So earlier this week, a heavily Republican Congressional district somewhere in New York elected a Democrat. The dynamics of any one local race* are seldom indicative of any greater theme, despite everyone's best attempt to say, see, this proves what I've been claiming all along! There are always local issues to consider, individual dynamics of the race and, in this case, an utter wingnut tea-party candidate who may have been a spoiler. But one thing is certain: The DCCC, Democrats' House election arm, did everything it could to make the election about Paul Ryan (R-Galt's Gulch) and his plan to destroy medicare, because the Republican in that race voiced her support early and often for Ryan's plan.
Right there, what I just did, saying that Ryan's plan would destroy Medicare, is what those who have always wanted to destroy Medicare (except in election years, when in a fit of black-is-whiteism the GOP asserts it's Democrats who will destroy Medicare) would call a "mediscare tactic." Funny, eh? But please, recall that since Medicare's inception, the Republican Party has stood for its end, with St. Ronald de Tampico even making a record--yes! a record!--in 1961 opposing the plan and claiming that within a generation the federal government would be telling doctors where they could live and what kind of medicine they could practice. Like Harold Camping's predictions of Armageddon, Reagan's opposition to Medicare seems laughable now.
Except not to Paul Ryan. As we have discussed before on this very blog Ryan is not afraid to invoke Reagan's rhetorical style when it suits him, and for basically the same purposes. So let's be clear: Ryan's plan does destroy Medicare. This is not an exaggeration designed to "scare," but an accurate description of Ryan's plan to institute a completely different system under the same name. (Politi"Fact" finds the semantics of the argument--Ryan still calls his plan Medicare, they say--persuasive enough to call honest opposition to the idea false, which is just mind-boggling.)
And this is where Patrick McIlheran comes in: He blogs to throw out the "mediscare" label and defend Ryan's plan. But he can't do that without lying, because, let's be honest here, a whole lot of Ryan's plan is indefensible. McIlheran:
As Ryan has endlessly pointed out, his plan leaves Medicare completely unaltered for anyone now on it or who is now 55 or older. It manages this feat [. . .] by changing the deal for people 54 or younger into a subsidized selection of insurance plans more or less identical to what Congress gives itself as coverage. This is an “end” to Medicare only if you imagine that our lawmakers have left themselves destitute and tubercular in a gutter when it comes to their own health care.Of course Ryan's plan doesn't touch the Boomers' and the WWII generation's Medicare; those people vote and they really like Medicare, giving it just about the highest satisfaction rates of any insurance provider in the country. But the next part, about giving everyone else the same health care coverage that Congress gets? That's baloney:
In many ways, the federal plan works a lot like the run-of-the-mill employee-sponsored health insurance plan. The bulk of the costs are picked up by the employer--in this case, the government--with the employee contributing his or her share according to a set or negotiated rate. Under a 1997 law, the government pays a set rate of 75 percent of the costs of the health plans selected by federal employees and members of Congress. The employee (and members of Congress) pick up the other 25 percent. [. . .] The Congressional Budget Office, the nonpartisan arm of Congress, analyzed Ryan’s plan and estimated that, by 2030, the government would pay just 32 percent of the health-care costs, less than half of what it currently pays. The other 68 percent of the plan would have to be shouldered by the retiree.That just-like-Congress tale ends up a two-Pinocchio lie. But happily spread by local huckster McIlheran. Who goes on:
And since the alternative, according to Medicare’s own accountant, is leaving things alone until it all goes bankrupt in 2024 and doctors stop seeing recipients, then Ryan’s plan is “immoral” only in the way that it’s somehow wrong to disturb a drunk’s calm by telling him he’s driving onto the wrong-way off-ramp of a freeway.This is what we call a false dichotomy (and the word false, you know, tells you McIlheran is lying again). This is the new Republican tactic, seen all over the place lately, which is to pretend that Democrats don't have a plan. They do. It's called Medicare--you may have heard of it, and it's a pretty awesome deal.
But not merely the unaltered Medicare that will, indeed, drive federal debt ever higher. Rather, Democrats have been trying to build on Medicare's signature strength, which is that it holds costs down better than private-sector insurance; over the years, Medicare inflation has been significantly lower than inflation in the health-care market as a whole. Ryan's plan, on the other hand, holds payments down, which does nothing to control costs. Indeed the CBO's analysis is devastating:
[T]he CBO conclusion is shocking: The plan would not only fail to decrease health-care costs per beneficiary, it would increase them–-by an astonishingly large amount that grows over time. By 2030, health spending on the typical beneficiary would be more than 40 percent higher under the Ryan plan than under existing Medicare, according to the CBO report.The short version is that the end of Medicare as we know it under Ryan means an end to the government's ability to make big deals with doctors and hospitals and other providers: When you're on your own with a voucher, you do not have the negotiating power of 40 million other patients behind you. Just you. So where Ryan's plan allows actual costs to skyrocket (but not the size of your voucher), Medicare as is holds actual costs down.
But there's more: Democrats want to further bend that cost curve downward, and the Affordable Care Act starts that process. The ACA establishes an Independent Payment Advisory Board, which is all about finding the most effective and most cost-effective treatments to pay for instead of expensive stuff that doesn't work. However, there's a giant obstacle to this board, and if you guessed the House GOP you'd be right: They want to abandon the additional cost controls that the IPAB would bring in favor of, as we've seen, destroying Medicare instead.
The truth of the Ryan plan and the destruction it would bring to one of the most important entitlement plans we have today is what's really scary. And that's why Ryan and his media enablers like McIlheran have to lie to you in order to sell the plan.
* Steve Benen argues that this is not an isolated case, and that Democrats have been making significant gains, including flipping Mike Huebsch's GOP-heavy Assembly district here in Wisconsin a few weeks ago.