JONATHAN COHN JUNE 1, 2011
Very Serious People ™ continue to accuse the Democrats of dishonesty and demagoguery on Medicare. On Sunday, it was the Washington Post’s Ruth Marcus during an appearance on “Meet the Press.” Today it is Time’s Don Von Drehle, writing at the Swampland blog:
Medicare promises more to future retirees than it is going to be able to deliver. Change is urgently needed. ObamaCare envisions change within the existing structure of the health care industry, while Republican Paul Ryan’s proposal would impose change by having elderly patients buy their own coverage, using government vouchers. Both of these represent huge departures from the status quo. If this election educates voters to make an informed choice between these options, we’ll be a stronger country for it.
But we certainly didn’t see that sort of informative campaign in the special Congressional election in New York’s 26th District last week. Instead, we saw candidates accuse each other of trying to destroy Medicare.
Actually, Von Drehle has it half-right. Medicare does need to change. And, under the terms of the Affordable Care Act, Medicare will change. Specifically, the government (which runs Medicare) will take corporate welfare away from some insurance companies. It will reduce payments to providers while introducing payment reforms that encourage efficiency. It will create a series of budget targets for the program – and then empower an independent commission to enforce those targets, unless super-majorities in Congress overrule it.
There’s an honest debate to be had over how these changes will play out. Optimists will tell you that the reforms will turn the program into something much more efficient, providing beneficiaries with better and less costly care. Pessimists will tell you that the reforms will inevitably reduce seniors' access to treatment, as providers see fewer and fewer patients. But even if the pessimists are right – and, to be clear, I don’t think they are -- the program’s fundamental structure will remain the same, at least as far as beneficiaries are concerned. At worst, seniors might wait a little longer for services. They'd still have the assurance that they can pay for their medical care, no to mention better coverage of preventative services and prescription drugs (both of which the Affordable Care Act bolsters).
A smarter critique is that the payment reforms already in place don’t go far enough: That even if the law takes effect as planned, the program will still become too costly, too soon. I’m more sympathetic to that argument -- in fact, I’ve made it myself a few times. But I would also argue that the way to fix that problem is to move more quickly and aggressively on the law’s payment reforms, as President Obama has proposed doing, and then watch patiently to see which reforms work and which ones don’t. The complicated truth of Medicare is that you can't reduce the programs's spending too radically or too hastily -- unless you're willing to end the commitment this country has made to its seniors.
Of course, that is precisely Republicans propose to do -- and why it is perfectly accurate to say Republicans want to destroy Medicare.
Remember, they're not simply transforming a government insurance program with guaranteed benefits into a voucher scheme without them. They're also taking far more money out of the program. As I wrote just the other day, for what seems like the umpteenth time:
This is the essential point that Republicans and their supporters never mention. Over time, they would provide the program with dramatically less money than the Democrats would. It's difficult to find a hard estimate of how much exactly. But if you include proposed cuts to Medicaid (which pays for long-term care and other services the elderly use) and do some math based on the official Congressional Budget Office projections, you'll see that the Republican budget would reduce federal health care spending by an additional 7 to 9 points of gross domestic product by 2050. That's an immense difference.
Paul Krugman, who has been banging his head against the wall trying to get this point across, came up with a good analogy the other day:
think of Medicare as a footbridge that is deteriorating and will eventually become unsafe. You could propose structural repairs to fix its faults; Ryan doesn’t do that. Instead, he proposes knocking the bridge down and replacing it with trampolines, in the hope that pedestrians can bounce across the stream.
To extend the analogy a bit, I think it’s totally reasonable to suggest we need even more structural repairs – i.e., more Medicare payment reforms – than the Affordable Care Act has already begun. But it doesn’t change the fact the Republicans want to destroy the bridge altogether.
Steve Benen had a great post on this Sunday, after watching that "Meet the Press" in dismay:
I’m at a loss to understand what, exactly, Ruth Marcus, David Brooks, and their cohorts would have Dems do. Congressional Republicans have a plan to end Medicare and replace it with a privatized voucher scheme. The proposal would not only help rewrite the social contract, it would also shift crushing costs onto the backs of seniors, freeing up money for tax breaks for the wealthy. The plan is needlessly cruel, and any serious evaluation of the GOP’s arithmetic shows that the policy is a fraud.
Which part of this description is false? None of it, but apparently, Democrats just aren’t supposed to mention any of this.
Update: I see that House Budget Chairman Paul Ryan is now claiming that the Affordable Care Act "ends Medicare as we know it." Sigh. Igor Volsky explains why this is, um, wrong.