The pivot

by on July 7, 2012 at 7:30 am in Current Affairs, Games, Medicine | Permalink

…since the Supreme Court upheld the Democrats’ 2010 health care law, Republicans, led by Mitt Romney, have reversed tactics and attacked the president and Democrats in Congress by saying that Medicare will be cut too much as part of that law. Republicans plan to hold another vote to repeal the law in the House next week, though any such measure would die in the Democratic-controlled Senate.

“Obamacare cuts Medicare — cuts Medicare — by approximately $500 billion,” Mr. Romney has told audiences.

I have been predicting this.  There is more here.  Paul Ryan offered this account:

Mr. Ryan, of Wisconsin, was unavailable for comment, but, pressed on the issue on ABC’s “This Week” on Sunday, he said: “Well, our budget keeps that money for Medicare to extend its solvency. What Obamacare does is it takes that money from Medicare to spend on Obamacare.”

Norman Pfyster July 7, 2012 at 7:56 am

What pivot?

Dan Weber July 7, 2012 at 10:31 am

When the Republicans propose Medicare cuts, Democrats say they are evil.

When the Democrats propose Medicare cuts, Republicans say they are evil.

reality July 7, 2012 at 11:11 am

that is because when republicans cut medicare they cut benefits while when democrats cut it they cur corporate subsidies and wasteful spending

TmC July 8, 2012 at 11:32 am

And yet your handle is ‘reality’.

Richard July 8, 2012 at 7:48 pm

I’m sure that was sarcasm, the lowest form of wit.

Orange14 July 7, 2012 at 8:09 am

This is no pivot, but the point the Republicans have been making for the past two plus years. Paul Ryan is cynically disingenuous and pandering to the Medicare and near-Medicare crowd (disclosure: I’m one of them) by letting all of them (ages 55+) off the hook with his budget proposal. If his proposal is so great, why doesn’t he sweep them all in under the same health care plan? The answer is simple, they like their Medicare and won’t support any change; no surprise there. I would further add (and I don’t know how many readers of this blog are seniors or near-seniors), that Part B of Medicare is means tested and if you are in a high income bracket as judged by your tax return, the premiums can be quite high. Both my wife and I are going on Medicare this year (we have lifetime insurance from my employer as a benefit which transitions to our Medigap policy) and instead of the base $99/month for Part B, we are paying about $250/month based on our income! So don’t be giving me the story line that this is “free” health care for we “old folks.” It’s not.

John Thacker July 7, 2012 at 9:15 am

So don’t be giving me the story line that this is “free” health care for we “old folks.” It’s not.

Simply because you’re paying something doesn’t mean it’s not subsidized. Your comment above seems to me to be exactly the sort of thing that gets us in trouble. By the way I look at it, you’re still getting something for free.

Orange14 July 7, 2012 at 11:28 am

You are wrong because my wife and I both pay separate Medicare premiums based on our joint AGI and we are paying more (at least for this year) per month than we were paying under the employer’s coverage which was a group plan. Factor that also into all the Medicare premiums that we have been paying over the years that we have been employed and that we are really not at this point in time big users of health care. My point stands, the well off pay much more into Medicare and are likely not big beneficiaries.

JVM July 7, 2012 at 3:52 pm

Correct me if I”m wrong but can’t you choose not to pay in? And if I’m correct about that, why are you paying if it’s such a bad deal?

Mike July 7, 2012 at 5:18 pm

So you’re going from a group plan where you’re averaged in with lots of younger people too to one where you’re now among the youngest and you’re surprised that premiums are higher? And how much was your employer paying of the premiums?

The actuarial cost of Medicare Part B runs about double your premiums, so you’re getting a pretty large subsidy.

John Thacker July 7, 2012 at 9:20 am

People pay taxes for Social Security and Medicare, but the programs can still not be actuarially balanced and thus people can be getting things for free.

Your “So don’t be giving me the story line that this is “free” health care for we “old folks.” It’s not.” comment is exactly the sort of thinking that underlies that “get your government hands off my Medicare” sign. People think that since they paid something, that they paid for it all, and thus it’s not free, it’s not something that the government is giving them, but something that they have a right to. Naturally, then, since they think that they already pay for it, they complain about cuts.

I’m a bit confused, since it seems like you’re decrying the pandering at the same time as you express exactly the opinion that leads to the pandering.

blahhhh July 7, 2012 at 11:15 am

its ironic because people with employer based healthcare get larger government subsidies than those on medicaid, or who will now be in obamacares exchanges

jott July 7, 2012 at 11:03 pm

$250/mo seems cheap to this young, healthy male

Benny Lava July 7, 2012 at 8:10 am

Thus Paul Ryan vindicates Alan Simpson.

Orange14 July 7, 2012 at 8:31 am

…as one who is pandering to the geriatric crowd?

Benny Lava July 7, 2012 at 9:06 am

Alan Simpson opined that grandparents don’t really like their grandkids. So they will vote for measure like Medicare at the expense of the younger generation, who ultimately foots the bill, because they don’t like them. It was humorous because Simpson mispronounced the names of two rappers. I think they were Snoop Dogg and Eminem.

Paul Ryan makes this rather explicit. Obamacare will take from the elderly and give to the young.

John Thacker July 7, 2012 at 9:17 am

Obamacare actually roughly takes from both the young and the elderly to give to the near-Medicare crowd. The community rating provision limits the difference in premiums due to age such that no one can be charged more than twice any other age; the amount based on actual use would be about 4 or 5 times.

There is, of course, also a bit of taking from the healthy to give to the sick, which is possibly less controversial.

wrong July 7, 2012 at 11:20 am

actually obamacare increases the elderly benefits. for example it remove s the donut hole, provides free preventive care, removes medicare advantages which has 10% lower outcomes, increases homecare access, uses comparative research, bundle d payments, computerized systems and much more

Orange14 July 7, 2012 at 8:47 am

And it’s also useful to read this: http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/07/is-the-obama-administration-the-best-vehicle-for-conservative-health-care-ideas/ Until the Republicans step up to the plate and offer something, they have no credibility. “Repeal and Replace” means having something to present to voters so they can see what the option would be. Right now there isn’t one.

John Thacker July 7, 2012 at 9:26 am

Even more importantly, this demonstrates why the polls showing that “while voters prefer complete repeal to keeping it, they do like provisions X, Y, and Z, and prefer partial repeal or modification to complete repeal or keeping it” are on the one hand completely expected and yet a very bad thing. Voters always like getting things without paying for them. The mandate is unpopular, community rating and guaranteed issue are popular, but experts on all sides insist that they need to be a package deal.

So it doesn’t help that the polls suggest that partial repeal is the most popular option of all. Partial repeal means getting things without paying for them. That means coverage expansion without Medicare cuts. That means, on another issue, highway spending without gas tax increases.

“Repeal without replacing” may be a bad option, but if voters prefer a straight repeal to keeping the deal, it at least has the advantage of being fiscally balanced and responsible. “Partial repeal” is much worse. The problem is that partial repeal has always been pretty likely (and I expect Democrats to join in to repeal various onerous provisions.)

Democrats and progressives who tout that tweaking is the most popular option in the polls, or highlight the popularity of single provisions even as the overall package deal is unpopular may think that they’re making an argument against Republican repealing it, but they’re really making an argument that the whole bargain is doomed, and that the law should never have been passed, since the pay-fors were never sustainable. The only poll worth looking at is total repeal versus totally keeping it.

Benny Lava July 7, 2012 at 9:44 am

Sadly this is true. People want spending without paying for it.

JonF July 7, 2012 at 4:10 pm

Re: Partial repeal means getting things without paying for them.

In and of themselves community rating and guaranteed issue cost the public treasury $0 (OK, well maybe some nominal amount in enforcement.) Where the publicly costly stuff comes in is not with the insurance regs, but with the subsidies.

And yes, you can have community rating with no mandate. Maryland, where I live, does this. There’s no insurance death spiral here. That’s just an urban myth. Costs go up a bit then stabilize. After all, health insurance is desirable to have regardless so people who are not sick will not drop coverage nor wait until they get sick to sign up. Perhaps any problem of this sort that might exist could be fine-tuned by only allowing open enrollment once a year as workplace benefit plans do.

ila July 9, 2012 at 12:52 pm

This is a finer point that gets missed. A series may either converge or diverge. It seems that in Maryland, the series converged successfully. That does not necessarily mean that in every state the series will converge. “Death spirals” still might occur, even if they did not in Maryland. Having an open enrollment period will help to clamp down on the problem, but I don’t think it will stop everybody from trying to go without.

Bill Nichols July 7, 2012 at 9:55 am

The Pivot is adopting Democrat rhetoric, Democrats should be flattered, not angry. Characterizing reductions in projected growth as “cuts” has a long history. Of course special pleading and half truth is a bipartisan sport with a longer history, see for example the witches in “MacBeth”.

Telling the truth, partially, is an effective way to lie. It’s hard to refute in 140 characters.

Michael July 7, 2012 at 11:05 am

“Characterizing reductions in projected growth as “cuts” has a long history.”

Ultimately, the part of health care that the elderly care about is the “goods and services” they receive, not the nominal dollar amount. If the nominal dollar amounts they get grows less than the actually costs such that they receive less goods and services, is it really so wrong to say that’s a cut? It is indeed a lesser amount of stuff received.

Take the voucher idea (aka premium support.) If in year one the voucher can buy health insurance, but in year 10, it is not enough money to buy health insurance, then the value of that voucher has gone down, even if it’s a higher dollar amount. Similarly, if Medicare switches from covering people 65 and over to 67 and over, that’s too less years of coverage, even if the dollar amount spent is higher in the latter scenario.

In some sense, characterizing reductions in growth rates as cuts is to see through the “money illusion.” To say that they aren’t actually cuts because of this illusion seems even less correct to me. What ultimately matters is the real outcomes, not the nominal illusions.

If you want to make the argument that even in real terms, that even when you look at the goods and services received, that things aren’t going down then there is a valid point to be made.

Dana July 7, 2012 at 1:17 pm

Michael: An excellent point, very well explained. But it fails the 140 characters test, and will fall victim to the eastern elite jibberish fallacy.

Jan July 7, 2012 at 3:38 pm

Michael, this is exactly why the savings in Medicare are being misrepresented as “cuts.” The goods and services received through Medicare will not go down. Savings will come from the costs of the goods and services decreasing, as compared to cost projections under a no-reform scenario.

The $500 billion reduction comes not by beneficiaries paying higher amounts out of pocket or anything else that negatively impacts the amount of care they receive, but through fraud and abuse savings, reductions in subsidies for Medicare Advantage insurance companies, and slower growth in provider payment rates (which, to be clear, does not imply less care–doctors will continue to take Medicare patients for whatever rate the feds pay, due to their market share).

mulp July 7, 2012 at 10:38 pm

You seem to be arguing the cost of your doctor’s clerks pushing paper for billing purposes is not a patient health benefit… Or that selling Powerchairs is not critical to health?

Republicans know Powerchairs, $25 a pair diapers, and other Medicare health benefits are critical to good health for the elderly which is why they repeatedly cut the wasteful Democratic spending on Medicare fraud prevention that stifles these critical Medicare benefits.

Todd July 7, 2012 at 10:11 am

So Romney is just gonna run his campaign from the center-left?

Has anyone explored the idea of just eliminating the Republican primaries, and picking a nominee with a dartboard?

JVM July 7, 2012 at 4:04 pm

Left and right are extremely deceptive in contemporary politics. Romney is trying to build a coalition around white people and seniors, because he thinks he can possibly carry them by a wide enough margin to beat Obama (this is basically the Republican party’s MO). White people like to see programs for poor people cut because they see the primary beneficiaries of those programs as being minorities and immigrants. That’s what makes people think of the Republican party as a “right wing” party. But he also has to pander to seniors, and that means defending Medicare from all threats.

Romney’s going to squeak it if he does win, and the other guys didn’t stand a chance, so I think the primary did its job.

dead serious July 7, 2012 at 10:39 am

To Republicans, a corporation that leverages cheap debt is seen as doing something smart, but running a government with anything short of a balanced budget is seen as apocalyptic.

I should clarify: running up a government debt to maintain/expand our military industrial complex is a good thing. Running up a government debt to provide tangible services to citizens is a bad thing.

I get that we’re way too far in debt as a nation, but I think the magnitude doesn’t matter; this is a philosophical battle, not a practical one.

JWatts July 7, 2012 at 6:36 pm

“To Republicans, a corporation that leverages cheap debt is seen as doing something smart,”

No. A corporation that has a high debt to equity ratio is considered riskier and has a lower stock price, ie it’s worth less. Certainly a corporation is smart to get the best rate it can on it’s debt, just like the government is smart to do the same, but that doesn’t mean it’s considered smart to have a lot of debt.

“I get that we’re way too far in debt as a nation, but I think the magnitude doesn’t matter”

If you don’t think the magnitude of debt doesn’t matter, you either, don’t know what the word magnitude means or have no grasp of economics.

dead serious July 7, 2012 at 9:36 pm

It doesn’t matter in this debate, and I think most Republicans would argue for the same cuts and defense spending even if we had a balanced budget.

mulp July 8, 2012 at 1:43 am

Duh… They had a budget surplus in 2001 and then Alan Greenspan was worrying that this was potentially going to lead to insufficient debt that it would eliminate any safe debt that is needed to provide a safe haven in any crisis.

If Republicans were in the White House now, my guess is Republicans would be arguing the global economy needs debt that will always be rated AAA+++, which they would argue US Treasuries are and they would be hiking the debt limit quickly and easily, attacking Democrats for trying to attach irrelevant riders to clean debt limit hikes.

byomtov July 7, 2012 at 10:56 am

What have you been predicting?

That Romney and the GOP would make false claims about Medicare cuts?

I also suggest reading the entire NYT article.

Ed July 7, 2012 at 11:52 am

This all is somewhat predictable.

1. It can’t be emphasized enough that political parties exist primarily to elect candidates to office, not necessarily too import a philosophy into public policy. But this is especially true of American political parties (and the Democrats more than the Republicans), who were organized specifically for non-ideological candidate promotion reasons. If you look over the history of the two party system, you see them swapping their positions and even entire blocks of voters between them every few decades.

2. In the past several elections, its emerged that the Republican base is white working class voters. Among white voters, the Republican electorate now looks like the electoral base of a socialist or labor-based party in Europe. The Republican leadership historically has somewhat more open to influence by their grass-roots than the Democrats. I expect the Republicans to veer well to the left on economic issues in the near future, though admittedly if Romney is elected it will retard the process, and I’m not taking into account the increased influence of Big Money which may keep the entire system firmly on the right economically regardless of the voters’ opinions (but even then the rhetoric could change).

3. The policies of the Obama administration have left a big opening for his opponent to run against him from his economic left. I was actually somewhat surprised this wasn’t done against Clinton. Had Gingrich managed to win the Republican nomination, we would be seeing this, Gingrich is nimble/ opportunistic enough to pull it off. I think Huckabee could also have pulled off the pivot. Again, Romney being the standard bearer will retard the process.

4. Also the electorate skews elderly, and its been demonstrated again and again that the main priority of a big chunk of this electorate is to keep their benefits and pensions coming, regardless what happens to the rest of the polity.

Strategists on the Democratic side have been talking pretty openly about relying on a coalition of the more monied whites plus minority voters, and I expect we will eventually see the rhetoric and policies catch up to this.

I’ll note that in the UK, Labour has returned to its roots on the left side of the economic spectrum after flirting with “the third way” under Blair, but here we are dealing with European party politics which work somewhat differently, and second we have to see what Labour does when they return to government before drawing any firm conclusions.

Boonton July 7, 2012 at 11:55 am

Hey wait a minute, didn’t the Ryan budget phase in massive Medicare cuts to create their ‘voucher plan’? And wasn’t this same budget endorsed by Romney? Granted politics is politics but we’ve reached a point IMO where the GOP automatically looses on health care because simply lack any credibility. At what point will we have enough of “no gov’t health care” followed by “keep gov’t out of my Medicare”?

Todd July 7, 2012 at 12:10 pm

Hence “pivot”

8 July 7, 2012 at 12:34 pm

This is why America is going to experience an economic/currency collapse at some point, maybe by 2030 at the latest, or maybe by 2016 if Europe and Japan collapse in the next four years, because entitlements must be reformed by 2016 to get the deficit under control. The Republicans are the party of fiscal responsibility (by Washington standards, not by objective standards) and they are also effectively the white party, and a large block of white voters are old people who want their entitlements. So the choice for America will be between a party that bankrupts the country on entitlements and defense spending, or the party that bankrupts the country on entitlements, defense spending, and anything else they can get passed. Voting should be strategic based on whether you are prepared for it (vote Obama) or need a couple more years to prepare for it (vote Romney).

Bill July 7, 2012 at 1:10 pm

8, So you’re in favor of eliminating the Bush tax cuts?

JWatts July 7, 2012 at 6:46 pm

I’m in favor of eliminating the Bush tax cuts. All of them. In addition, I’m in favor of significant reductions of spending across the board and elimination of most tax deductions.

Boonton July 9, 2012 at 11:01 am

So the choice for America will be between a party that bankrupts the country on entitlements and defense spending, or the party that bankrupts the country on entitlements, defense spending, and anything else they can get passed

This is an interesting example of what I can only call the mental illness of the punditry class. Let’s look at Republicans and Democrats on entitlements:

Democrats – Decrease an entitlement to refocus it on providing more health coverage to the non-well off eldery. Interestingly their program is not technically even an entitlement as individuals have to buy their own plans and how much that will cost them will be a function of the market plus the subsidies they get, which could become lower depanding on a lot of factors. Costs are as any reasonable analysis can tell roughly offset by spending reductions elsewhere and tax revenue (i.e. the mandate). (And yes it is, despite all the claims of ‘gaming the numbers’ the best analysis of the ACA for the foreseeable future is either neutral or a net reduction to the deficit. This is why Republicans have to create special exemptions to their deficit rules when they introduce bills to repeal the ACA).

Republicans – Errrr Medicare Part D. Anyone? Please? Pure entitlement expansation with not even an attempt at paying for it with either cost reductions elsewhere or tax increases. It’s only saving grace is that costs seem to have come in less than projected due to the slowdown in new drugs (making more drugs generic) and possibly some improved health outcomes from old people who don’t try to save pennies by skipping pills as much.

Let’s not even go to the last Republican administration which declared in a time of nearly full employment that deficits don’t matter, fiscal surpluses were a moral evil, and that major military adventures would not cost more than $100B and even if they did there was no need to ask for even a show of austerity to pay for them.

By what right does anyone who did not fall out of a timewarp from 1979 have to write that Republicans are even by silly standards the party of fiscal responsibility?

Zach July 7, 2012 at 2:50 pm

This has been the only effective Republican attack against Obamacare. They’ve been employing it for 3 years. Confused as to where the pivot is… this has been part of Romney’s stump speech since the primaries. Somehow I don’t know that “Obama cuts Medicare Advantage to fund Medicaid and health care subsidies while I will cut Medicare Advantage to give tax cuts to rich people” is particularly effective rhetoric. A lot of the persuasive power of Romney/Ryan’s language hinges on people not knowing that the debate isn’t about whether or not we’ll waste $500B on Medicaid Advantage but rather whether we’ll either spend money that we don’t have on subsidized healthcare or lowering taxes for the rich. The success of Obama’s campaign will hinge on communicating this effectively in the debates and in the ad war. He was the first Democrat in my lifetime to win on income tax policy in 2008… this seems like a relatively easy problem.

Greg Ransom July 7, 2012 at 3:01 pm

Except you have the facts wrong.

Romney has been doing this for months — MONTHS.

Bogus facts are the fuel of the punditry industry.

Rich Berger July 7, 2012 at 8:04 pm

Don’t rely on the New York Times for your news.

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