Tag: medicare

Rock Bottom

In other settings the media normalization of the coming shit storm might be charming or even amusing.

First, we have the “that will never get 60 votes in the Senate” crowd. People, there will be no filibuster when the new Congress convenes in 2017; the only possible hope for a retained filibuster is that Mitch McConnell cynically enjoys power more than actually governing and wants a safety hatch of “someone to blame” (namely: Democrat minority in the Senate) for the outcomes of GOP policy decisions.

Similarly, we have the “what might they do” thought pieces. People, we know what they’ll do. They have an incurious leader that has repeatedly expressed his complete lack of interest in the policy details of even his own policy proposals. Assuming Ryan remains Speaker, we know what he’ll do. He’s been talking about it for years in explicit, legislative terms.
One notable example, “Medicare,” as a name for a program will still exist, but it will be converted to a fixed payment with which program recipients can attempt to go buy insurance on the open market. From Day One of the program, said payment will be insufficient to actually, you know, buy coverage on the market, but you can rest easy in the knowledge that the payment will never increase. But: Medicare is still there, folks! Nothing to see here, and I fully expect it to be reported in exactly those terms, because it’s been reported in exactly those terms every time he’s talked about it. Again, this is not a secret. It’s right there in the Plan for America.

Ryan’s broader proposed budgets actually contains no non-military discretionary spending at all, so the fact that Medicare will at least remain in name only is going to be characterized as a big liberal victory, I guess.

As far as Obamacare (or, really, the ACA): also toast. All the media assurances about “but the GOP will have to do the hard work of coming up with a replacement before repealing coverage” for the ~20M folks that were uninsured pre-ACA: Again, super-funny in other circumstances, media elite. The GOP has had the better part of a decade to suggest a replacement for the ACA and has offered nothing. If anything, they will drop in a high risk pool plan with capped lifetime benefit limits. The more likely outcome is the ACA is replaced with nothing. Is it any wonder that drug company stocks spiked on news of the election?

What a Democratic party should do: there’s no stopping most of it (see: filibuster, lack of), but the better long range strategy is to induce the healthcare death spiral. The community rating and associated benefits of the ACA are extremely popular. With heavy heart the Democrats should offer to gut the unpopular parts of the ACA, namely the mandate and the “Obamacare” portion, which actually subsidizes coverage for people unable to afford it on their own. We need to face the fact that the poors are in for quite the kicking over the next four years, no matter what, and but also work to keep the massively popular parts of ACA in force. The GOP, ever attracted to bad policy like cats to catnip, will be unable to resist, because: hey, popular! And so the Democrats shall have ushered in single payer health care, courtesy of the poison pill; briefly, the community rating forces coverage but eliminating the mandate allows people to buy healthcare only when they really need it, thus slowly burning the medical insurance establishment to the ground. Once there is no functional insurance infrastructure, the only remaining option is single payer. Good thing we still have that Medicare name sitting around and largely going unused.

Mostly, The Democrat needs to be planning based on gaining some seats in 2018, but then creating a wave election in 2020. You’re not going to be in control of any lever of govenment until at least 2018. Plan accordingly. Make small changes around the edges that, longer term, create a death-spiral situations to which your policy provides a positive (and ultimately the only) answer. They’re going to destroy most of the ACA no matter what, you can at least work to keep the popular parts that also happen to inexorably drag our healthcare system towards single payer.

There is zero doubt that this sort of approach creates real pain and suffering in the short term. But we’re going to get that pain and suffering no matter what. May as well make it worth something.

It’s really amazing to see political reporters dutifully passing along Republican complaints that President Obama’s opening offer in the fiscal cliff talks is just a recycled version of his old plan, when those same reporters spent the last year dutifully passing along Republican complaints that Obama had no plan. It’s even more amazing to see them pass along Republican outrage that Obama isn’t cutting Medicare enough, in the same matter-of-fact tone they used during the campaign to pass along Republican outrage that Obama was cutting Medicare.

This isn’t just cognitive dissonance. It’s irresponsible reporting. Mainstream media outlets don’t want to look partisan, so they ignore the BS hidden in plain sight, the hypocrisy and dishonesty that defines the modern Republican Party. I’m old enough to remember when Republicans insisted that anyone who said they wanted to cut Medicare was a demagogue, because I’m more than three weeks old.
[…]
I realize that the GOP’s up-is-downism puts news reporters in an awkward position. It would seem tendentious to point out Republican hypocrisy on deficits and Medicare and stimulus every time it comes up, because these days it comes up almost every time a Republican leader opens his mouth. But [journalists are] not supposed to be stenographers. As long as the media let an entire political party invent a new reality every day, it will keep on doing it. Every day.

Michael Grunwald writing for Swampland because such things just aren’t said in the polite company of mainstream journalism or even journalistic criticism like that on offer at Reliable Sources. Still: Huzzah. That anyone says it, even a lowly blogger out here on drugs, is a small victory. And, just as he concludes, it will take people screaming about this, every day, for decades, because that’s exactly how the GOP has done it since the late 70s. And it’s worked out pretty well for them.
Source: TIME

The lesson here is simple. At a deep ideological level, Republicans believe that federal bureaucracies are inherently inept, so when Republicans occupy the White House they have no interest in making the federal bureaucracy work. And it doesn’t.

Kevin Drum, making a point that I’d take even further: The GOP not only has no interest in “making it work,” they have a vested interest in the federal bureaucracy looking as ineffective as possible. That’s the only way to feed the larger narrative that government is bad in every instance, in every venture, and must never be tried as a potential solution for anything. Thus Mitt’s “just let industry clean it up” blather; he knows there will be no challenge, there will be no “so what’s the business model there, exactly and in detail?” question from an ever-pliant media. He can say it with impunity because the GOP has been peddling versions of this line for 20 years now and people have essentially stopped thinking about or even really hearing it.
This is also why the Post Office is being run into the ground with malice aforethought; no program major, minor, or indispensable can be seen to work. At best, government programs can only be tolerated. This is why there’s no interest in actually managing defense procurement (which would seem to be a GOP darling on its face). The GOP does want the weapons the better to kill people with; but any overruns are just excellent evidence as to the inability of government to do anything. So why bother actually reigning anything in? Forget those damnable statistics showing the decline in bureaucrats in military procurement exactly tracks the explosion in cost overruns and delays. That’s just numbers. They lie. Follow your gut and most of all your basest fears: government can do nothing and must be eliminated wherever possible. Therefore, more in sadness than in anger, the time has come to eliminate Medicare and Social Security.

Government can do nothing. Go die in the streets. This is who they are.

Every year we get a slightly different version of the same old [Paul Ryan budget proposal], and every year we have to waste entire man-years of analysis in order to make the same exact points about it. And the biggest point is that his budget would force enormous, swinging cuts in virtually every domestic program, especially those for the poor. If this bothers Ryan, he’s had plenty of time to revise his budget roadmap to address it.

But he hasn’t. He knows perfectly well that his budget concentrates its cuts on the poorest Americans. It’s been pointed out hundreds of times, after all. If he found that troublesome he’d change it. Since he hasn’t, the only reasonable conclusion is that this is exactly what he intends. Let’s stop pretending otherwise.

Kevin Drum and I are in agreement. Stop making excuses for Ryan. Stop calling him “serious” or “wonky.” He’s neither. He simply puts an unachievable yet comfortingly numerical face on the GOP broader policy goal. Namely, reduce taxes on rich to as close to zero as can be achieved in a single go-round. Then make a show of balancing this huge deficit driver by a) failing to name any substantive tax reforms and but also specify that you’re going to be relying on extensive, substantive tax reform –and– b) cutting all programs for the poor to the bone or entirely. Can’t have a safety “hammock” after all.
When this still fails to balance the budget, you are free to go after Medicare, which was the plan all along. While there, may as well functionally end Social Security; even though it’s not a deficit driver, you’ve got huge constituencies and the MSM convinced that it is so why the Hell not? Then you call it a day and can efficiently sand the gears against putting any of it back in place even if you find your party in the legislative minority for decades. Huzzah for democracy.
Source: Mother Jones

On top of the terrible politics, they even admit that [Ryan/Wyden] dismantles Medicare but achieves no budgetary savings while doing so – the worst of all worlds. Thanks for nothing.

A “Very Senior” Democratic Aide weighs in on the Ryan/Wyden “plan” to save Medicare by dismantling and replacing it with a system already shown to be at least 25% more costly. The problem here is that Serious People know that Medicare must be destroyed. The only thing they are more certain of is Social Security’s imminent end. Therefore, anyone favoring Medicare as it stands (or, gods save us, the atheistic but sharia-mandated nightmare that would be Medicare for All) is going to be fighting the GOP, some non-trivial number of Democrats, and the always totally objective, non-partisan MSM “referees” running this rotten discourse of ours.
So get ready. They’re coming for this. This is who they are. All the deficit whinging is merely prologue for a pitched fight to end every part of the already dwindling social safety net.
I’d also advise anyone who thinks voting doesn’t matter to go ahead and take the long position on stock in whatever company is going to clear the dead from the streets. Halliburton, presumably. Once your vote didn’t really matter because there’s no difference anyway, there’s going to be a lot of business in that particular sector.
Source: tpmdc.talkingpointsmemo.com

The Rub

In all the rush to cast a pox on both houses, most Serious People seem to be missing the underlying point here.

The Republicans want tax rates to remain at current (i.e. Bush/Obama tax cut) levels or to be lowered. To do that without collapsing the Federal Government, they have to end Medicare. Period, the end, no other way to do it. Zero the non-military discretionary budget and you still aren’t getting particularly close. Thus, this:

…committee Republicans offered to negotiate a plan on the other two health-care entitlements–Medicare and Medicaid–based upon the reforms included in the budget the House passed earlier this year [this is what is commonly referred to as the “Ryan plan”; it ends Medicare but leaves in place a voucher system which seniors would use to try to buy coverage on the open market. Good luck with that, seniors. Anyone paying attention will recall that this is the issue Medicare was created to solve. At any rate, under Ryan’s plan everyone that fails to find coverage they can afford with regard to the differential between voucher and actual cost: go die in the streets.]

Republicans on the committee also offered to negotiate a plan based on the bipartisan “Protect Medicare Act” authored by Alice Rivlin, [which would allow seniors to] choose from a list of Medicare-guaranteed coverage options, similar to the House budget’s approach–except that Rivlin-Domenici would continue to include a traditional Medicare fee-for-service plan among the options.

So, the GOP “choices” here are: completely voucherize and functionally end Medicare under the Ryan plan, or vastly extend Medicare Advantage and get to Ryan’s plan stepwise. After all, Medicare Advantage has bee such a smashing success; it’s the plan that delivered a ~14% more costly version of Medicare, the program it sought to “revolutionize.”

Democrats, on the other hand, believe that a return to Clinton era tax rates fundamentally solves the near- to mid-term budget issues. This is widely known to be true; it is also known to be true by Republicans, who are simply using the current “crisis” (which, not coincidentally was invented by them during the run-up and denouement of the debt ceiling “crisis”) as an excuse to attempt various long-held policy goals, most notably: ending Medicare.

Long term issues in our budget do indeed exist, these can only be handled by bringing health care costs under control; Democrats wish to work towards that goal, Republicans choose to address the issue by simply ending that program entirely. This is the point at which it’s worth noting that, if we paid for medical care the per-capita rates that our next-nearest “competitor” pays, we’d be facing surpluses as far as the eye can see. Right now.
But, a massive step in that “solvency” direction would, in fact, be Medicare for all. Instead, the GOP demands Medicare for none or they blow up the country. Those are your two GOP-approved choices. They simply don’t want to talk about it in public, because eliminating Medicare is a wildly unpopular position to hold. You’d think someone in the media would mention something as explosive as this from time to time. Doesn’t ever seem to come up.

Clearly, though, both parties are equally at fault here. Truly a triumph of 21st Century Journamalism.

Cokie’s Law vs. Social Security

Dean Baker at Beat the Press:

… it was incredibly irresponsible for NPR to tell listeners in its top of the hour news segment that the market plunged because Standard and Poor’s downgrade of U.S. debt. NPR does not know this to be true and it certainly is not obviously the case.

The market that should have been most immediately affected by the S&P downgrade was the U.S. bond market. However bond prices soared in the trading immediately following the downgrade and continued to rise through Wednesday. If there was greater fear that the U.S. would default because of the downgrade, then bond prices should have plunged as investors demanded a higher risk premium. This did not happen.

The most obvious alternative explanation for the plunge in the market is the risk that the euro could break up as the debt crisis spread from relatively countries like Greece and Ireland, to the euro zone giants, Spain and Italy. The prospect of a euro zone break-up raises a real risk of a Lehman-type freeze up of the world financial system. It is far more plausible that this prospect led to the plunge in the stock market than the downgrade by one of three major credit rating agencies.

This point is important because many political actors, including National Public Radio, are trying to use the debt downgrade as an argument for cutting Social Security and Medicare. Their argument will be furthered if they can claim that the downgrade had enormous consequences for the stock market, since so many people involved in political debates (i.e. columnists, policy wonks, reporters, congressional staffers) have substantial amounts of money invested in the stock market.

This is exactly right. All this nonsense about S&P’s downgrade “causing” movement in the US stock market (which, as far as the MSM is concerned, is entirely comprised of the Dow Jones index) is wrong. Foolish, even. This has been reported occasionally, and NPR and other political actors are at least slightly tempering the “S&P caused it!” meme.

But it won’t matter. The facts do not matter. Cokie’s Law, the ironclad rule that anything, any information be it merely incorrect or proven to be an outright lie or pure fabrication, once “out there” must be reported as though it is fact. Period. Therefore, as weeks and months pass, the core narrative becomes:

“S&P downgrade caused massive loss of wealth in DJI; therefore Social Security and Medicare must be cut; elimination is the GOP’s preferred outcome, therefore the "sensible center” is merely devastating cuts followed on every few years with more “sensible” cuts until we reach said elimination. This is the only Serious Position possible on the issue when one considers the facts of the S&P downgrade and its devastating impact on the Dow. Why, some say that as much as $1T in wealth evaporated. We simply must act to cut Social Security. Everyone knows it is the problem here.“

There will be nothing else. No other opinion will be allowed, and if directly challenged by the reality of the situation, reporters and pundits will characterize the truth as simply one other fringe "opinion” that the dirty fucking hippies are pushing again, and no better or worse than the obvious fallacy that was created by them simply because said fallacy has been widely reported. When (and if) directly challenged on the ontogeny of said MSM-created fallacy, they will elect to “leave it there,” declare it “complicated,” or, in the case of Cokie herself, sputter about it being “out there.” You heard it here first.

We’re seriously talking about defaulting on our debt, and cutting Medicare and Social Security, so that Google can keep paying its current 2.4 percent effective tax rate and GE, a company that received a $140 billion bailout en route to worldwide 2010 profits of $14 billion, can not only keep paying no taxes at all , but receive a $3.2 billion tax credit from the federal government. And nobody appears to give a shit. What the hell is wrong with people? Have we all lost our minds?

Matt Taibbi (via paxamericana)
No, Matt, we haven’t lost our minds. Instead, we’ve all been told for twenty years that government can do nothing right, that taxes are the root of all evil, and that anyone else receiving so much as one red cent of guvmint money is a freeloader and likely a sub-human of some variety.

Where’s the Left’s Grover Norquist, out there day in and day out agitating and extracting oaths over Social Security or Medicare or in favor of single payer health care? Where have they been for twenty years, messaging relentlessly, and not just when their pet subject is “in the news” for a week or two (and we’re lucky to get that)? Where have the folks been who organize guaranteed primary challenges of Democrats and Republicans who stray from their oaths? Where is the Progressive News Network, the most popular national news organ on television, daily vomiting outright lies and relentless spin tuned to the broader national political message and aimed squarely at the lowest common denominator?

Until some version of one or all these things show up: we will fail. This is why.

Source: paxamericana

Krugman Asked

Paul Krugman: David Altig points out that given the recent decline in gasoline prices, we’re likely to see a negative headline inflation number by June. What will the inflationistas say?
Lemkin: They will say that this is definitive proof that further austerity measures must be implemented immediately, the deeper and harsher the better, and preferably coming through brutal cuts to Medicare and the social safety net. Likewise, deep cuts to the tax rates of the top 1% are indicated. What other response is even possible?

How to square the circle: Assuming Medicare for all tomorrow and that you can find a way to return the dollars in-between the red and blue lines to the people paying it: the American worker with employee provided health insurance. Right now, that’s all invisible income, spirited away into the employer-shared costs of providing coverage. It’s the underlying reason that real wages have been stagnant for most of my lifetime. Turn that into real wages and the broader economy would explode. There would suddenly spring into existence a middle class with (gasp) actual purchasing power. Who knew?!?

Naturally, the plutocrats would, at least initially, turn that space into more profits for themselves. Sooner or later, though, it seems likely that constraints on quality workers would gradually bring the money over into regular salary as companies competed to find highly trained folks. You’d still have to solve the manufacturing issue and/or something to do with all that idle but essentially untrained labor force out there…but it would be a start.
At any rate, a few more than the 17 Americans vaguely cognizant of this cost gap need to be made painfully and continually aware of it. Every day, every hour, every time a microphone is switched on with a Democrat behind it. Complete with this graph. That Medicare, far from being “expensive,” saves money in dramatic fashion. And that, since they, the average hardworking healthcare consumer, cannot buy into that massive bargaining pool or something very much like it, they are being robbed. Every. Single. Day. With malice aforethought. And that they have precisely one party, the GOP, and Joe Lieberman to thank for it.

But that would be shrill. And Weiner lied to his fellow Democrat. That’s what’s important here.

Source: The New York Times