The hard-working, intelligent, and thoughtful Josh Barro writes:
The Democrats' Version of Mediscare: Paul Ryan’s nomination acceptance speech last week was less than forthright on a number of subjects… includ[ing] Medicare, where he attacked President Barack Obama for Medicare cuts that Ryan kept, and then some, when writing budget proposals for the House Republicans.
Now we look forward to another week of Medicare distortions, this time of the Democratic variety.
The real landscape on Medicare is this: Both parties want to cut Medicare…. There are two key falsehoods in the Democratic message on Medicare. One is Obama’s oft-repeated claim that the Patient Protection and Affordable Care Act “won’t touch your guaranteed Medicare benefits. Not by a single dime.” That’s true only with a tortured definition of “guaranteed Medicare benefits.” PPACA cuts Medicare spending by $716 billion, or about 10 percent over the next 10 years. It achieves these cuts in roughly equal parts by: eliminating subsidies for enhanced, private “Medicare Advantage” plans used by many seniors; reducing reimbursement rates to hospitals; and various other measures, including cutting payments to compensate hospitals for unpaid bills and payment rates for home health providers.
Medicare Advantage insurers use those subsidies to offer enhanced benefits or lower co-payments and cost sharing. Eliminating them will lead to reduced health benefits for some seniors. Democrats might retort that these benefits are not “guaranteed,” but under current policy, they are: Medicare Advantage insurers today are entitled to payments that exceed those for traditional Medicare, and if that’s more than they need to replicate traditional Medicare benefits, they are required to plow the excess into benefit enhancements…
The cuts in disproportionate share payments are more than made up by (i) the fact that many whose bills previously went unpaid will now have exchange-sponsored insurance, and (ii) that others whose bills previously went unpaid will not now have Medicaid (of course, the Medicaid expansion may not happen everywhere--but blame that on John Roberts and Republican power structures in the states: they are the ones who dropped that particular neutron bomb).
And, at least IMHO, the expansion of Medicare Advantage was, it has turned out, a failed experiment: a hideous waste of federal Medicare dollars. It should be rolled back--and all the evidence I have seen says it can be rolled back with no or at most a minimal impact on any Medicare beneficiaries.
But then Barro's complaint about the reductions in hospital reimbursements is a fair cop.
So Barro then piles on to and reinforces his strongest point:
Democrats who talk about reimbursement rates as an issue divorced from the level of the Medicare benefit should ask themselves: Are Medicaid’s reimbursement rates relevant in evaluating the quality of the Medicaid benefit? The reason Medicaid is widely viewed as bottom-tier insurance is that its low reimbursement rates are unappealing to providers. Similar reasoning should apply to Medicare, whose reimbursement rates will still be higher than Medicaid’s, but not by as much as before….
The other falsehood we are likely to hear at the DNC is that the Romney-Ryan Medicare plan “could force new retirees to pay up to $6,400 more a year for health care”… [from] the budget House Republicans passed in 2011, which Paul Ryan wrote. This was indeed a bad plan…. But Ryan sharply changed his Medicare plan…. While the candidates have very different visions on how Medicare should be structured in the future, their proposals for the amount of Medicare spending in the long term are roughly similar.
(If, that is, you believe that their real plans have changed since 2011 rather than simply gone underground…)
And then Barro closes with the traditional hapless wish for a real, substance-based policy debate:
These distortions are unfortunate… there is a serious debate to be had.… After the election, I hope to see the two parties agree on a Medicare plan that takes a “yes, and” approach to cost control -- combining the Democrats’ top-down saving strategies like the Independent Payment Advisory Board with Republican ideas for competitive bidding that aim to push seniors to cheaper plans. Until then, I expect Mediscare to continue from both sides.
Barro should have noted that the IPAB was, originally, a Ryan-Romney idea as well--until it made it into the Affordable Care Act and so became, in Ryan-Romney's eyes, yet another form of Kenyan Muslim socialism. And Barro should note that the results of the Medicare Advantage experiment are very bad news for people (like me) who used to have some hope in competitive bidding as a cost control measure.
In all, Barro does as good a job as somebody can possibly do in attempting to make the "both sides do it, and are equally bad" case. And because he--unlike so many, many others who pull down paychecks in the media these days--has been willing to work, learn, and think, his piece is a useful analysis, not least because it contains enough hooks into fact and reality that it can be examined and critiqued.
And so I say: both sides do it, yes, but equally badly? I do wish Obama were saying "the ACA scales back the failed Medicare Advantage experiment and demands that hospitals treating Medicare patients waste less money, and here is how we think they can do it without reducing the quality of Medicare" rather than the flat-out "the ACA doesn't cut Medicare benefits". But these are different levels of spin: we are not talking motes and beams here, but we are talking 1"x2"s and 4"x8"s.
Don't get me wrong: there are substantive policy debates. But ever since I landed at National Airport wearing a necktie for the first time in 1993, they all have been substantive policy debates within the broad disorganized coalition that is the Democratic Party. Trying to have a substantive policy debate with any Republican office-holder or spear-carrier has been like trying to hold a geometry study group including a goat.>
