Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say. Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending. The likelihood that they would stand by that irresponsible pledge after the election is close to zero. And the likelihood that they would be better able than Democrats to preserve Medicare for the future (through a risky voucher system that may not work well for many beneficiaries) is not much better. THE ALLEGED "RAID ON MEDICARE" A Republican attack ad says that the reform law has "cut" $716 billion from Medicare, with the money used to expand coverage to low-income people who are currently uninsured. "So now the money you paid for your guaranteed health care is going to a massive new government program that's not for you," the ad warns.
What the Republicans fail to say is that the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.
In reality, the $716 billion is not a "cut" in benefits but rather the savings in costs that the Congressional Budget Office projects over the next decade from wholly reasonable provisions in the reform law.
One big chunk of money will be saved by reducing unjustifiably high subsidies to private Medicare Advantage plans that enroll many beneficiaries at a higher average cost than traditional Medicare. Another will come from reducing the annual increases in federal reimbursements to health care providers — like hospitals, nursing homes and home health agencies — to force the notoriously inefficient system to find ways to improve productivity.
And a further chunk will come from fees or taxes imposed on drug makers, device makers and insurers — fees that they can surely afford since expanded coverage for the uninsured will increase their markets and their revenues.
NO HARM TO SENIORS The Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare. But if Mr. Romney and Mr. Ryan were able to repeal the reform law, as they have pledged to do, that would drive up costs for many seniors — namely those with high prescription drug costs, who are already receiving subsidies under the reform law, and those who are receiving preventive services, like colonoscopies, mammograms and immunizations, with no cost sharing.
Mr. Romney argued on Friday that the $716 billion in cuts will harm beneficiaries because those who get discounts or extra benefits in the heavily subsidized Medicare Advantage plans will lose them and because reduced payments to hospitals and other providers could cause some providers to stop accepting Medicare patients.
If he thinks that will be a major problem, Mr. Romney should leave the reform law in place: it has many provisions designed to make the delivery of health care more efficient and cheaper, so that hospitals and others will be better able to survive on smaller payments.
NO BANKRUPTCY LOOMING The Republicans also argue that the reform law will weaken Medicare and that by preventing the cuts and ultimately turning to vouchers they will enhance the program's solvency. But Medicare is not in danger of going "bankrupt"; the issue is whether the trust fund that pays hospital bills will run out of money in 2024, as now projected, and require the program to live on the annual payroll tax revenues it receives.
The Affordable Care Act helped push back the insolvency date by eight years, so repealing the act would actually bring the trust fund closer to insolvency, perhaps in 2016.
DEFICIT REDUCTION Mr. Romney and Mr. Ryan said last week that they would restore the entire $716 billion in cuts by repealing the law. The Congressional Budget Office concluded that repealing the law would raise the deficit by $109 billion over 10 years.
The Republicans gave no clue about how they would pay for restoring the Medicare cuts without increasing the deficit. It is hard to believe that, if faced with the necessity of fashioning a realistic budget, keeping Medicare spending high would be a top priority with a Romney-Ryan administration that also wants to spend very large sums on the military and on tax cuts for wealthy Americans.
Regardless of who wins the election, Medicare spending has to be reined in lest it squeeze out other priorities, like education. It is utterly irresponsible for the Republicans to promise not to trim Medicare spending in their desperate bid for votes.
THE DANGER IN MEDICARE VOUCHERS The reform law would help working-age people on modest incomes buy private policies with government subsidies on new insurance exchanges, starting in 2014. Federal oversight will ensure a reasonably comprehensive benefit package, and competition among the insurers could help keep costs down.
But it is one thing to provide these "premium support" subsidies for uninsured people who cannot get affordable coverage in the costly, dysfunctional markets that serve individuals and their families. It is quite another thing to use a similar strategy for older Americans who have generous coverage through Medicare and who might well end up worse off if their vouchers failed to keep pace with the cost of decent coverage.
Mr. Romney and Mr. Ryan would allow beneficiaries to use vouchers to buy a version of traditional Medicare instead of a private plan, but it seems likely that the Medicare plan would attract the sickest patients, driving up Medicare premiums so that they would be unaffordable for many who wanted traditional coverage. Before disrupting the current Medicare program, it would be wise to see how well premium support worked in the new exchanges.
THE CHOICE This will be an election about big problems, and it will provide a clear choice between contrasting approaches to solve them. In the Medicare arena, the choice is between a Democratic approach that wants to retain Medicare as a guaranteed set of benefits with the government paying its share of the costs even if costs rise, and a Republican approach that wants to limit the government's spending to a defined level, relying on untested market forces to drive down insurance costs.
The reform law is starting pilot programs to test ways to reduce Medicare costs without cutting benefits. Many health care experts have identified additional ways to shave hundreds of billions of dollars from projected spending over the next decade without harming beneficiaries.
It is much less likely that the Republicans, who have long wanted to privatize Medicare, can achieve these goals.
This is what we do know about what Republicans intend overall:
Romney/Ryan budget:
- would not balance federal budget for 28 or more years
- would revoke tax breaks such as mortgage-interest deductions, and others
Romney/Ryan Medicare:
- would require seniors accept fixed payments
- would require citizens at age 55 choose vouchers, private insurance, or Medicare
- vouchers would not necessarily cover Medicare
- would raise qualifying ate to 67 by 2034
- would cap spending at $7,400 per person
- would require average senior pay $1,200 to $2,400 a year
Romney/Ryan tax policy:
- would keep Bush tax cuts
- would ADD $4.5 trillion in cuts through 2022
- would replace six-tax-rates with two: 10% and 25%
- would eliminate alternative minimum tax
- would cut corporate taxes
- would repeal tax breaks for low-income families with children
- would increase taxes for bottom 1/5 of households
- would increase taxes average $1,000 for households earning $10,000 to $20,000
- would cut taxes $265,000 over 10 years for those making $1 million and more a year
- would lower or eliminate tax on capital gains, interest and dividends, etc.
Romney/Ryan Medicaid
- would cut aid for poor, disabled, and health care for children
- would transfer remaining funding to states as block grants
- would repeal expansion of aid in current law
- would repeal Affordable Care legislation
Romney even suggested vouchers to replace VA care.
Best wishes always,
Bill Harasym
"Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral." -Paolo Friere-
