Medicare and the Overton Window

This Pelosi post got me thinking about just what a Democratic response to a Ryan-style plan on Medicare should even be. After all, if you work from Ryan’s far right starting point and counter with “well, let’s just privatize x% of Medicare for this set of individuals” or some other “sensible middle” type compromise, then you’ve already lost. You’ve advanced the GOP’s idea of the program (which is a bad one) significantly and at the expense of the better solution: Medicare as it stands or Medicare plus substantial improvements.

It is a fact that the real driver of deficits in this country are healthcare expenses. Don’t take it from me, here’s the CBO’s report (PDF link):

Medicare and Medicaid are responsible for 80 percent of the growth in spending on the three largest entitlements over the next 25 years and for 90 percent of that growth by 2080.

But if we could achieve the per patient healthcare cost of most of the other developed nations in the world, we’d be facing yawning surpluses in this country, not deficits, and we’d very likely have better individual health outcomes to boot.

Therefore: the Democratic response to Ryan’s “privatize Medicare” should in fact be: Medicare For All. Period. We don’t want to reduce this program. Like 87% of all Americans, we think it should at the bare minimum stay just as it is. Preferably, we’d like to massively expand it. This has the dual benefit of covering medical expenses for everyone in the country and relieving the number one deficit driver in the economy: everyone’s medical expenses. Plus this means we eliminate the dread ACA and its totalitarian horrors. Everyone wins!

Now, of course, I don’t really think Medicare For All has any particular chance of becoming law; what using this sort of proposal does do is set the limits of the debate more appropriately and in ways that tend to favor outcomes preferable to the Democrats.
On the right: Eliminate Medicare and let the wealthy fend for themselves.
On the left: not only keep Medicare, but make it the healthcare provider for all, with tremendous humanitarian benefit but also knock-on budget benefits.
Then you’d be down to arguing about whose plan actually saves more money long term and how that impacts health outcomes in America. Which is precisely where the debate needs to be.

Never. Is never good enough for you?

Nancy Pelosi on when the Democratic plan to destroy Social Security would be introduced. This is the sort of Democrat we need a whole lot more of.
And, as Atrios notes, the Bush administration hadn’t yet even offered their plan and wouldn’t, really, until after the whole thing was effectively dead. They were, in fact, counting on that Defeatocratic impulse to get out there and co-own a truly terrible idea just because the Serious People wanted them to. For once, they didn’t do it. That’s true leadership.

It’s Courageous To Go Die in the Streets

David Brooks:

Today, Paul Ryan, the Republican chairman of the House Budget Committee, is scheduled to release the most comprehensive and most courageous budget reform proposal any of us have seen in our lifetimes….His proposal will set the standard of seriousness for anybody who wants to play in this discussion….This budget tackles just about every politically risky issue with brio and guts….Paul Ryan has grasped reality with both hands. He’s forcing everybody else to do the same.

Kevin Drum responds:

Courageous. Serious. Gutsy. I imagine that within a few days this will be the consensus view of the entire Beltway punditocracy. A plan dedicated almost entirely to slashing social spending in a country that’s already the stingiest spender in the developed world, while simultaneously cutting taxes on the rich in a country with the lowest tax rates in the developed world — well, what could be more serious than that?

I think I’m going to be sick.

He’s right, but it didn’t take a few days and it’s not just Our Punditocracy; here’s the generic Democrat legislator last night on Hardball (sorry, no transcript yet):

[it was] “courageous” [for Paul Ryan to put up a plan to abolish Medicare and other federal social programs]

This is deadly serious. It’s easy to say we drugged bloggers out here are simply another example of the smelly hippies flying off the handle on something. Rest assured: We are not. You are going to be fighting 100% of the GOP caucus, some non-zero percent of the Democratic caucus (exactly 100% of the Democrat caucus), the entire Beltway elite media, and the do-nothing defensive crouch of the President and his administration heading into 2012. Keep in mind where that “sensible compromise” is going to land when the Overton Window has been set far, far to the right. Every possible outcome other than status quo within the current frame of the debate is going to be a major GOP win, far beyond anything that’s happened in recent political history. And that’s with a Democratic Senate and a Democratic President faced with a politically daunting 87% public approval of either continuing or increasing Medicare coverage relative to today’s levels. This is why they fail.

It’s going to be just like the Social Security fight, only worse: once again, Very Serious People will pretend not to notice that the Republican plan is a giant game of bait-and-switch, dismantling a key piece of the social safety net in favor of a privatized system, claiming that this is necessary to save money, but never acknowledging that privatization in itself actually costs money. And we’ll have endless obfuscation, both-sides-have-a-point reporting that misses the key point, which is that the putative savings come entirely from benefit cuts somewhere in the distant future that would, in all likelihood, never actually materialize. (What do you think will happen when retirees in 2025 discover that their Medicare vouchers aren’t enough to buy insurance?)

Paul Krugman, on the coming Medicare privatization fight. Add to that an administration that has shown zero interest in coming out of a defensive crouch on such issues, even when 87% of Americans favor keeping Medicare as is or increasing funding.
And, just to get a sense of where the MSM and its serious people are going to come down on the issue, you might review how that overwhelming majority of Americans favoring the continuation and expansion of Medicare is played. tl;dr: second to last paragraph, after about 17,000 words on how Americans “flunk” the budget test. Newsflash, CNN: your own poll shows they know that Medicare is relatively costly; however, they see the value of not putting folks over 65 out there on a competitive market with a fixed amount of 2010 dollars with which to try and find care. But, by all means, journalistic integrity means playing up that folks overestimate our outlays in foreign aid as a cudgel against their views on (and apparently clear understanding of) Medicare funding. Might those sad rubes out there in the many diners of flyover country be conflating military spending with “foreign aid?” We shall never know.
It aint going to be pretty.

Welcome the Responsibility

E.J. Dionne posits that the coming “Ryancare” enforced destruction of Medicare will either be Obama’s defining moment or the final end of progressive government in America:

Americans are about to learn how much is at stake in our larger budget fight, how radical the new conservatives in Washington are, and the extent to which some politicians would transfer even more resources from the have-nots and have-a-littles to the have-a-lots.

And you wonder: Will President Obama welcome the responsibility of engaging the country in this big argument, or will he shrink from it? Will his political advisers remain robotically obsessed with poll results about the 2012 election, or will they embrace Obama’s historic obligation — and opportunity — to win the most important struggle over the role of government since the New Deal?

And that’s exactly what this is. If you “privatize” Medicare, you are in effect creating a real live death panel for those individuals who cannot afford to pay the difference between the arbitrarily low payments (pegged to the dollar circa 2010) that will be made in the name of “cost containment.” Scare quotes there because such a move is categorically not cost containment; it is payment containment, or total government outlay containment, if you will. Costs will still rise, whether that rise is at the rate of inflation or at some other rate doesn’t really matter: the payments are locked, now and forever, to roughly today’s value. It is therefore only that fraction of individuals that are capable of paying the difference between real cost and subsidized value that will be “contained.” This number of individuals will, of course, be diminished day by day, year after year after year, as the subsidy represents lower and lower actual healthcare buying power. This is how Ryancare “works.” Hope you’ve been rather aggressive and uniformly successful with your by then privatized “Social Security” 401(k). Because you’re going to need it. Cat food doesn’t buy itself, after all. Otherwise, kindly go die in the streets.

In a decade or two, yes, even the very wealthy will begin to feel that pinch and there might be some movement to address the issue. But, by then, assuming all goes to Ryan’s master plan, tax revenue will have ratcheted to such historic lows (the other part of this “plan” is to limit next year’s spending to a fractional percent of the previous year’s, regardless of inflation and actual vs. projected economic output or overall economic conditions) that the federal government will have drowned itself in a teacup and will be laughably incapable and plainly impotent relative to doing anything about it. Problem solved! Think of how free we’ll all feel on that wonderful day!

And but so: do I think Obama will rise to this particular challenge? No I do not. Nothing coming out of the administration leads me to believe he or his advisers have any interest whatever in fighting for the future of Medicare, much less Social Security (which, having its own funding source, is utterly secure for decades to come: so Serious People all know that we must act now to destroy it because otherwise it won’t be there! This makes sense to our Beltway Punditocracy.). The administration and, by and large, The Body Democrat will remain in their defensive crouch, trying not to “screw up” 2012 with a lot of progressive mumbo-jumbo, because, as any Serious Person can tell you, those dozens of Tea Partiers that showed up in DC the other day are the ones that run the country, now and forever, without any regard to election results, polling data, or the stated wishes of the American People at large. Those 100k that showed up in the tundra of Wisconsin? Just out of town Union thugs. No reason to pay attention to them at all. They’ll only win in 2012 if ACORN steals the election for them.

Welcome the Responsibility