Nothing brings out America’s political schizophrenia like Medicare. The program is universally popular with consumers, and universally seen as a necessity by providers. Despite these facts, the reality is that Medicare is Socialism. The program ranks behind only Social Security and public education (by percentage of GDP) in the United States welfare state (with police, firefighting, and Medicaid ranking behind it). In 2009, literally millions of independent and conservative voters were convinced to fight health care reform on the grounds that it damaged Medicare, the United States’ preeminent example of Socialism. Confusion reigns supreme!
But American politics likes when a program inspires schizophrenia, because it means American politicians can use the program like a weapon. During the aforementioned debate over health care reform, Republicans (who fought Medicare’s enaction in the 1960’s and have spent decades trying to kill it), used the cuts to Medicare against the Democrats. The Affordable Care Act provides for $500 billion worth of direct cuts, reimbursement changes, and quality programs to Medicare over a 10 year period. None of the cuts will deny coverage or service, focused as they were on reductions designed to force providers to be more efficient, and the elimination of subsidies for the Medicare Advantage Program. This idea sounds suspiciously like fiscal responsibility, but it was a convenient and well-used weapon in the conservative arsenal circa 2009.
Fast forward to 2011, and a Republican majority in the House of Representatives. The Republican Party passed a budget that would have privatized Medicare, issuing vouchers to citizens with which they could shop for private insurance beginning in 2019. If the Republicans had taken the Senate in 2010, the plan would have passed that body and been sent to President Obama. He would then have the option of vetoing the measure. It won’t become law, but it is important to state how far the measure got, because a legion of disingenuous commentators are now writing and reading posts about the “fear tactics” used by Democrats. I will not state that the Republicans tried to kill Medicare (this time); I will state that the Republicans came very near their goal of privatizing the program. And they aren’t done yet.
Senate Minority Leader Mitch McConnell has made cuts to the program a necessity before he will agree to raising the nation’s arbitrary and dangerous debt ceiling. That he voted five times to raise the debt ceiling under President Bush (along with Speaker Boehner) is, apparently, testament to his born-again fiscal responsibility. His approach isn’t new and represents nothing less than the true applications of his principles. Medicare is Socialism, Medicare is single-payer health care. Medicare is a sore on the body of conservative politics, and anathema to libertarians. Period. The idea that a Republican could look at a camera and state that Democrats are misleading Americans about conservative intentions for Medicare is ridiculous. They don’t like the program. They want the program privatized or eliminated…it has been a part of their party platform for 40 years now. This isn’t fear tactics, it is the truth. The notion that conservatives, they of purity tests and an apolitical ability to cling to their “principles”, won’t admit to their constituents what they want for Medicare is a scandal.
What I won’t say, is that Paul Ryan’s budget (recently defeated on the floor of the Senate with 40 out of 47 Republican Senators voting for the measure), is a scandal. It isn’t…well, most of it isn’t. Mr. Ryan’s inclusion, in a budget designed to pay down the debt, of a trillion dollars in tax cuts for corporations and wealthy individuals, is asinine. Republicans continue to insist that tax cuts pay for themselves, and the data continues to say they are wrong. The principle conservative argument defining the last 30 years, is that tax cuts increase revenues. But conservatives have ignored the real results of the Bush Tax Cuts and revenue totals from the 1980’s.
According to data provided by the Office of Management and Budget, and The Bureau of Economic Analysis, the results of tax cuts and tax increases stand in direct opposition to conservative ideology. In the six budget years that followed the Clinton tax increases of 1993 (and led to the balanced budgets at the end of last century), our nation’s economy grew by 40.45% (almost $3 trillion). In the six budget years that followed the first of President Bush’s two tax cuts, our nation’s economy grew by 32.13% (about $3.5 trillion). Tax receipts never recovered their 2000 peaks (as a percentage of GDP), and took 4 years to recover that level in actual dollars.
Those tax cuts, and the ideology that they spring from, are the major internal threat to Medicare. They didn’t grow the economy, they didn’t add jobs, they didn’t help middle income Americans, but they have created a major portion of the total current national debt. Representative Ryan proposed, and his House colleagues passed, a budget that cuts another trillion in taxes. Perhaps only God knows why. My bigger issue with his plan is that it doesn’t address the principle external threat to Medicare, and to every budget in our nation be they federal, state, local, or corporate; the inflation in health care costs.
In fact, medical inflation is one of the principal flaws in the Republican budget. The vouchers provided by the plan are scaled to inflation; not medical inflation, but base inflation. While this is reasonably from a purely budgetary perspective, it is the reason Democrats can accurately claim the plan rations health care. The reason our health care payment system needed (and still needs) reform, is that inflation in health care has been averaging 4 times that of base inflation. Vouchers will quickly become insufficient to cover the needs of our nation’s elderly. This is before we look at the reality of senior citizens shopping for private health insurance. The private health market for Americans below retirement age is already incapable of covering more than 85% of Americans, and that number was continuing to fall prior to the passage of the Affordable Care Act. It is entirely accurate to say that a minimum of 10% (and certainly more) of our nation’s senior citizens would (under the Republican plan) be unable to pay for medical care in the next decade.
Republicans may protest that they will receive medical care, and they would be correct…to a point. Americans not covered by insurance are treated for acute and critical conditions, stabilized, and released. They are not given the full range of intervention and rehabilitation that covered Americans are, and the providers are not paid for the services rendered. Mr. Ryan and other fiscally responsible (and I use that phrase advisedly) Republicans have a plan for safeguarding the Federal Budget, but it is remarkably similar to treating a fever with an aspirin only. It might be better to understand and treat the reason for the fever, lest the patient die from infection. This analogy, I am afraid, is not too severe in the context of this debate.
In casting the Medicare Villain, it is important that we not affix the wrong motivations, or accuse the reasonable of evil. Paul Ryan has, to his credit, been more than willing to engage his critics in reasoned debate. His efforts, had the Republicans elected a few more Senators, might have balanced the federal budget. But as conservatives often point out, what would the cost of that plan been to the economy? Today’s working class could ill-afford to pay for their parent’s health care cost, let alone their own in a world without true Medicare. Today’s hospitals, clinics, and providers are writing down as much as a quarter of their annual revenues due to services rendered the uninsured; what of tomorrow’s uninsured elderly, with their higher per capita costs? The real villain in the battle over Medicare is the politician who ignores the real problems while using the debate for political gain. Socialism or not, Americans want their Medicare, and are correct in their demands it be saved.
The Rational Middle is listening…