From Ezra Klein of The Washington Post:
I’ve got a modest proposal: You’re not allowed to demand a “serious conversation” over Medicare unless you can answer these three questions:
1) Mitt Romney says that “unlike the current president who has cut Medicare funding by $700 billion. We will preserve and protect Medicare.” What happens to those cuts in the Ryan budget?
2) What is the growth rate of Medicare under the Ryan budget?
3) What is the growth rate of Medicare under the Obama budget?
The answers to these questions are, in order, “it keeps them,” “GDP+0.5%,” and “GDP+0.5%.”
Let’s be very clear on what that means: Ryan’s budget — which Romney has endorsed — keeps Obama’s cuts to Medicare, and both Ryan and Obama envision the same long-term spending path for Medicare. The difference between the two campaigns is not in how much they cut Medicare, but in how they cut Medicare.
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These plans get at the basic disagreement between Democrats and Republicans on Medicare. Democrats believe the best way to reform Medicare is to leave the program intact but vastly strengthen its ability to pay for quality. Republicans believe the best way to reform Medicare is to fracture the system between private plans and traditional Medicare and let competition do its work.
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But it’s simply a conservative myth that the White House hasn’t put forward a Medicare reform plan. What that line really means is that White House hasn’t put forward some variant of Ryan’s plan, which in many Republican circles, has come to be seen as the only policy change that counts as “entitlement reform.”
But Obama’s plan is, without doubt, far more detailed than anything Romney has put forward, and Republicans are well aware of its existence." (emphasis mine)Ironically, Romney has attacked Obama for these cuts to Medicare growth. It should be noted that, of all the ways Medicare growth can be cut under Obama's plan, there is one area that is protected: benefits:
"It’s worth noting that there’s one area these cuts don’t touch: Medicare benefits. The Affordable Care Act rolls back payment rates for hospitals and insurers. It does not, however, change the basket of benefits that patients have access to." (emphasis mine)In the time since this article appeared, Romney has declared he will not keep Obama's cuts to future Medicare growth, despite the fact that these cuts would keep the Medicare trust fund solvent through 2024 (without them, they could lose solvency as soon as 2016). However, this will also make his budget promises practically impossible. Ezra Klein explains:
"Consider what Romney has promised. By 2016, he says federal spending will be below 20 percent of GDP, and at least 4 percent of that will be defense spending. At that point, he will cap federal spending at 20 percent of GDP, meaning it can never rise above that level.
All that’s hard enough. Romney will have to cut federal spending by between $6 and $7 trillion over the next decade to hit those targets. As my colleague Suzy Khimm has detailed, those budget promises already require cuts far in excess of what even Paul Ryan’s budget proposes.
But Ryan’s budget includes more than $700 billion in Medicare cuts over the next decade, Romney’s budget won’t. And Romney promises that there will be no other changes to Social Security or Medicare for those over 55, which means neither program can be cut for the next 10 years. But once you add up Medicare, Social Security and defense and you’ve got more than half of the federal budget. So Romney is going to make the largest spending cuts in history while protecting or increasing spending on more than half of the budget."
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"Consider what the Romney campaign, then, is saying: If Romney is elected, then by his third year in office, every single federal program that is not Medicare, Social Security, or defense, will be cut, on average, by 40 percent. That means Medicaid, infrastructure, education, food safety, road safety, the postal service, basic research, foreign aid, housing subsidies, food stamps, the Census, Pell grants, the Patent and Trademark Office, the FDA — all of it has to be cut by, on average, 40 percent. If Romney tried to protect any particular priority, it would mean all the others have to be cut by more than 40 percent.
That’s not even remotely plausible. The consequences would be catastrophic. The outcry would be deafening. And Romney has shown no stomach for selling such severe cuts.
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And yet Romney, who has never released the specific cuts that would make his numbers add up, repeatedly touts it on the campaign trail, and the media dutifully reports his promises to cut federal spending by more than $500 billion in 2016, and in fact to balance the budget by the end of his second term, which would require far larger cuts than what I’ve outlined here, despite the fact that everyone basically knows these cuts aren’t credible and will never happen.
I’m not sure what alternative there is, exactly, except to say, as clearly as possible, Romney’s budget plan is a fantasy, and it will never happen." (emphasis mine)But what about Ryan's plan. Isn't it supposed to be a bipartisan option? To answer this question, Ezra Klein interviewed Sen. Wyden (D-OR), then man for whom the "bipartisan" label is referring to:
"Ron Wyden: My view is that the policies that were adopted by the Republican House majority and the Romney campaign do not preserve the Medicare guarantee. And that’s what the [Ryan/Wyden] white paper was all about. It was a set of options for improving on the existing Medicare system with public and private choices, beefing up consumer protection, adopting a new way to control costs and put Medicare on a budget so you can protect the guarantee.
Probably the two most significant specific differences between what Governor Romney is talking about and the white paper is, first, that the Romney campaign and the governor would repeal the Affordable Care Act. To lay a foundation for putting together a program to protect the guarantee and protect the budget, you need the changes the Affordable Care Act makes to Medicare, like bundled payments and moving the system towards pay-for-quality. Without it, you can’t move to premium support.
The second difference is that the Romney approach completely pulls the rug out from under the poorest and most vulnerable seniors. In the white paper, protections for so-called dual eligibles, the people in both Medicare and Medicaid, are bulletproof. There’s no way to throw them under the bus. Gov. Romney says he’d block grant the Medicaid program and push those cuts onto the people, which would do enormous harm to those people whose protection was at the center of the white paper." (emphasis mine)Indeed there has been little attention to Ryan's proposals for cutting government healthcare spending outside of Medicare. And these cuts are no small thing. For instance, Sen Wyden mentions Ryan's Medicaid cuts, which total $800 Billion. Of course there will be impacts:
"The Urban Institute estimates that between 14 million and 27 million people would lose coverage because of Ryan's spending restrictions."No wonder this plan isn't really bipartisan. So you have the presidential candidate passing off a nearly impossible solution as serious budget talk, and you have his VP proposing draconian right wing measures and calling them bipartisan. Both are accusing Obama of having no plan for Medicare reform, yet Obama has the most serious and detailed plan of all three. And then they attack him for the plan they claim he does not have! What is going on?! Some conservative pundits actually possess the cognitive dissonance to buy into this. But will the American people?
The Roundup:
Mediscare Edition
Private-Market Tooth Fairy Can’t Cut Medicare Cost"The bottom line is that, if anything, Medicare Advantage bids are above, not below, traditional Medicare -- once you do the analysis correctly, on an apples-to-apples basis. So regardless of whether you use the CBO analysis of Ryan 1.0, or the evidence to date with Medicare Advantage to analyze Ryan 2.0, the conclusion is the same.
We don’t want to put all our chips down on the health-care competition tooth fairy."And yes, he notes that the CBO analysis is of Ryans 2011 plan:
"I focused on the 2011 plan because that is the only one that CBO has evaluated in terms of total, not just federal, cost.
The difference in the new version of the Ryan plan is that traditional Medicare would coexist with private plans. To suggest that this would change everything is to make an odd argument: Moving entirely to private competition would not generate big savings, but moving partially would."The Morning Plum: Romney and Ryan muddy the Medicare waters
Great read!
Greg Sargent goes over the various back and forth blows from the Obama and Romney campaign. Both campaigns think they will carry the medicare message. However, Democrats may need to explain whats really going on here between both campaigns' plans for Medicare:
"The difference is not over whether to do something about Medicare over the long haul; it’s over how to do it. The true nature of this difference is what Romney’s strategy is designed to obscure" (emphasis mine)Paul Ryan and the Problem With Competitive Bidding
"Private corporations all rely on competitive bidding, and it just hasn't done much to hold down costs. That's because the real source of America's high medical costs is the fact that we simply pay more than other countries for everything we get: more for doctors, more for procedures, more for hospital stays, more for drugs, and — yes — more for insurance. If you really want to hold down costs, you have to hold down costs at the source, and Paul Ryan's Medicare plan has no mechanisms for doing this. It relies solely on competitive bidding, and there's very little chance that this alone can keep Medicare costs from outpacing his "fallback" growth cap. It's a near certainty that his growth cap will be the real mechanism for reining in costs."PolitiFact: Do Mitt Romney and Paul Ryan want to turn Medicare into a voucher program?
After bitching about the 2011 lie of the year, democrats are finally getting it together and making accurate statements about Ryan's Medicare plan:
We agree that in the world of policy wonks, there are distinctions between "vouchers" and "premium support," having to do with the type of inflation adjustment used and the degree of marketplace regulation imposed. Compared with his original plan, Ryan’s most recent plan does move closer to fitting the definition of pure premium support. But substantively, it’s still somewhere in between the two approaches.
But the Romney-Ryan approach pretty much matches the dictionary definition of "a form or check indicating a credit against future purchases or expenditures." We think that describes the general way Ryan's plan would work. For a political discussion aimed at voters rather than policy wonks, we think Obama’s use of the term "voucher" is close enough to earn it a rating of Mostly True. (emphasis mine)David Frum: Paul Ryan Declares Generational War
Paul Ryan's criticism of Obamacare and the $700 billion in Medicare savings essentially amounts to a generational war:
"The talking point isn't even about changing Medicare, its about keeping the entitlements for the old, and not spending any of that money on the young. You could title this speech: Entitlements for Me, Not for Thee. Spending money on 'deserving' old people is good, spending on anyone else is a waste."PolitiFact: Ryan's plan includes $700 billion in Medicare "cuts," says Stephanie Cutter
"Cutter said that Romney attacked Obama for cutting $700 billion out of Medicare, but "Paul Ryan protected those cuts in his budget." Again, with this item we are not addressing whether they are cuts, but simply whether she is correctly characterizing Ryan's plan.
Cutter is correct that the Ryan budget plan included cost savings that were part of the future health care law. Just recently, the Romney campaign backed away from that play, saying Romney’s plan would restore the spending that the health law is set to curtail, such as extra funding for private insurers under the Medicare Advantage plan." (emphasis mine)As PolitiFact has noted before, these are not technically cuts. The reason they assigned a "true" rating is because it is of no consequence to cutter's speech. Cutter is essentially saying that what people are protesting in the Obama law, these "cuts," are preserved in the Ryan plan. So they should not criticize Obama for it without also criticizing Ryan.
Romney's Health Care Plan Freaks Out Utah Republicans
"When asked what they thought should be done to fix health care, Love and McCain offered up an unintentional endorsement of some of the very laws that they've been campaigning angrily against for the past two years, Obamacare and the federal stimulus package." (emphasis mine)Mitt Romney: Paul Ryan Medicare Plan And Mine Are The Same, 'If Not Identical'
A possible unintended consequence of the Ryan plan?
Update 8/21/12:
David Cutler: Hey Republicans! Stop Misusing My Medicare Study!
Supporters for the Ryan/Romney Medicare plan misrepresent a study on the effects of premium support healthcare systems.
David Brooks Badly Misrepresents the Romney/Ryan Medicare Plan
Update 8/26/12:
Ezra Klein: The problem with Romney’s Medicare chart: It’s not true
"You could take one of two views on this. You could say that Ryan’s and Obama’s plans put Medicare on a sustainable fiscal path, while Romney’s doesn’t, because that’s pretty much what the CBO will say, and they’re the folks who judge these things. Or you could say that none of the plans really make Medicare solvent — that they’re all just theory and prayer. What you can’t say is that Romney has released a plan that makes Medicare solvent." (emphasis mine)
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