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Tilting at Windmills

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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 i>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.

Steve Benen 10:50 AM Permalink | Trackbacks | Comments (39)

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Comments

There's probably a whole lot of Congresspeople that would be directly affected by this, also, no? Or do they not have to worry becuase they're so well covered by the government option?

Posted by: bignose on April 5, 2011 at 10:54 AM | PERMALINK

GOP 2011: Welcome too Our Death Panels!

Posted by: mr. irony on April 5, 2011 at 10:54 AM | PERMALINK

Ronald Reagan is laughing his ass off right now.

Posted by: Lifelong Dem on April 5, 2011 at 10:55 AM | PERMALINK

Steve is right on this one, except for one thing: Before Medicare and Medicaid there was no "system." The elderly, disabled, and poor either lived at home with relatives or they lived in the streets and died before their time. Period.

Posted by: John B. on April 5, 2011 at 11:00 AM | PERMALINK

We should also note that the GOP plan would also repeal the ACA, thus ending the prohibitions against recission and existing health conditions.

Posted by: wordtypist on April 5, 2011 at 11:01 AM | PERMALINK

My guess is that the Medicare voucher proposal will prove very unpopular with voters very quickly, and will have to be shelved. If nothing else, private insurers have no interest in covering the oldest, sickest patients, subsidies or no. Combine big business opposition with angry seniors... and you've got a dead proposal. Which brings us back to gutting Medicaid... much easier, and no one really to stand up loudly enough to stop it.

Posted by: weboy on April 5, 2011 at 11:05 AM | PERMALINK

What Benen is ignoring is that Democrats don't have an alternative plan.

Unlike Social Security, Medicare does pose a significant budgetary problem going forward. It is a real problem. One solution -- the Ryan solution -- is to abolish the program.

Democrats don't have to like that solution. But they do have to propose an alternative.

Broadly speaking, if Democrats want to maintain Medicare in its present form, there are only two ways to address the budgetary shortfall: Raise taxes or lower the costs of health care to Medicare (or some combination of the two). There are no other answers.

We learned during the HCR legislative process that neither the White House nor a majority of Congressional Democrats has a stomach for taking on the largest health care stakeholders. That rule out cost savings.

And it is obvious that Democrats don't want to raise taxes. Thus, the Democratic plan is tantamount to "do nothing."

That isn't necessarily the worst plan. But it does mean that, going forward, we will have to significantly cut discretionary spending, including defense, to make up for the budgetary shortfall caused by rising Medicare costs.

Posted by: square1 on April 5, 2011 at 11:05 AM | PERMALINK

It would seem that the Republican destruction of Medicare would also needlessly insure lots of healthy older people. With Medicare, when you are ill, it is available. When you are not ill, you don't cost the system anything. The Republicans seem to want to give every older person a voucher. The healthy will simply pay the insurance company, which will thank them very much. The ill will have inadequate insurance that will deny coverage (ACA being repealed and all). So, the ill will not cost more than, let's say $15,000 a year and the well will put lots of money in their $15,000 insurance company coffers for bigger executive bonuses.

Posted by: Mudge on April 5, 2011 at 11:10 AM | PERMALINK

I hope when Paul Ryan sees his final days, nobody is there to take care of him. I could not wish a more cruel fate upon him, except maybe burned to death, which is an excellent alternative where Paul Ryan is concerned.

Too soon?

Posted by: Trollop on April 5, 2011 at 11:10 AM | PERMALINK

"And now Republicans want to roll back the clock."

They should call their plan, "Back to the Future!"
In it, they can explain why 2012 should look like 1912 - you know, before those pesky women and black people got to vote, and before unions made the playing field bit more lever.

When men were men, women were women - and had no say, and if you got sick, well, you died.
NOW THAT's NATURE, not some form of socialist nurture.

Posted by: c u n d gulag on April 5, 2011 at 11:12 AM | PERMALINK

Seniors relied on this [non-]system for many years, but it didn't work.

Not only that, but it failed to work for seniors in an era where even the most expensive medical care was much, much cheaper than it is now. If seniors couldn't get insurance then, it's not going to be any better now.

Posted by: low-tech cyclist on April 5, 2011 at 11:14 AM | PERMALINK

I've been trying to follow the news of Ryan's plan and sort out what it really means to different people. My question is, under this proposal would those under 55 still pay into the Medicare system to keep benefits for those over 55, but phase out those benefits by the time the under-55s reach Medicare eligibility?

In other words, paying for something but getting nothing in return?

If that's the case, I don't see why anyone under age 55 would support this proposal or any rep who would vote for it.

Posted by: philonius on April 5, 2011 at 11:21 AM | PERMALINK

Ryan wants to save Medicare the same way the Army Captain told Morley Safer the army saved the Vietnam City of Hue - "We had to destroy it to save it!"

These Republican leaders are serving up too many ghost of our wretched past! -Kevo

Posted by: kevo on April 5, 2011 at 11:22 AM | PERMALINK

Steve Benen quoted Josh Marshall: "Medicare is this single payer program that guarantees seniors health care, as noted above."

Well, Obama and Nancy Pelosi declared that single-payer was "off the table" before the debate over health care "reform" even started.

And "sensible liberal" bloggers castigated anyone who advocated single-payer "Medicare For All" as fools, traitors and self-indulgent ideologues who were making the perfect the enemy of the good.

So now, the Republicans are taking them at their word, and proposing that single-payer Medicare be taken off the table and replaced with the same ACA-style, mandatory for-profit insurance system that had folks like Steve Benen hollering "Pass The Damn Bill".

So, what's the problem with "ACA For All"?

Posted by: SecularAnimist on April 5, 2011 at 11:23 AM | PERMALINK

Until the poor ( i.e. everyone not in the highest income bracket) start making campaign contributions, they DO NOT MATTER.

Posted by: DAY on April 5, 2011 at 11:25 AM | PERMALINK

I had expected them to sack Medicaid since that's a "welfare" program for people the Rebobocans don't like. But Medicare?! That's audacious, in the vein of their extremist framers saying to throw the most horrible stuff up there and see what sticks, while pushing the Overton Window along (note that title by "Beck"!) Cowards, not courageous as the odious enabler Brooks pretends. I left a message on his FB Fan Page, check it out and pile on:
David Brooks on Facebook.

Posted by: neil b on April 5, 2011 at 11:34 AM | PERMALINK

Most people want Medicare for everyone.
Given the political situation the only way the Republicans can prevent that eventual outcome is to get rid of it quick.

Posted by: thebewilderness on April 5, 2011 at 11:41 AM | PERMALINK

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.

It is ironic, isn't it? Why Benen thinks Democrats will go to bat to defend Medicare, when they expressly rejected it as a model in crafting HCR is beyond me.

As I have said before, there are two intellectually coherent arguments about Medicare. One is that it doesn't work and should be scrapped. This is Ryan's argument.

The other is that Medicare does work, is efficient, and should be expanded to allow anyone to enter the program. This is the liberal position.

The argument that doesn't make sense, but that Benen thinks Democrats will now make, is that Medicare is an efficient program, but only for Seniors. The rest of us will do just fine with a subsidized private-insurance scheme.

Posted by: square1 on April 5, 2011 at 11:47 AM | PERMALINK

Kevo: I thought immediately of the same idea, but I think you have upgraded it. It was a provincial capital, Ben Tre. Although not attributed by the journalist, an officer present ascribed it to Major Booris: "But at one point he got flustered, and blurted out, “We had to destroy Ben Tre in order to save it.”
But you are so correct as to Ryan's reasoning.

Posted by: Johnny Canuck on April 5, 2011 at 11:47 AM | PERMALINK

Surely you don't expect BHO to stand up for Medicare? He didn't in 2010 and he won't now. I suspect he actually believes a system of vouchers and a mandatory purchase requirement is all that's needed, and what's good for a 45 year old should be just fine for a 65 year old.

We've been abandoned by the Dems. Our little progressive-sphere isn't likely to be enough to overcome a joint GOP-Obama initiative. If we couldn't stop tax cuts for millionaires, I don't see what hope there is here...

Posted by: Jim Pharo on April 5, 2011 at 11:49 AM | PERMALINK

Square1:the Democratic plan is tantamount to "do nothing."

Aren't you engaging in a little rhetorical excess?
I thought the point of the ACA was not only to expand towards universal coverage, but also to initiate a whole series of programs, many of which were designed to try to bring the health care cost curve (whether private insurance, Medicare's single payer, or VA's socialized medicine) under control.

Posted by: Johnny Canuck on April 5, 2011 at 11:51 AM | PERMALINK

Ryan is a monster. Yet the NYT gives his plan front page space acting as if it is some kind of 'solution.'

The weirdness of these Ayn Randian perverts is that they have to imagine that they themselves will never have any struggle with disease or even death.

Those Health Savings Accounts are pure scam, by the way. We tried it once and had endless wrangles with the administrators, endless requests for document after document, and then, outright fraud perpretated on our account by them.

Posted by: jjm on April 5, 2011 at 11:57 AM | PERMALINK

I was talking to a black friend who played the, "Obama is a puppet and there's no difference between the parties" card nonsense. I tried to explain to him that's EXACTLY what Republicans want you to think so you don't vote and then wonder where your social security and medicare went.

Conservatives win in part because only liberals think there's no difference between the parties or that their party isn't worth fighting for. Say what you want about the Tea Party but they FOUGHT for their party and are now literally in control of the political agenda of our nation, while liberals put up the white flag and whine that Obama didn't turn out to be Shaft.

Liberals need to wake the f' up.

Posted by: Archon on April 5, 2011 at 11:57 AM | PERMALINK

SecularAnimist nails it. My prediction is that the WH will calculate that "ACA for all" is a rallying cry that they can defend. Obama will calculate that if he plays eleventy-dimensional chess with Ryan and gets Republicans to signoff on a ACA-like program for seniors that Republicans will be unable to credibly attack the rest of "Obamacare".

The fact that it is shitty policy that will increase America's health care cost per-capita will be noted by purists, but rejected by political realists who sneer at those of us who would refuse to accept "less than 100%" of what we want.

In 12 months, Benen will be praising "ACA for all" and calling Obama brilliant for throwing a "death hug" around Ryan.

When Obama loses in 2012 and receives 10% of the Senior vote, Benen will still be scratching his head, unable to figure out why the stupid "confused" voters blamed Obama for taking away their Medicare when "it was a Republican idea in the first place."

Posted by: square1 on April 5, 2011 at 12:20 PM | PERMALINK

Thank you for the correction JC! -Kevo

Posted by: kevo on April 5, 2011 at 12:23 PM | PERMALINK

Article: "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."

Exactly. Medical costs rise about 8% a year, regardless. A voucher tagged to the cost of living would rise, or in some years not rise at all if the cost of living does not rise. Social Security recipients who paid into that system have not had a cost of living increase in three years. This year it may be 1%. Rising health care costs are the reason real wages have flatlined for over a decade, and the number one reason for personal bankruptcy. Unless you are in the top 1% why would you even consider supporting GOP proposals for Medicare.

Posted by: max on April 5, 2011 at 12:24 PM | PERMALINK

@Johnny Canuck:
Aren't you engaging in a little rhetorical excess?

No. I mean it literally. I am talking about health care for seniors now, not the general population.

Democrats have no plan to reduce the costs that Medicare pays on behalf of senior. And they have no plan to raise taxes to cover rising health care costs. If you aren't proposing one or both of those then you have no plan.

Actually, I partially take it back. Democrats MAY be planning to reduce Medicare costs by reducing benefits. However, to give them some benefit of the doubt, I will not accuse them of that until it is clearly on the table. Hence, I conclude that they have no plan.

Posted by: square1 on April 5, 2011 at 12:27 PM | PERMALINK

Are we winning the future yet?

Posted by: beep52 on April 5, 2011 at 12:35 PM | PERMALINK

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.

It's getting rid of the fed employees who administer the program plain and simple.

Posted by: flyonthewall on April 5, 2011 at 12:38 PM | PERMALINK

THIS IS ALL very fine if you are a member of the upper class who can afford health coats out of pocket, but for the rest of us who deal with health insurance companies we now they do not have the public interest in mind, only the short term profit of their shareholders.

Anyone can say differently, but those are the facts, They are for profit corporations and all of em pretty much have the same goals ... Excessive Profit, profit, profit for the über rich which is usually against the public interest.

Any many companies cut corners to satify their shareholders which prove disastrous to the public interest. Union Carbide in India, BP in the Gulf of Mexico, EXXON In Akaska. We had pass laws to reign in corporations at the beginning of the 20th century.

NOW, Republicans want to return to those rapacious days.

I say not only NO, but HE'LL NO!

Posted by: KurtRex1453 on April 5, 2011 at 12:47 PM | PERMALINK

philonius - -

I am 53, and as far as I can tell, anyone under 55 gets screwed twice.

1. We will have to pay for people older that 55 to have medicare until they die. That means that we will have to continue using the old system, and thus, paying for it. In any of Ryan's rantings does he propose how to a) reduce Medicare costs, AND b) increase revenue? So that will be a 30 + yr liability.

AND

2. If we are to proceed with point 1, we under 55 will "get vouchers", which, unless 1 a and b are dealt with, MUST require lower cost health care for us, meaning, work longer, or die, or hope to get coverage or .... F*** it.

I simply cannot see how the math works. We will continue with a system of rising costs, and institute a new system. IF the idea is to reign in out year costs, the new system MUST provide fewer benefits.

Posted by: bigtuna on April 5, 2011 at 1:35 PM | PERMALINK

End of Prescription Drug coverage already in process. So far my "coverage" has been eroded from 8 prescriptions to just 2 that are in the insurance company's "formulary" and will be paid with co-pay. Hasn't anyone else had this problem? A few people I know have also had their medication coverage stopped because of their "formulary" rule. Who decides what they list in their formulary? Are they trained in medicine at all. My chronic conditions require all 8 name brand meds; I can't afford the name brands but am allowed to buy generics myself, however almost all generics cause severe side effects. The ins. co. said my doctor could file a pre-authorization order and they would cover the presciption; but they still won't okay it;, they just stall for months. So, this is most likely the same way the Medicare program will end, in whimpers and premature deaths.

Posted by: wynterlynx on April 5, 2011 at 2:45 PM | PERMALINK

Rep. Ryan's choice of language was poor" He doesn't want to save Medicare, he wants to preserve it. In the same way that Grandma preserved those apricots, or, perhaps more precisely, the same way that Soylent Green will preserve humanity...

Posted by: Cap'n Phealy on April 5, 2011 at 3:28 PM | PERMALINK

And look at how the so-called liberal media is slobbering all over Ryan's plan as "serious" and "visionary".

Look, the US spends more per capita on health care than any other western democracy, with the fewest people covered. The one and only way to maintain coverage at some reasonable level and control costs is single payer, or as Ryan has properly identified it, Medicare (Medicare for all = single payer). Therefore Medicare must die, now, before the proles wake up and realize how completely we've been screwed. Tossing in a little age-related warfare between the over 55's and the under's will go a nice way towards distracting from the class warfare they've been hitting us with for years.

Posted by: StringonaStick on April 5, 2011 at 4:15 PM | PERMALINK

The real solution is jobs, jobs, jobs! American jobs, that is. Jobs pay people a living wage (unless the Republicans are successful in eliminating the minimum wage) and FICA deductions are paid in support of Social Security and Medicare (unfortunately, only 57% of Medicare is covered by FICA and premiums).

Lack of jobs diminishes the pool of money available for Social Security. Congressmen need to be reminded of this as in the effort to save money and reduce the deficit their focus has been on cutting the budget instead of creating adequately paying jobs that would go a long way toward solving the problem.

They also could raise the cap on salaries for FICA purposes.

Posted by: cincerely on April 5, 2011 at 4:15 PM | PERMALINK

The real solution is jobs, jobs, jobs! American jobs, that is. Jobs pay people a living wage (unless the Republicans are successful in eliminating the minimum wage) and FICA deductions are paid in support of Social Security and Medicare (unfortunately, only 57% of Medicare is covered by FICA and premiums).

Lack of jobs diminishes the pool of money available for Social Security. Congressmen need to be reminded of this as in the effort to save money and reduce the deficit their focus has been on cutting the budget instead of creating adequately paying jobs that would go a long way toward solving the problem.

They also could raise the cap on salaries for FICA purposes.

Posted by: newsylade on April 5, 2011 at 4:17 PM | PERMALINK

The real solution is jobs, jobs, jobs! American jobs, that is. Jobs pay people a living wage (unless the Republicans are successful in eliminating the minimum wage) and FICA deductions are paid in support of Social Security and Medicare (unfortunately, only 57% of Medicare is covered by FICA and premiums).

Lack of jobs diminishes the pool of money available for Social Security. Congressmen need to be reminded of this as in the effort to save money and reduce the deficit their focus has been on cutting the budget instead of creating adequately paying jobs that would go a long way toward solving the problem.

They also could raise the cap on salaries for FICA purposes.

Posted by: newsylade on April 5, 2011 at 4:22 PM | PERMALINK
They also could raise the cap on salaries for FICA purposes.
Drop the cap on salaries for the so-called payroll taxes, and treat all income as ordinary income (and thus taxed as such) regardless of source.

Then Medicare Part E(veryone).

Posted by: IOKIYAR on April 5, 2011 at 4:55 PM | PERMALINK

So, all those Tea-Party "Hands off my Medicare" activists will protest in their (hundreds of )1000's against the Tea-Party in action??

Posted by: AINET on April 5, 2011 at 6:53 PM | PERMALINK
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