“We’re gonna get ridda your Medicare and you’re gonna like it. Capisce?”
I just finished perusing the Republican budget proposal for fiscal year 2012. It was unveiled at a news conference today by Wall Street bailer-outer Paul Ryan and about fifteen House Republicans; and with the exception of one woman, all were white men over the age of 40.
The GOP proposal is like something you’d find being advanced by a 1980s Latin American military junta hoping to win favor with the IMF and World Bank in order to obtain loans. The budget plan calls for $6.2 trillion in cuts over the next ten years, but still wouldn’t lead to a balanced budget until the late 2030s. Part of the reason is its insane call for huge permanent tax cuts for individuals and corporations, including drastically lowering both the top individual and corporate tax rates to 25% from 35%. The proposal would eliminate the 2010 health care reform law. Naturally, the Pentagon’s budget is barely touched, and the GOP proposal has essentially deferred to Defense Secretary Robert Gates’ budgetary recommendations. Most of egregious of all, however, is that the GOP plan eliminates Medicare. Of course, that’s not the word Republicans are using. They’re saying they’re saving Medicare by reforming it, but Republicans want to save Medicare in the same sense that Lieutenant Calley saved
Here’s the crux of the GOP’s plan to eliminate Medicare:
Starting in 2022, new Medicare beneficiaries will be enrolled in the same kind of health care program that members of Congress enjoy. Future Medicare recipients will be able to choose from a list of guaranteed coverage options, and they will be given the ability to choose a plan that works best for them. This is not a voucher program, but rather a premium-support model. A Medicare premium-support payment would be paid, by Medicare, to the plan chosen by the beneficiary, subsidizing its cost.
The premium-support model would operate similar to the way the Medicare prescription-drug benefit program works today. The Medicare premium-support payment would be adjusted so that wealthier beneficiaries would receive a lower subsidy, the sick would receive a higher payment if their conditions worsened, and lower-income seniors would receive additional assistance to cover out-of-pocket costs.
This is interesting considering how similar it is to what Republicans call Obamacare. In the same budget proposal, Republicans are advocating the repeal of the president’s health care law with its sliding scale government subsidies allocated based on personal income levels, while simultaneously calling for the implementation of the same general plan for people who turn 65 after 2021. Even though this is the kind of idea that Republicans find worthy of the “socialist” epithet, they’re pushing this approach because it is much less socialistic than the current single-payer Medicare system.
What is surprising about the GOP’s proposed abolition of Medicare as we know it, is the brazen manner in which it’s being presented. Medicare is a very popular government program, even more so than private health insurance, which is remarkable considering that its only customers are people over 65—a demographic that can sometimes be difficult to please. Furthermore, everyone who is under the age of fifty-five right now would be affected by this change, which will have the surely anticipated effect of increasing out-of-pocket expenses. This is because there is nothing to prevent private health insurance premiums from continuing to rise at a rate that outpaces wage growth or inflation. Will the GOP’s premium-support model contain provisions for adjusting subsidies based on premium increases or will it be subject to a cost of living adjustment scheme that lags behind these hikes? Most likely the latter, since the whole point of “reforming” Medicare is for the government to spend less on it, and for the citizens to spend more. Even if this reality does not explicitly enter the minds of Americans under 55, they are still going to have some serious questions about gutting a program that has done well by their parents and other elderly loved ones. Frankly, I anticipate that the GOP’s Medicare proposal will be rebuked by the electorate with extreme prejudice.
On a related note, Ryan’s budget also contains a long-sought wet dream of the American right, federal tort reform. In this case, tort reform means placing a cap on damages rewarded by juries in medical malpractice lawsuits. By implementing a ceiling on damages, so the argument goes, malpractice insurers won’t have to pay out as much money in lawsuits, meaning the insurers could lower the premiums they charge doctors and hospitals, meaning the doctors and hospitals could lower what they charge to HMOs for providing those HMOs’ customers with care, meaning the HMOs could lower premiums for their customers, i.e., the American people. Notice that the American people are last in this wondrous chain of trickle down tort reform. Of all the entities in this relationship, patients are likely to benefit the least simply by virtue of being the furthest removed from where the reform is being initiated. That is, of course, unless you’ve been the victim of medical malpractice, in which case you’d be right in the thick of it, as you’d be unable to reap the kinds of damages you would have been under various state laws, which brings me to my next point.
Not a day goes by when some prominent Republican doesn’t decry increasing encroachments by the federal government on states’ rights and individual liberty. And yet one of the key proposals in Republican health care reform has been the enactment of a federal tort reform law that would supersede state laws pertaining to medical malpractice. I’m not quite sure how conservatives square that one.
As if these proposals weren’t bad enough, we come to Ryan’s not-so surprising take on the Pentagon’s budget, which defers to the Obama administration’s insistence that the decades-long boondoggle for military contractors is maintained:
Reflects $178 billion in savings identified by Defense Secretary Robert Gates, reinvesting $100 billion in higher military priorities and dedicating the rest to deficit reduction.
Nice try, but that’s not $178 billion in savings. It’s $78 billion in savings. Spending $100 billion on weapons programs X, Y and Z instead of A, B and C because you deemed the latter projects wasteful doesn’t mean you saved $100 billion; it just means you spent that money, but more wisely (you think). Of course, this is the Pentagon we’re talking about, which has seen it appropriate to spend more than the
Obviously the Republicans don’t expect all or even most of their ideas to make it into whatever FY 2012 budget finally gets passed. Nonetheless, they are hoping to frame and control the nature of the budget debate. By putting Medicare essentially on the chopping block in their budget, the GOP wants this proposal germinate into something that they hope will soon become “mainstream,” or at least be seen as a viable policy prescription.
As far as the Obama administration’s response to this plan goes, anything short of derisive laughter, mockery, and criticism will not do. When it comes to Medicare and Social Security, the electorate is on the side of the Democrats, who historically have enacted and protected these programs. Whenever the Republicans win an election, they always seem to overreach. Whether it was George W. Bush after the 2004 election proposing the privatization of Social Security, the unpopular gutting of labor unions in
That’s assuming Obama doesn’t cave once again, but at this point who the hell knows?
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