Prosperity were leaning on Republican Senators to vote for the Ryan budget, and Grover Norquist plans to send an army of activists out to sell the plan. One Republican admitted that the House Republicans couldn't tinker with the Ryan plan "or the Tea Party will kill them". The only conservatives to wander off the reservation and admit that Ryan's plan is indeed a voucher plan are Fox and Herman Cain.

Another sign: when the GOP attack on Medicare enabled the Democrats to steal a House seat in New York that hadn’t gone blue in decades, the Republicans refused to accept that Medicare was the cause. “Ryan’s a great guy, his plan is just a conversation starter, we have other plans, one plan is to make Medicare optional, we need to sell the plan better, it’s the Democrats who really want to cut Medicare, we're going to save Medicare, the media is making too much of one close race, we lost in upstate New York because it's hostile to Republicans and the state party is incompetent and we had to deal with Davis and our candidate ran a bad race!” Republicans like Ryan complain that the Democrats indulged in scare tactics and demagoguery, which, again, is a bit much, coming from a party that told scary lies to seniors throughout the 2010 race.

Medicaid is also in danger from the GOP. Two Republican governors are working to make it practically impossible for Medicaid patients to get care: Chris Christie of New Jersey, by lowering the eligibility threshold to way below the poverty line, and Mitch Daniels of Indiana, by signing an illegal anti-Planned Parenthood law which pulls the plug on Medicaid in his state. Texas is working on a bill to convert Medicaid into a capped block grant, seeking exemptions from Medicaid rules and allowing the privatization of Medicare; Texas, which already has the highest rated of uninsured in the country, is on a path to lose a third of its federal dollars which would force deep Medicaid cuts.

Also Rick Scott in Florida privatized Medicaid coverage for two million residents. It’s based on a local experiment which failed: patients complained that they couldn’t get specialists and doctors complained that necessary care was denied. It is purported to cut costs and improve care, but it also increases reimbursement rates and limits lawsuits, which is rather counterintuitive.

Two more lines of attack which the GOP is using to take away the programs we were told would be there: the House GOP has introduced a bill to destroy Social Security by making it optional -- they're out on the stump claiming it's all a pyramid scheme -- and Republicans in state legislatures are attacking children's health programs, which will actually cost more in long run.

The Democrats attack

More and more, the Republicans are returning to the delusional theme that they just need to sell their plan better. The Democrats are biting their tongues and crossing their fingers, hoping the Republicans will blunder in this direction, and spend months telling voters that their really terrible, dangerous plan is really a good thing for Americans. They may actually make 2012 the Medicare Election, promising every day in hundreds of districts to take away Medicare.

The Democrats are not waiting, however. They are already exploiting this issue: they want 2012 to be the Medicare election, rather than the jobs election, and make Ryan the public face of the GOP. Obama versus Ryan. Chuck Schumer, a real wartime consigliere, said “we will not miss a single opportunity of reminding the public what it means for seniors”: those seniors went for the GOP by 21 points in 2010 because the GOP lied to them, so if that bloc swings back to the left, election day will be ugly for the Republicans. Democrats are already using Newt’s anti-Ryan language against the Republicans who supported Ryan, and they are using Romney’s public support for Ryan against Romney.

Schumer pounced again when a GOP Congressmen was recorded berating one of his own constituents: “Hear yourself, ma’am. Hear yourself. You want the government to take care of you, because your employer decided not to take care of you. My question is, ‘When do I decide I’m going to take care of me?’” then told another “If you want a socialized health care program, there are lots of places to find that.” In other words if you want coverage, leave the country. Schumer responded: “No matter how hard you’ve worked your whole life, no matter how severe your medical hardship, the Republican motto is clear: you’re on your own. This lays bare the ideology behind their goal of ending of Medicare as we know it.”

Another wartime consigliere, Anthony Weiner: "Well, ladies and gentlemen, that might be the rationale for our Republican friends wanting to eliminate Medicare, but none of those things are true. It is not a ‘construct to develop a plan’ it is the proposal of the Republican party of the United States of America to eliminate Medicare as a guaranteed entitlement. If you don’t believe me, go get the book that they wrote, go get the budget that they wrote, go get the bill that they wrote."

Occasionally a Democrat will walk in front of a camera and open the door to Medicare cuts, which is incredibly sloppy: they must publicly, repeatedly, daily, reject cuts to Medicare benefits.

If they stick to their guns, they have a winning issue. According to a June CNN poll, Americans hate the Ryan plan to kill Medicare, they say Obama is trying to work with the GOP but the GOP isn’t trying to work with him, and they no longer are in love with the idea of having the GOP control the House: they want Obama to have more influence over the direction of America. Even half of Republicans and conservatives hate the Ryan plan. Ninety percent of Americans say “no major changes to Medicare”.

The Democrats are particularly incensed about Ryan’s Medicare attack because the Republicans lied about all this stuff to win back the House in 2010. “The Democrats are going to destroy Medicare and throw grandma under the bus!” And as soon as the Republicans regained the House, what did they do? They launched an effort to destroy Medicare and throw grandma under the bus. So who is it who tried to pull the plug on grandma, again? The Republicans won the 2010 election by egregious fraud. "Democrats will take coverage from seniors, raise premiums, cost five million jobs, enlist the IRS to hunt people down, pave the way for rationed care and a government takeover and a European social welfare system!" The Republicans are weakly counterattacking by insisting that it’s still Obama who’s trying to kill Medicare, but they’ve been busted.

The Republicans also lied about other things, and then flipflopped: during the campaign they hollered that Democrats would put a bureaucrat between you and your doctor, and then in 2011 they began doing exactly that themselves, whenever abortion is involved. In dozens of states, legislatures are forcing doctors to accede to bureaucrats on giving abortion patients wildly inaccurate warnings about abortion, and imposing a lot of other needless restrictions. Hat tip to Rachel Maddow.

If the Democrats wanted to play ball the way Republicans do, they could certainly use Republican logic to argue that the Ryan plan uses government action to force seniors to pay $6000-8000 more each year. In other words, it sounds an awful lot like a tax.

Meanwhile the House GOP leadership is using their control of the franking office to prevent Democratic members from using their campaign fliers to warn their constituents about the GOP attack on Medicare. So Democrats can't tell their story to constituents, but Republicans can. Thus, the death of democracy.

The debt ceiling

Perhaps the Republicans and their primary voters will make crashing the debt ceiling a litmus-test issue too, as they tried to do in the spring 2011 budget talks: “shut down the government!” Mitch McConnell said he will block a rise in the debt ceiling, and in so doing crash the economy, unless there are some Medicare cuts, thus ensuring that the Republicans will get credit for destroying either the U.S. economy or Medicare, or possibly both. Other Republicans are competing to show how rigid they can be: McConnell and Boehner are insisting that canceling the tax cut for the rich must be off the table, which is particularly counter-intuitive right now since the New York special election in a very red district was won by a Democrat who opposes tax breaks for the rich; Romney and Pawlenty insisted that cutting the size of the defense budget must also be off the table, which means that Pawlenty would rather cut Social Security than the defense budget.

As the debt-ceiling talks began, the Republican posturing and chest-beating grew worse. One Republican refused to meet Obama, claiming that he didn't want to be lectured by Obama, the man who caused the whole problem. They whined about Democratic demagoguery, which out in the real world is known as "facts". McConnell is not only demanding spending cuts, but specifying that Democrats must approve Medicare cuts, to neutralize the toxic issue of the Ryan budget; Kyl went further by specifying that merely cutting waste, fraud and abuse in Medicare wasn't enough -- he wants the Democrats to sign up for benefit cuts. One Republican demanded that Obama write a plan which the CBO could score; the White House response was "nice try, let's reach a joint deal and then score that". Another Republican  bragged that Obama was in the most danger, and that in the end Obama would be forced to give in. After the House debt ceiling vote, the NRCC sent out talking points attacking the Democrats who voted for and the ones who voted against. Democrats, they’re going to attack no matter what!

Republicans may be thinking they have nothing to lose: if they're doomed to be crushed by Obama and the Medicare issue in 2012, why not crapshoot by wrecking the entire economy and hoping to deflect the blame? Of course they were confident in 1995 that they could at least split the blame with Clinton for the government shutdown that year, but Clinton mopped the floor with them, and Obama should be able to do it too.

Democrats like Steny Hoyer initially bobbled the ball by hinting that they could be persuaded to cut Medicare, but now Hoyer, presumably after a trip to the woodshed with Miss Pelosi, has pledged to strengthen and preserve Medicare. They are ruling out attacks on Medicare and Medicaid, and Obama demanded a cancellation of Bush's tax breaks for the rich. A couple of Democratic Senators stepped forward to get Pelosi's back on this, and they're pressing Biden to hold the line also, both on Medicare and on Medicaid. Now the Democrats are specifying no vouchers or benefit cuts. They got a boost from the Fed chair who undercut the GOP’s debt argument by indicating that we shouldn’t necessarily be cutting spending right now, in a recession: “a sharp fiscal consolidation focused on the very near term could be self-defeating,” and will probably “undercut the still-fragile recovery.” The Dems should also be arguing that the debt isn't Obama's fault, and that we did in fact have surpluses before the Bush tax cuts.

The debt ceiling is going to make Boehner’s summer unpleasant. Boehner is under pressure from the young radicals who are growing in numbers and strength; they think Boehner is an cranky, abrasive, old-school dealmaker, and are wary of Boehner’s compromises. They began to rebel when Boehner backed down during the budget fight, and Cantor is already distancing himself from Boehner, claiming his heart wasn’t really in Boehner’s budget deal. So Boehner will not go too far to the left in the next budget fight – the young guns will depose him if he does. That split is also reflected outside Washington: corporate America and Wall Street are terrified of the prospect of a default, but the tea party folks love it.

Two things that make the GOP stance even more foolish. The GOP let Bush raise the debt ceiling seven times, without trying to take their president hostage. Also, the Ryan plan will require more rises in the debt ceiling. So they're hypocritcal and clueless.

Obamacare

The Republicans still want to kill Obama’s ACA health care package: they are very emphatic about it, and they are going out into their districts trying to peddle all sorts of tall tales about how top Democrats are gaming the system with waiver fraud, for example. They are recycling all the lies from a year ago: Obama's plan cut Medicare, death panels, rationing, threat to your liberties etc. But now the Republicans are getting pushback in the townhalls that they didn’t face in 2010. Republican members of Congress began to ban reporters and even camera-phones from town halls, so that when constituents bust them for lying about the ACA or threatening Medicare, they won’t become instant Youtube stars – they were pretty good at dishing out the lies at Democratic town halls two years ago, but not so good at taking it when the truth is rubbed in their faces.

Obama still must do a much better job selling the ACA successes: it saves Medicare $120 billion, extends the life of Medicare and expands coverage, rewards doctors and hospitals that do well, cracks down on waste, fraud and abuse, uses an independent commission to bring costs down, brings equipment costs down, cuts annual increases to medical institutions, provides free preventive care and physicals for Medicare patients, it paves the way for $24 billion in annual savings if HHS can negotiate drug prices, and helps with the dreaded doughnut hole. It cuts the giveaways, overpayments and corporate welfare which now goes to insurers. And amazingly, no death panels or dead grandmothers: they need to remind folks that all the scary Republican warnings about the plan turned out to be nonsense. Likewise, many of the ACA changes to Medicare are also in the Ryan plan.

The Republicans are trying to assume the mantle of grown-up tough-love budget masters, but they have a dreadfully tin ear with respect to telling the difference between frugal and just plain mean. Just as Missouri was reeling from the tornadoes that killed more than a hundred people, House Republicans were not only working to cut tornado warning services, but actually refusing to provide emergency help for the victims unless Obama cut something in the budget. Holding tornado victims hostage.

Obama can also remind people that the notion of end-of-life consultations that caused so much brouhaha (a clamor launched by Palin in a paroxysm of either ignorance or deliberate dishonesty) was sponsored by Susan Collins, endorsed by Gingrich, and signed into law by Bush, who also approved the biggest government takeover of health in history with Medicare Part D, unpaid for, like the Iraq war.

Any day that focuses on health care is a bad day for Gingrich, but worse for Romney. Because the GOP spent two solid years condemning any comprehensive health plan, promising to repeal it, nominating Romney means admitting tacitly that they were wrong. Romney’s state plan actually did well and is popular: it got more people covered, stayed under budget, and reduced so-called free care. But now he must run away from his greatest achievement, like Eisenhower not being allowed to run on winning World War Two. It is rather sad: many Republican candidates advocated sensible health-care innovations and then backed away like Romney did, but the others didn’t make the issue a central pillar of their careers, the way Romney did, so he’s stuck. Of course the Republicans do have one other thing to hate Romney’s plan for: unlike Obama’s plan, Romney’s covers abortions.

Yet another dangerously stupid move: there is an effort afoot to set up a board which would eliminate waste in the Medicare system. The GOP should like the idea, they’re all about cutting the costs, right? Nope, they’re blocking it, because it is linked to Obama’s health care plan. Attacking America’s Democrats is more important than attacking America’s problems.

Also, by the way, Republicans, studies show that tort reform does not cut health costs.