Suicide by Wonk

Sometimes It’s Simple: When I heard pollster Pat Caddell–who usually blasts Dems these days–say on Saturday that Rep. Paul Ryan’s budget plan was a near-suicidal act leading Republicans “off the cliff,” my initial instinct was to agree, especially regarding Ryan’s proposed Medicare changes. Here Republicans were winning the grinding debate over relatively small cuts in the federal discretionary budget. Democrats–the party that desperately needs to convince voters it can be trusted to get rid of $1.6 trillion annual deficits–seemed to be reflexively defending government bloat, measuring success by the amount of spending preserved the way antipoverty activists measure success by the number of people on the dole. 

But I’ve now read David Brooks (who thinks Ryan’s proposal is a “pivotal moment of truth” that “set the standard of seriousness”) and Ezra Klein (who thinks “Ryan gets to set the parameters of the debate. He won’t achieve all of what he wants, or even much of it. But he’ll get partway there”)  and Ross Douthat  (“brutally honest with the American people”)  and Reihan Salam (it starts “an interesting conversation”)- and, having read all that, and the Medicare provisions in Ryan’s plan, I have to reluctantly conclude that it’s … a near-suicidal act that will lead Republicans off the cliff. Voters like Medicare, for good reason. It provides them with more security than the alternatives. The threat to Medicare is a big reason why they reject Obamacare. So the GOP strategy is to replace Medicare with something that looks a lot like the private insurance exchanges in Obamacare. Huh? …

  • joeedh

    Ryan’s plan is a brilliant tactical move. He’s showing the Republican base what “no new taxes” really means. This will help head off a tea party revolt when the Republican and Democratic leadership craft their inevitable compromise.

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  • Edgar99

    As noted above, the Ryan plan does not affect anyone currently on or within 10 years of getting Medicare. While it may hack off those of us who will suffer the taxation used to provide this largesse, it won’t be all sweetness and light for Medicare beneficiaries either with or without the Ryan plan. No doc-fix will ever be sufficient to allow beneficiaries to continue to receive health care services in the manner to which they are accustomed. “Accountable care organizations” are just warmed over HMOs and that is all anyone is going to have access to. Say bye to doctors and hello to PAs and Nurse Practitioners. Say good bye to registered nurses and hello to LPNs. The extra cost to being a beneficiary under a Ryan style plan will likely be worth it in terms of better networks and easier access to care than what will exist under traditional Medicare.

    • joeedh

      Why do people admire primary care doctors? After many years of being invisibly disabled, I have found them utterly useless (the single appointment I had with a nurse practitioner impressed me with her competence, probably because she has enough time to adequately deal with patients).

      I’ll go further. 80% of Primary care doctors are criminally incompetent, and if I was vindictive I’d go around suing the many, many doctors who ripped me off with useless service.

      I mean, some of the dead simple things that were wrong with me that no one caught! Ugh!

      • joeedh

        Not that I’m in favor of rationing useful care. Primary care physicians do not fall into that category, however; if they were all exiled to Canada and we had to rely on NPs, I don’t think anything bad would happen, and, after we trained more NPs, things would get better.

        (you can probably tell I have emotional issues with doctors :) )

  • The_anniebanannie

    “The threat to Medicare is a big reason why they reject Obamacare”

    You really haven’t been paying much attention, have you?

    • HC68

      On the contrary, he’s right about the Medicare cut Obama and Co. proposed being a major issue with the collapse of popularity in Obamacare, I watched it happen as I followed the debate, I breathed a sigh of relief because I think Obamacare is a total disaster, and the realization that it threatened Medicare helped turn the public against it.

      That’s why the public opinion polls, late in 2010, for the first time pretty much in the history of polling, reported the that public trusted the GOP more on Medicare than the Dems, for the first time the Dems were perceived as being the greater threat of cutting it.

      Now Paul Ryan has thrown that advantage away, as Caddell accurate noted.

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  • Nathan_of_brainfertilizer_fame

    Mickey sez: “Voters like Medicare, for good reason. It provides them with more security than the alternatives. The threat to Medicare is a big reason why they reject Obamacare. So the GOP strategy is to replace Medicare with something that looks a lot like the private insurance exchanges in Obamacare. Huh?”

    Okay, so turn it around. How do Democrats block this plan?

    “Um, the evil GOP is going to take away your Medicare by, um…a plan that is similar to, uh, Obamacare that we used procedural tricks to pass….the difference being the GOP plan actually, uh, reduces the deficit instead of increasing them…ahem”

    Ryan is also clearly taking the long view: he’s young, and he’s seen how Sarah Palin managed to influence the national narrative more since she’s not in office. If he gets tossed out by WI for getting this plan passed, he can move to nearly any relatively conservative state and be a favorite for Governor or Senator almost immediately, or stay out of campaigning be free to influence politics while burnishing his “Man With a Workable Plan” credentials for a Presidential run.

    Finally, the beauty of this plan is if Democrats oppose any 2-3 items, it is easy to then claim the Democrats agree with the rest…so the GOP gives up those 2-3 items in exchange for Dem concessions elsewhere, and the bill gets passed and just takes 3-4 years longer to end the deficit. Or if Democrats attempt to oppose ALL the items, the GOP can accurately portray the Dems as fundamentally unserious and unwilling to make any cut in unnecessary spending to improve the economy.

    I don’t see how the Democrats can turn this into a winner at the ballot box for themselves.

    • HC68

      It help the Dems by taking away the _advantage_ Obamacare and the corruption and incompetence on display around its enactment gave the Republicans. If BOTH parties represent a threat to Medicare, the GOP edge on the subject is wiped away.

      Further, the GOP is already tarred (half-legitimately and half-mendaciously) as being ‘the part fo the rich’, they’ve struggled with that for years, from the POV of elderly Medicare recipients, this looks a lot like confirmation of that, while the Dems have a (mostly unjustified and bogus) reputation from the past as being the ‘party of the little guy’. So the GOP operates with one strike against them in government spending debates before it even starts, and this plays into that.

  • Jess81

    The writer here needs to seriously get off the “accepted wisdom” train and onto the reality one. Please remember that “accepted wisdom” said an extreme left wing guy who cheated his way to the top through the back rooms of Chicago couldn’t be elected president. Please remember that most of us didn’t think legislating by fiat and ignoring court orders (drilling in the Gulf) couldn’t happen; please remember that before Obamacare, we didn’t think the Congress could get away with disposing of all rules and use taxpayer money to bribe members for votes and refusing to let members even SEE a bill before it was voted on could have never happened in our Constitutional system. Please remember that the President lies daily. Witness his promise YESTERDAY to hold meetings continuously until Friday to keep the gov open and today he’s going to a fundraiser (that we’re paying for, please).

    And then it’s time every speech, every article, every talking head starts every conversation about this with the FACT that Ryan’s proposal won’t affect anyone over 55 and a brief summary of what will actually happen when China stops buying our debt…like there will be a PERMANENT shutdown and no one will get checks for anything unless the Fed prints more money…AND follow that with a brief description of the left-wing (make sure you say that because the left is rewriting history about who exactly made up the Wymar Republic) Wymar Republic needing a wheelbarrel full of cash to buy a loaf of bread.

    There are two charts necessary to this debate. One shows the trajectory of the Obama budget. One shows the deficit skyrocketing in two years. When they talk about starving old people, ask how many were starving BEFORE Obama…and, BTW, if someone is too feeble to feed themselves, they need to be in an assisted living place, not at home (I had NO idea we were doing that!). And “tax breaks” for oil companies? Are these bozos actually going to get away with saying they support further increase in gas prices to save PBS and an abortion clinic that practices EUGENICS!!!!! (talk about real racism–why isn’t that the first line of every, single conversation about Planned Parenthood).

    And commercials. We need hard-hitting commercials like this one: http://www.youtube.com/watch?v=662R2awSwPQ These commercials need to remind the American people of the daily outrages of this Administration and Pelosi and Reid. Cover EVERYTHING from the total incompetence in the Gulf oil spill; shutting down our drilling while financing Brazil’s; prosecuting 3 Navy SEALS for supposedly hitting a terrorist who cut off the head of an American contractor; support of Islam and degrading Christians; 2400 page bills passed without reading; George Soros; Israel….there are so many unspeakable acts by this new Democrat Party, American has got to rise and kick the communists (Progressives, if you like) back to the dark recesses of infamy and evil they came from.

    The lines have been drawn and weasely same-old, same-old tactics like avoidance is more than a messaging problem: it’s literally the end of freedom and liberty…it means we get to be a 3rd World country, controlled by Imams and Mexican drug cartels…financial collapse is happening while I write this. 3 years ago, the Democrats decried Drill Now because it would “take too long”. Too long has arrived and the incompetent, weak sister in the White House IS the driving force that is collapsing the Middle East. That’s another “freedom” fight that is a total lie. Already the animals who raped a that woman in Egypt are coming under the banner of the oh, so “moderate” Muslim Brotherhood and NBC is still carring CAIR’s water.

    We are on the verge of total collapse. And I will NOT wear a burqua…and I’ve watched John Wayne movies so when the revolt against tyranny begins, I won’t be a Lybian rebel firing my gun into the air like an insane 10 year old playing with fireworks.

  • AJsDaddie

    “FIRST you reform the underage (<65) health care system, make it universal, force insurance companies to offer all comers a universal basic plan at basic rates,"

    The devil is in the details. What is covered in this "basic" plan? And how much does it cost? Does the basic plan cover cancer treatments? How about bariatrics? Heart transplants? If it doesn't cover those sorts of things, then you really aren't giving any sort of universal coverage, are you?

    And then how much does this cost? Who determines the payout? The insurance companies won't do it if there's no profit, and there's no payout unless you charge the healthy to pay for the sick. You might want to look into your Swiss system a little more closely. It doesn't provide dental or vision benefits, or even semi-private rooms and costs $300 to $400 a month per adult (and more than $50 per child). You pay additional for things like semi-private rooms. Thus, families can easily pay $1000 a month for pretty much basic coverage. Where do you think we're going to get $1000 a month for all the families in this country, when nearly half of them already pay no income taxes? Are you expecting to charge working families $2000 a month to get a plan that doesn't even cover vision and dental?

    Things look good until you actually do the math.

    • jvanke

      Good questions. I’ve answered them all!

      Absolutely right about devil in details. In Switz. or Neth. or both, there is an annual three-way negotiation of premiums and reimbursements. (And yes, ALL the basics are covered — citizens in those countries are not complaining about lack of coverage, except I’m sure for some rare diseases and/or experimental stage treatment, which will ALWAYS be an issue, in any private or state coverage.) The three annual negotiation parties are providers, insurers, and people-government. The third of those can include representatives from all major parties. (Both countries have multi-party political systems.)

      In both of those European countries, the insurance companies make their money by selling extra features, choice, etc. to customers who want and can afford it.

      47% of adult Americans pay no Federal income tax. But all working Americans pay Social Security and Medicare withholding. Same would be true for health insurance under a universal coverage. (BTW, this is why Obamacare is requiring employers to show employees the full employer cost of health care — so that employees know their total compensation for employment, in case employers cut coverage, so that employees know this is a huge pay cut and can react accordingly.)

      From the first dollar you earn in my scheme, you contribute 9% to health insurance coverage. For each dollar above 150% of the poverty level, you pay 22% (until your premium is paid in full). Any remainder is subsidized by the other c.80% of Americans. (Means-testing would include assets — more than a couple months’ bills in assets, and your premium subsidy gets lower or eliminated — so the comfortable savings temporarily unemployed from high-paying jobs don’t get subsidized.)

      (Note: except the super-rich and/or those whose income is mostly long-term capital gains, Americans pay an aggregate nearly flat tax of 45%-49%, from the poorest decile to the top 1%. I’ll lay out the research and math for that in a book I’m writing this year on consensus / centrist policy solutions for the U.S. Those aggregate flat rates are derived from all taxes paid at local, state, and Federal levels. I had ABSOLUTELY NO IDEA the math would produce those results when I ran the numbers from extensive Federal and state-local data. The flat-rate outcome is stunning: http://thislandvotes.com/uploaded_images/income-group-tax-rates-775905.bmp )