Laying It All Out On Medicare

The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year's will be no different. Ryan's budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes.

I'm sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he'd keep the tax increases and Medicare cuts that the bill included in order to pay for it all, which helps him achieve his "balanced" budget.

Yes, it's true that when Ryan was running for vice president, he joined Mitt Romney in condemning those very Medicare savings. But nobody really believed he was doing anything at the time but being a team player. So we can give him credit for taking at least a step toward putting his money where his mouth is on Medicare. Sure, it may be couched in some misleading words (the document refers to "strengthening Medicare" no fewer than ten times), but there's no mistaking the policy.

Because the rest of his party is, to put it kindly, of two minds when it comes to the program. On one hand, they will tell you, Medicare is unsustainable, a ravenous beast that will devour the entire nation's financial well-being if we don't find a way to suppress its appetite. In Washington-speak, this is translated as "doing something about entitlements." We have to Do Something About Entitlements! If you don't want to Do Something About Entitlements, you're just not serious about our nation's fiscal challenges.

On the other hand, Republicans believe that Medicare is utterly sacrosanct, a jewel whose every facet is so perfect that even the most modest attempt to curtail its costs should be met with howls of anguish and outrage. Or at least that's what they believe at election time, when they'll air one ad after another condemning Democrats for cutting the Medicare seniors so desperately need. Democrats all over the country have been subjected to ads saying, "Congressman Fnurbler voted to cut $716 billion from Medicare!" over a picture of an elderly couple sitting at the kitchen table, looking over their bills with an engulfing despair, then meeting each other's eyes in a tragic look that says, "Thanks to Congressman Fnurbler, all is lost. If only we had been able to pay our gas bill so we could stick our heads in the oven and end it all right now."

Republicans are so deeply opposed to the idea of cutting Medicare that they can't even stomach anyone trying to see if Medicare is spending its money wisely. Mention the Independent Payment Advisory Board, a component of the ACA that was designed to restrain Medicare costs if they rose too fast, and steam will come out of their ears. (The IPAB would make recommendations to Congress on ways to save money, and Congress would have to act on them. But since Medicare spending has slowed dramatically in the last couple of years, the requirement has yet to kick in, and President Obama hasn't bothered to appoint anyone to what is still a theoretical board.) They waged a virtual war on comparative effectiveness research, effectively saying that it was dangerous to even ask which competing treatments work well and which don't.

In other words, most Republicans believe we must, must, must reduce the cost of Medicare—excuse me, Do Something About Entitlements—but are adamantly opposed to every step that has been taken to reduce the cost of Medicare. I'm sure that lots of them are sympathetic to Ryan's vision, which is to essentially turn the program into a voucher system, in which the government helps you buy private insurance, and over time costs magically go down (and if you're thinking that sounds a lot like what people are getting on the Obamacare exchanges, any Republican will tell you that it's totally different because freedom).

So let's give Paul Ryan some credit. Sure, his numbers might not add up. But when he puts out a budget, there's no mystery about where he's coming from and what he wants to do.

 

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