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Tilting at Windmills

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April 4, 2011

THE REPUBLICAN PLAN TO 'ESSENTIALLY END MEDICARE'.... It seems like quite a while ago, but just last fall, Republicans blanketed the airwaves with campaign ads, attacking Democrats for "cutting Medicare." The criticisms were substantively ridiculous, but offensive took its toll and contributed to the GOP takeover of the House.

Six months later, those same House Republicans have an ambitious new plan to effectively destroy the entire Medicare system. Sorry, voters, you fell for a con.

Republicans will present this week a 2012 budget proposal that would cut more than $4 trillion from federal spending projected over the next decade and transform the Medicare health program for the elderly, a move that will dramatically reshape the budget debate in Washington.

The budget has been prepared by Rep. Paul Ryan, a Wisconsin Republican and the new chairman of the House Budget Committee, and it represents the most complete attempt so far by Republicans to make good on their promises during the 2010 midterm elections to cut government spending and deficits. [...]

The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills.

After "essentially ending Medicare," Republicans intend to replace it with a privatized system. It's exactly the idea Paul Ryan has promised to pursue for quite a while -- and precisely why GOP candidates were so reluctant to endorse the radical "roadmap" plan before the election.

As part of the sales pitch, the House GOP will assure today's seniors that they will continue to enjoy their popular system of socialized, single-payer health care. As Matt Yglesias put it, Republicans will then tell younger workers that they'll "get to pay the high taxes to finance old people's generous single-payer health care system, but then we won't get to benefit from it."

Paul Ryan told Fox News yesterday that his radical plan is necessary to find cost savings, but even that's wrong. Paul Krugman explained this morning, "Privatizing and voucherizing Medicare does nothing whatsoever to control costs.... I'm sure that the Republicans will claim savings -- but those savings will come entirely from limiting the vouchers to below the rate of rise in health care costs; in effect, they will come from denying medical care to those who can't afford to top up their premiums."

And in terms of implementation of such a plan, the Center on Budget and Policy Priorities' Paul Van de Water explained that, if adopted, this privatization scheme would mean "Medicare beneficiaries would no longer have access to a guaranteed set of health benefits but would instead receive a voucher to be used to purchase private health insurance. Similarly, the federal government would no longer pay a specified share of states' Medicaid costs but would pay each state only a fixed amount, or block grant. The amount of the Medicare voucher and the Medicaid block grant would grow less rapidly than costs and hence would become increasingly inadequate over time."

In other words, seniors would get a voucher, but its value wouldn't keep up with costs. This would save the government money, but screw over those in need of care.

Again, I realize Republicans and the far-right believe there's a strong public appetite for extremist moves like this one, but there isn't. The party knows this at a certain level -- it's why they won in 2010, railing against Medicare cuts -- but has decided to swing for the right-wing fence anyway.

The politics of this are likely to be fascinating, setting up a critical showdown. Democrats were up to the task in 2005, when conservative ideologues tried to privatize Social Security, and must be similarly prepared in 2011.

Steve Benen 10:05 AM Permalink | Trackbacks | Comments (39)

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What you don't get is that since this would affect only those who turn 65 in 2021 or later, those same elderly teabag-sympathizer voters who voted against "Democratic Medicare cuts" last November will like this proposal just fine. They've never shown any reluctance to pull the ladder up behind them.

Posted by: Steve LaBonne on April 4, 2011 at 10:13 AM | PERMALINK

I think the GOP will be astonished how fast the pendulum swings away from them.

That said...

Look for $100 million or more to be poured into this by private groups using the wisdom of Frank Luntz and others to convince America why this is a "good idea."

Americans bought Pet Rocks and still watch Reality TV. The Dems better be damn sure to get the truth out in force. They cannot rest on the assumption that Grandpa is just going to "know" that the GOP and their moneymen are lying.

Posted by: Greg on April 4, 2011 at 10:15 AM | PERMALINK

As they're over-reaching, it would be nice if the Democrats gave them a some more rope to hang themselves.

But I have little confidence in the Demcorats to do the right thing.

Outside of a handful or two in the House and Senate, the rest of them are Whoreporate DINO's.

Posted by: c u n d gulag on April 4, 2011 at 10:16 AM | PERMALINK

Little known fact: "Mein Kampf" translates into "republican projection".

Posted by: ComradeAnon on April 4, 2011 at 10:17 AM | PERMALINK

Greg, Grandpa doesn't care. He's confident (wrongly, but he's wrong about lots of things) that this won't end up affecting him.

This is what happens to a society that glorifies selfishness.

Posted by: Steve LaBonne on April 4, 2011 at 10:20 AM | PERMALINK

I wonder what the size of the voucher would be today if Regan implemented a system like this in 1980.

Posted by: Steven Rumbalski on April 4, 2011 at 10:20 AM | PERMALINK

Wouldn't the healthcare industry vigorously oppose this as it means a guaranty of lower future revenue?

Posted by: Steven Rumbalski on April 4, 2011 at 10:24 AM | PERMALINK

@Cdung: I don't know what you mean by the right thing but Democrats ain't touchin' what Ryan is selling with a ten foot pole.

Posted by: Alli on April 4, 2011 at 10:26 AM | PERMALINK

So who's really gonna kill grandma?

Posted by: Gandalf on April 4, 2011 at 10:27 AM | PERMALINK

Could someone please explain to me how anyone can pretend that private insurers would want to insure the most inevitably expensive demographic? The premiums would be enormous and drive up rates for the rest of us as the risk is spread out, because these are the people who a) tend to stick with one service provider over time, and b) are expected to get sick and die in the near-to-middle future. There's no actuarial model I've ever heard of that remotely supports insuring the elderly except broad taxation & guaranteed benefits, and even Medicare's impossibly low admin costs don't make it a break-even operation, much less a profitable one.

Obviously this is just one of the GOP's many attacks on the expectation of a decent standard of living, but I keep thinking that anyone who has ever helped an older relative navigate marketing and spam and supplemental odds & ends will hate this.

Posted by: latts on April 4, 2011 at 10:30 AM | PERMALINK

Anyone who has been paying any attention should NOT be surprised by Congressman Ryan's plans!

There is nothing newsworthy about Congressman Ryan's budget plans. He has been saying the same thing for an extended period of time and it all makes sense.

Medicaid - Slowly defund Medicaid and let the sick poor die. If they had any value to the wealthy, we would provide health care for them! They don't!

Medicare - Turn it into a voucher program and let the sick old poor die. Provide substantial tax credits for health care insurance for the old. If they do not pay taxes to take the credit against, they are obviously not worthy of continuing to live.

Social Security - Privatize, privatize, privatize. If the wealthy cannot make a profit from people's retirement savings and if old people have not saved enough, let them starve and die.

Taxes - Cut taxes on corporations and the wealthy. We now have more than 30 years of proof that supply side economics would work, if only taxes were sufficiently reduced for the wealthy job creators of our country. The only reason we do not have a healthy economy is that the wealthy continue to be overtaxed!

Posted by: RepublicanPointOfView on April 4, 2011 at 10:31 AM | PERMALINK

Well, by right thing, I guess I mean fighting tooth and nail. And, mock Ryans proposal openly.

Like I said, outside of a few of them, they're much too timid for my tastes.
I miss people like Paul Wellstone. He was a fighter. I appreciate Bernie in the Sentate, and Wiener in the House. And I miss Grayson.

Posted by: c u n d gulag on April 4, 2011 at 10:32 AM | PERMALINK

Expecting the Dumbocrats to do anything let alone the "right" thing requires a fervent belief in the tooth fairy, the Easter bunny and Santa Claus.

Posted by: rrk1 on April 4, 2011 at 10:41 AM | PERMALINK

Democrats were up to the task in 2005, when conservative ideologues tried to privatize Social Security, and must be similarly prepared in 2011.

Good luck with that. In 2005, they were led by Nancy Pelosi. Now they're led by Barack Obama.

I agree with cundgulag; the corporatists will sell out the middle class.

Posted by: bleh on April 4, 2011 at 10:42 AM | PERMALINK

Alan Grayson was right.

But the idea of giving Republicans 'more rope to hang themselves' is clearly what has been going on. They have hung themselves with quintessentially stupid legislation in the House and their Koch-aine fueled 'agenda' for America is really out of touch with public opinion. Krugman's send up of their ludicrous 'hearings' on climate change that listed marketing executives as expert witnesses and Rand Paul's hearings that used an anti-Lincoln (!) author as an expert witness on how we are becoming a 'fascialistic' society show how silly and totally incompetent they are overall.

So while many complain Obama hasn't used the 'bully pulpit' to excoriate them, I say he hasn't had to lift a finger to destroy them. They are doing a great job of it themselves.

Posted by: jjm on April 4, 2011 at 10:47 AM | PERMALINK

"As part of the sales pitch, the House GOP will assure today's seniors that they will continue to enjoy their popular system of socialized, single-payer health care."

'Cause it will work so much better and be so much cheaper when we insert a layer of profit for the Mega Health Care Conglomerates between you and your doctor.

Same way the contractors in Iraq were cheaper. As a matter of fact why don't we use them to administer the plan, their death panels will be ever so efficient.

Posted by: John R AKA Mr. Serf Man on April 4, 2011 at 10:49 AM | PERMALINK

Wonder if we will hear the words 'death panels' come from the corporate mouths of Brian Williams, Katie Couric, Diane Sawyer, Wolf Blizter, et-al now ? What do you think ?

Posted by: stormskies on April 4, 2011 at 10:59 AM | PERMALINK

GOP Death Panels. GOP Death Panels, Gop Death Panels...............

Posted by: Jim B on April 4, 2011 at 11:04 AM | PERMALINK

We have to realize that by copying the Repubilican plan put into effect by Mitt Romney in Massachussets, and ignoring a Medicare-for-all single payer system, Obama made this a risk.

What is a medicare voucher? A subsidy to purchase insurance. If this bill was actually negotiated, there would have to be "guaranteed issue" required - all companies would be required to insure all seniors at certain base levels. And to make sure they don't profit-gouge seniors, there would have to be limits like the required medical loss ratio. And every senior would have to sign up - a mandate.

If they really want to kill this - maybe they should try to call Ryan's plan Obamacare for Seniors. That will end the Republican attempt pretty quick.

Posted by: Chris on April 4, 2011 at 11:14 AM | PERMALINK

Republican policy: Best if the old and sick die early and decrease the surplus population.

My question is if the Scrooge McRepublicans take away Medicaid and Medicare, can this be reversed by the Democrats when they regain control of the house?

Posted by: wbn on April 4, 2011 at 11:19 AM | PERMALINK

Chris nailed it. How can the Republican'ts be opposed to Obamacare yet support Obamacare for Seniors? By essentially putting in a mandate on seniors and forcing them to buy insurance (exchange or not) aren't they guilty of socialized medicine (please see GOP dictionary, where up is defined as down)?

Posted by: Gridlock on April 4, 2011 at 11:29 AM | PERMALINK

So now the "NO SOCIALIZED MEDICINE! KEEP YOUR HANDS OFF OF MY MEDICARE!" signs that we saw at tea bagger rallies makes sense.

Posted by: SaintZak on April 4, 2011 at 11:46 AM | PERMALINK

Seems to me that caring about life to these folks only applies to that with an umbilical cord and only until its cut.

Posted by: Kill Bill on April 4, 2011 at 11:48 AM | PERMALINK

as someone who deals with a number of elderly relatives, I know what an absolute fraud this is.

Posted by: rikyrah on April 4, 2011 at 11:51 AM | PERMALINK

Assuming that Ryan and the Republicans are proposing vouchers out of aincere belief that turning elders' health care over to the private insurance market will somehow result in cost savings, it seems to me there are at least the following problems:

1. Private insurance companies insist on making a significant profit margin, whereas Medicare does not. Therefore, privatizing this market adds a very significant cost factor--the insurer's profit.

2. I think it's doubtful that private health insurers are better able to force cost reductions on health care providers than the Government-run Medicare is. Private insurers have some incentive to impose cost controls, but they also can maintain there profit margin in numerous other ways: increasing premiums, reducing coverage, saving on overhead, holding onto reimbursement payments longer, etc. And private insurers are likely to be less sensitive to patient welfare in making determinations as to what they are willing to pay for than a Government program will be.

3. Moving to a voucher system will require the Government to establish an extensive set of regulations governing private insurance programs eligible for receiving vouchers, in order to protect seniors and ensure that the coverage they receive in return for the vouchers is adequate. This will be just the sort of "government control" of health care that Republicans currently castigate the Health Care Reform Act for.

All of this seems to derive from an unthinking attitude that, come what may, the private sector is better than the public sector. Of course, health care is one area where real-world experience, both in this country and elsewhere, demonstrates that this is not true.

Posted by: DRF on April 4, 2011 at 11:51 AM | PERMALINK

I expect Obama to wait until he has been reelected after which he will "negotiate" a "fix" for medicare that resembles Obamacare. He will also wait until he is reelected to "fix" Social Security. If you say I'm a cynic, I'll tell you wait and see, and then I'll tell you I told you so.

Posted by: CDW on April 4, 2011 at 11:59 AM | PERMALINK

Whenever you hear the term, "voucher", think "rationing coupon". For example, vouchers for education = rationing of white-standard education. The idea for rationing medical care to seniors came directly from the Simpson-Bowles plan, and has further antecedents in the Republican push for death panels. But, you say, they were against death panels. No, they were against Democrats getting credit for them.

Posted by: RonG on April 4, 2011 at 12:00 PM | PERMALINK

The Republican philosophy and effect of proposed budget reductions summed up: A Crashed Rolls: There goes this year's  Bush Era tax cuts  ergo the über rich get to treat money like it's carbon dioxide, but the poor and middle classes keep getting squeezed. 

Many Republicans across the country want to reduce modern worker & health protections by cutting the funding supporting enforcement, eliminate Medicaid, privatize Medicaid, and take away modern banking consumer protections with the intent to go back to the glorious 19th century when large banks controlled the flow of money, monopolies cheated everyone, and wages were so low that a mortified Prince Albert took to designing affordable worker housing.

"Impossible!" you say. I ask you, WHY do they defend the irresponsible spending habits of the over rich, denounce unions, and try to defund modern safety net programs if they do not see that most complex century's philosophy and morality as a model?  Without naming it, by their budget cuts in education they endorse social darwinism. By inventing the myth of American "Exceptionalism" they revive manifest destiny which gives them permission to sneer at cultures they do not understand.

So, I take them at their word.

Now remember, America and the world was never more prosperous than during those times when taxes on the rich were high aka the mid 20th Century and college costs were low.   THE SOLUTION to our problems is to tax the über rich and use the money to build infrastructure paying good wages for good work to good people.

Posted by: KurtRex1453 on April 4, 2011 at 12:02 PM | PERMALINK

I have a 61 year-old Republican friend who has had cancer. She pays $30,000 a year for high risk insurance and can't wait to get to medicare. How would vouchers work for her? We'll pay $10,000 of the 30,000 and if you can't afford the difference and have a relapse --- die quickly?

Posted by: patrick II on April 4, 2011 at 12:34 PM | PERMALINK

Many Republicans seem to take the attitude of AZ Republican Governor Jan Brewer to medicaid and medicare cuts...  My cartoon showing Jan with a guillotine saying to a person about to get their head chopped off This will hurt you more than it hurts me  illustrates this.

Now we all know, I think that Ryan's proposal is DOA, but this still does not prevent them from wasting time discussing it. We need to push the public discussion back to the irresponsible spending habits of the over rich, support unions, and  defend modern safety net programs. 

How? By showing their budget cuts in education, Medicaid, and Medicare are tantamount to endorsing social darwinism. By illustrating their invention of the myth of American "Exceptionalism" they revive manifest destiny which gives them permission to sneer and attempt to destroy cultures they do not understand.

We must take them at their word and let people know we unlike the children having a wild time until the adults take overKid Riding a Giant A Tea Pot at Supermarket prefer a sane, sober government.

Now remember, America and the world was never more prosperous than during those times when people paid their fair share.  THE SOLUTION to our problems is to tax the über rich and use the money to build infrastructure paying good wages for good work to good people while protecting those who cannot protect themselves.

Posted by: KurtRex1453 on April 4, 2011 at 12:35 PM | PERMALINK

Cole, I know you know how to read. This is just sad.

(The reference was made to Medicaid cuts in the budget in the general context of a "sick of it all, consider this an open thread" post)

Posted by: 4jkb4ia on April 4, 2011 at 12:47 PM | PERMALINK

Gridlock wrote: "Chris nailed it. How can the Republican'ts be opposed to Obamacare yet support Obamacare for Seniors?"

Good point.

So, how can Democrats and liberals who claimed that the ACA (a.k.a. "Obamacare") was the equivalent of Social Security and Medicare all rolled into one complain if the Republicans want to replace Medicare with Obamacare for Seniors?

Didn't sensible liberal bloggers like Steve Benen spend months telling us that the ACA was just as good as Medicare For All, and that anyone who said different was a fool and a traitor and a member of the "professional left" who was making the perfect the enemy of the good?

Posted by: SecularAnimist on April 4, 2011 at 1:12 PM | PERMALINK

So in the few newsfeeds I have read, Ryan says that seniors already in the program would continue to get care under the system we have now.

Can someone PLEASE explain the fundamental economics of ths?

I am 53. So, I will pay taxes to cover existing medicare beneficiaries until I retire. Then I will either

1. Retire at a timepoint to avoid a "voucher" based system, therby sticking my medicare bill onto the poor saps younger than me [as I am sure millions of others will too, accelerating a retirement schedule for many, reducing the paying workforce], who then get a crappy voucher system, OR

2. I retire when I want to, AND get stuck with a "voucher-based" system that will undoubtly be suckier than medicare, AND I get to have paid for people in the current system.

Unless I am missing something, either I, or people younger than me, get screwed.

Isn't the so called republican plan a way of shifting cost containment burdens from the federal govt, who actually could have clout since they write big fat checks, to individuals, who, don't?

Is this the basic point of the plan? To reduce the ability / burden of reducing medical costs from the feds, to the individuals, who have, let's see, - 0 clout? Hmm - and so who would win .... - insurance companies? And who would lose ? Hmm... people who need to pay for health care out of these magical vouchers?

Jack - Jack - I have some magical beans that I want to sell you ....

Posted by: bigtuna on April 4, 2011 at 2:10 PM | PERMALINK

The full quote from Yglesias (EMPHASIS ADDED) illustrates the politcal dynamics at work here:

"The idea here is that today’s old people—a VERY WHITE GROUP that’s also hostile to gay rights, and thus sort of PREDISPOSED TO LIKE CONSERVATIVE POLITTICIANS —will also get to benefit from an extremely generous single-payer health care system.

But younger people—a LESS WHITE GROUP that’s friendly to gay rights and thus PREDISPOSED TO SKEPTCISM ABOUT CONSERVATIVE POLITICIANS—will get to pay the high taxes to finance old people’s generous single-payer health care system, but then we won’t get to benefit from it.

This is in part in order to clear headroom in the budget so as to make gigantic tax cuts for rich people affordable."

They know they have maybe ten years max to cash in on these abominable policies, so THEY ARE GOING ALL IN, RIGHT NOW.

Posted by: bdop4 on April 4, 2011 at 2:26 PM | PERMALINK

Threats to Medicare could bring out hordes of horrified voters here in Florida, but at the moment, the state's firmly in the hands of a radical-right legislature and a governor to match. Former governor Bob Graham laments the ruination of his state in today's St. Petersburg Times.

Apart from Medicare, I don't anything that can break the grip of the current far-right regime. No one cares about Medicaid until an elderly parent needs a place in a nursing home. No one seems to care about schools--the governor would seemingly like to do away with public schools, anyway.

Posted by: Dave Martin on April 4, 2011 at 3:30 PM | PERMALINK

Well bdop4, the answer to that is to make it very clear to today's old people that if they don't fight this plan with everything they've got, the next step which will happen within a few years at most is to extend the same voucher system to them.

This will happen because a) the Republicans are lying sleazebags who can't be trusted to keep any deal with anyone that isn't a multi-millionaire and a reliable donor to Republican causes, and b) neither the Democratic Party nor younger voters will have any incentive to protect seniors if seniors stab them in the back first by supporting this piece of shit legislation.

Posted by: tanstaafl on April 4, 2011 at 4:00 PM | PERMALINK

The patient is 590 pounds overweight. Drastic action is called for. Drs Reid, Hoyer, Schumer, Pelosi, etc immediately announce that the patient may no longer have sprinkles on his ice cream, but the Resse's Pieces can stay. (anything less is too extreme..?)

Posted by: Neo on April 4, 2011 at 5:18 PM | PERMALINK

Why is Paul Ryan considered credible? He has a mere Bachelors degree in economics and worked for Dick Armey's FreedomWorks where he obviously got brainwashed. Yes, there is a death panel. It's called G.O.P., Group of Prevaricators or Grand Old Pharisees. Their goals: starve the elderly by cutting Soc.Sec., let the elderly die ASAP by eliminating medical coverage, let the elderly freeze to death by eliminating aid for winter heating, starve and kill the needy. Seniors better lace up their tennis shoes and get active or they're goners.

Posted by: Pangurban on April 4, 2011 at 9:30 PM | PERMALINK

It's a bit like the Republican plans (some have already happened) to sell the parking meter concesions to private companies, or sell state built interstates to private companies. The state collects a per centage fee or a one time huge windfall or whatever, and the user rates quadruple. Why? Because making a profit isn't free.

Having a bunch of different systems of providing health care doesn't make any sense. If you're really poor you get free MedicAid. You get a minimum wage job and you suddenly get nothing. (Huge incentive to avoid working, by the way). You get one of the remaining good jobs and you get health insurance largely paid for by the employer. (i.e. federal job: the feds approve a bunch of deals, pay 75% of the premium, you pay a lot of copays and corporate employment plans are I guess similar).

You get old enough, and suddenly you get single payer subsidized plans. One government plan for basic care, plus another optional plan (?) plus maybe you buy a medigap unsubsidized private plan plus you pick a subsidized private drug plan. WTF?

How about one system for everyone, with reduced or no cost to the individual who is poor or old. Oh, wait I guess that's what every other industrialized country in the world does, enabling them to provide their citizens with care similar to here (some better in general and in some particulars, some worse in some ways) for half the cost.

Posted by: emjayay on April 4, 2011 at 9:31 PM | PERMALINK
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