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Republicans Flunk Ezra Klein's Basic Medicare Test

Ezra Klein:

The Republican ticket’s big Medicare myth: I’ve got a modest proposal: You’re not allowed to demand a “serious conversation” over Medicare unless you can answer these three questions:

  1. Mitt Romney says that “unlike the current president who has cut Medicare funding by $700 billion. We will preserve and protect Medicare.” What happens to those cuts in the Ryan budget?
  2. What is the growth rate of Medicare under the Ryan budget?
  3. What is the growth rate of Medicare under the Obama budget?

The answers to these questions are, in order, “it keeps them,” “GDP+0.5%,” and “GDP+0.5%.”

Let’s be very clear on what that means: Ryan’s budget — which Romney has endorsed — keeps Obama’s cuts to Medicare, and both Ryan and Obama envision the same long-term spending path for Medicare. The difference between the two campaigns is not in how much they cut Medicare, but in how they cut Medicare.

This brings us to the big myth of this campaign, or at least of this particular conversation: That Republicans, but not Democrats, have a plan to cut Medicare costs. As Ryan pointedly put it in his first speech as Romney’s vice-presidential pick, “We won’t duck the tough issues. We will lead!”

Obama’s Medicare reform plan isn’t that hard to find. It’s largely in Title III of The Patient Protection and Affordable Care Act. The basic strategy has three components: First, figure out what “quality” in health care is. Second, figure out how to pay for quality rather than paying for volume. Third, make it easier for Medicare to quickly update itself to reflect both advances in knowledge about what quality is and how to pay for it.

And so, in Title III, you’ll find dozens of different efforts to achieve these goals. The most famous of them is Section 3403, which establishes the Independent Payment Advisory Board (IPAB). But there’s also Section 3021, which creates the Center for Medicare and Medicaid Innovation, and Section 3025, which cuts hospital reimbursements if too many of their patients are readmitted, and Section 3001, which establishes value-based purchasing for hospital services, and Section 3015, which collects data on quality, and Section 3502, which advances the medical home model.

Some of the efforts are outside Title III. The Patient-Centered Outcomes Research Institute is actually in Title VI of the law. And then there are the subsequent reforms the administration has proposed to save more money. Those can be found on pages 33-37 of the president’s 2013 budget proposal. They include expanding IPAB’s mandate such that it can change Medicare’s benefit package and setting a growth cap on Medicare of GDP+0.5 percentage points — which is, by the way, the same growth cap that Rep. Paul Ryan imposes in the latest iteration of his budget.

As for Romney’s plan? Well, it’s 902 words long, and basically sketches a less-detailed version of the plan Ryan released in his 2013 budget proposal (which is, for the record, much more moderate than the plan in his 2012 budget)…. On his Web site, however, it just says that Romney “is exploring different options for ensuring that future seniors receive the premium support they need while also ensuring that competitive pressures encourage providers to improve quality and control cost.”…

There’s a conflict of policy visions. But it’s simply a conservative myth that the White House hasn’t put forward a Medicare reform plan. What that line really means is that White House hasn’t put forward some variant of Ryan’s plan, which in many Republican circles, has come to be seen as the only policy change that counts as “entitlement reform.”

But Obama’s plan is, without doubt, far more detailed than anything Romney has put forward, and Republicans are well aware of its existence. One Republican accused Obama of a “bureaucratic approach to controlling Medicare costs” which “empowers a board of 15 unelected officials — the Independent Payment Advisory Board, or IPAB — to hold the growth of Medicare spending.” He said the cuts would be so severe that they “would simply drive Medicare providers out of business, resulting in harsh disruptions and denied care for seniors.”

That Republican? Paul Ryan.