Department of "Huh!?": This Is All Cosma Shalizi's Fault Department...
Greg Sargent: Republicans Lie, All the Time, About Everything

The Policy Substance Underlying Today's Politics-of-Medicare Debate

There are three four things going on in today's Politics-of-Medicare debate:

  • Core Medicare: Patients over 65 show their Medicare cards and doctors see us. That works well--much better than the private insurance market does, at least for those of us who don't work for large bureaucracies that handle the process so that we... show our employer-sponsored insurance cards, and doctors see us. Ryan wants to break that part of Medicare.

  • Medicare Advantage: Medicare beneficiaries who want can, now, sign up for what Ryan wants to turn all of Medicare into--an HMO. This was an experiment to see whether private insurance companies could provide better care for seniors at a lower cost than traditional Medicare. The experiment failed. They can't. Obama wants to cut back on this failed Medicare Advantage experiment and use the federal money someplace where it will do more good. Ryan wants to keep spending on Medicare Advantage.

  • Relative Reimbursements: Today our Medicare reimbursement system pays specialists too much and primary-care physicians and nurses too little--in large part because specialists have lots of time on their hands to fly to Washington and lobby in the reimbursement rate-setting process. Obama wants to establish an IPAB--a body that Ryan also wanted to establish--to reform the reimbursement process and save money by paying specialists less and front-line providers more. Ryan now opposes the IPAB that he used to support.

  • Romney: Nobody has a clue about what Romney wants to do.

Alternative Elevator-Pitch Attempts to Explain the Medicare Debate:

  • The Republicans want to end Medicare as we know it. The Democrats went to mend it, not end it.

  • At a policy level, over-treating specialists via reimbursement rates, insurance companies via Medicare Advantage, for-profit hospital executives, and general bureaucratic inefficiency have been taking Medicare to the cleaners for a generation. ObamaCare is taking that wasted money back and deploying it where it can do some good.

  • Everyone agrees that we have to cut Medicare spending growth somehow or other. Obama figures out where we're paying too much to hospital and insurance companies, cutting that waste, and using the proceeds to increase coverage for seniors (donut hole, etc.) and strengthen the system. The current Medicare Trust Fund is projected to last a lot longer under ObamaCare than it would be if ObamaCare was repealed.

  • We don't know what the Ryan-Romney plan for Medicare is: they won't tell us.

  • A month ago the Ryan plan was: cut Medicare spending growth via cutting waste as much as ObamaCare does--but instead of using the money to pay for seniors' drugs and fill other gaps in the system, use it for tax cuts for the rich.

  • Today the Ryan-Romney plan is--we think--to restore the $750 billion in waste to insurance companies, for-profit hospital executives, and over-treating specialists.

  • Today the Ryan-Romney plan is--we think--give seniors a smaller voucher and make them, not the experts, figure out how to bring Medicare spending growth down.

  • Ryan wants to make everybody sign up for Medicare Advantage, let the insurance companies decide on their own how much extra they want to charge you--and then cut back what the Federal government pays. How well is that going to work?

  • ObamaCare makes Medicare leaner and stronger by cutting out waste and abuse--the waste and abuse that give the insurance companies and the for-profit hospital executives their lifestyles and that give specialists the incentive to overtreat and sock you for the copays.

  • Seniors have only gained from ObamaCare: better preventive and drug coverage with no cuts in benefits. The program is being strengthened and preserved--and Republican claims that it has been cut are lies. Changes have been made to reduce waste. A month ago Paul Ryan was an enthusiastic supporter of the ObamaCare plans to reduce waste in Medicare. Now he--and the other Republicans--want to run as the party of waste, fraud, and abuse. Let them.

  • ObamaCare is cutting $760 billion in WASTE over the next decade. If Romney puts that back, it is going to cost you $150 billion MORE in co-payments plus an extra $760 billion in national debt that you will have to pay back. Do you want to pay $150 billion more for WASTE?

  • If Ryan and Romney have their way, Medicare enrollees would have to pay more--a lot more--than the $200 plus monthly for Medicare plus co-pays and deductibles than they already are?

  • “The bottom line,” said Representative Chris Van Hollen of Maryland, the senior Democrat on the House Budget Committee, which Mr. Ryan leads, “is that Romney is proposing to take more money from seniors in higher premiums and co-pays and hand it over to private insurance companies and other providers in the Medicare system.”

  • Obama takes $700 billion that was going to be wasted on inefficient and ineffective parts of Medicare--waste and abuse, in short--and spends it on (i) pharmaceuticals for seniors and (ii) better coverage for everyone. Ryan--until the week before last--took the same $700 billion and spent it on tax cuts for the rich. Now Ryan says he wants to give it back to the insurance companies.

  • The Republican plan for dealing with Medicare is like the Republican plan for dealing with Katrina.

  • Obama saved Medicare money, helping to extend the program's life, while giving MORE benefits to seniors. Romney wants to give those savings back to insurance companies, making the program go bankrupt faster.

  • It's like Obama is saying, I'll get you a Honda Accord for $25,000, and Romney is saying no, what you really want is a Honda Civic for $50,000.

  • Hey seniors! The Republican platform calls for turning Medicare into a voucher program and for eliminating important benefits for you--they want to reopen the Medicare drug "donut hole". They would want to raise your Medicare premium by an average of $577/yr a decade from now. Why? Because they seem hell-bent on restoring $716 billion in wasteful Medicare payments to insurance companies and over-treating specialists. We don't know the full details. They won't tell us. Republicans' rhetoric and plans keep shifting as the American people responds with dismay to what Republicans propose. It won't be good. We do know that two-thirds of Medicaid dollars are used to care for the elderly and the disabled, and that the Republicans have pledged to cut Medicaid dramatically.

  • The meta-message of the Obama campaign is that the Romney campaign is basically an exercise in the candidate looting the country for the benefit of himself and the small group of people like him.

  • The meta-message of each campaign is that the other campaign is basically an exercise in the candidate looting the country for the benefit of himself and the small group of people like him. The questions is which is the "them"--the lucky and corner-cutting rich or the shiftless Negroes.