Didn't Obama cut like, hundreds of billions of dollars from Medicare as part of the ACA? What is this "medicare as we know it" business? Surely it's a moving target.
Paul Ryan's plan is to scrap the entire program and replace it with coupons for private insurance. Coupons which would, in many cases, be insufficient to purchase coverage. Medicare, which provides efficient coverage to all seniors, and which has drastically reduced the poverty rate in our elderly population, would cease to exist. There would be a program called Medicare, but it would have none of the functionality, structure, or benefits of Medicare.
No, the cuts to Medicare in Obamacare are likely to be reductions in hospital reimbursement or something similar, not cuts in benefits. (or as your TPM link puts it, "The Independent Payment Advisory Board, or IPAB, may only propose cuts to providers, not beneficiaries. ") Because that totally makes economic sense, that you can just keep paying less and less for the same services without any consequences! Apparently that's not the kind of cuts we should worry about, that's "slowing the growth".
Nobody who actually thinks about it for a long time can possibly believe that Medicare can stay the way it is longterm without big changes in the way we fund it. Fundamentally, either that means raising taxes or cutting service. "Medicare as we know it" is an unsustainable, ever-growing beast. It's a service that does a great amount of good for a lot of people, but its costs are a problem that both thinking Democrats and thinking Republicans have to acknowledge.
Cutting payments to providers is how private insurance does it. Far more deeply than Medicare. Sometimes below cost.
But yes, doctors and hospitals are getting squeezed, and it's not good. We need serious health reform, and we couldn't get it through Congress. Cutting private insurers out of the system would have gone a long way towards fixing a lot of problems.
And, again, Ryan's plan keeps all the cuts in the ACA (while throwing the rest of the bill out). At least until he does away with all of Medicare.
Medicare needs some changes. The ACA is a start. Our entire health care system needs even more changes. As a nation, we're spending a higher portion of GDP on health care than just about any other first world country, and we're getting a lower quality of care for it. While Medicare's costs are rising, they're doing so more slowly than private insurance. There are things which can be improved with Medicare, but it's the whole system that needs to be overhauled. Throwing Medicare away, as Ryan wants to do, is not the solution.
As for Medicare's costs - are you including the giant unfunded Part D prescription coverage passed by Republicans?
Well, cutting payments to providers is indeed sometimes how private insurance cuts costs. Sometimes it finds cheaper alternative providers. Sometimes it also cuts services. Of course, Obamacare creates a list of services that MUST be provided by insurers, cutting out that possibility as a cost-saving mechanism in some cases.
I'm not sure why you think that arguing that Ryan also keeps the cuts in the ACA is an effective argument to me. I have never argued that Ryan supports 'Medicare as we know it'. In fact, it reinforces my point that neither Obama nor Ryan is committed to 'Medicare as we know it.' They're both committed to squeezing providers to save money on health care costs.
This argument needs to take place on its merits of two alternate plans. Claiming that Obama is committed to preserving 'Medicare as we know it" while Ryan is committed to destroying it is as ludicrous as Obama's consistent claims that anyone with pre-Obamacare health insurance would be able to keep their exact plan. These are two different plans for how to pay for healthcare. One pushes more cost onto individuals, and the other attempts to push more costs onto rich people. Both squeeze health care providers. Both attempt organizational cost-saving changes. Either way, the fundamental is unchanging- if a person wants better healthcare, somebody at some point has to pay for it.
As far as the root question of whether Medicare really needs saving, the economic arguments here are deep, complicated, and entangled. The US can keep borrowing money indefinitely to sustain spending programs- until the moment it can't. I can't tell you when that will be. Everybody in Italy and Spain and Greece knew that their spending programs were fundamentally unsustainable, also, but nobody there knew when the piper would come calling. It might be that we get lucky and are able to sustain our super-cheap borrowing rates until we get out of the recession, that the moment of truth won't come until we're in better economic shape and able to confront it less painfully. But if that moment of truth comes and the dollar collapses while we're already in tough economic times, it'll be a lot harder to dig out of if we don't start cutting back now.
My gut suspicion is that because of Europe's trouble, we're good to keep borrowing like this for a few more years. The US treasury bond is going to be considered the safest place to park money as long as China's government is unpredictable and dangerous to Western corporations and the Euro Zone can't figure out how to unify their monetary policy. My desperate hope is that Obama or Romney, we'll be out of the woods in three or four more years. So maybe you're right. Maybe we can keep borrowing like this and just rely on the natural turns of the economic cycle and the US's prime position on the world stage to bull ourselves through our inflating debts until we're in a better position to depreciate them.
But I find that proposition hella scary. Especially since when I try prognosticating further than three or four years down the line, I invariably end up with China more liberal and more economically dominant and the US no longer in a position to keep amassing debt.
My original point was that Ryan wants to get rid of Medicare. Your response was that Obama wanted to cut Medicare. So, among other things, I pointed out that Ryan isn't on any better footing because, even as the Romney/Ryan campaign criticizes Obama for those cuts, they've adopted those very cuts in their own plan... and then taken them much, much further.
I feel like every time I've responded to you here I've had to carry on two simultaneous conversations - the one I thought we were having and the one where you move off on a new and different tangent.
"Medicare as we know it" is a system which provides health care to seniors through a government-run plan. A very popular and successful plan which has drastically reduced the poverty rate amongst our seniors. The ACA made some back-end changes to it, but preserves the seniors' user experience. They still get their same plan, still get their same benefits.
The Ryan plan is to scrap that entirely. No more benefits from the government. No more publicly backed guarantee. Instead, you get a coupon, which may or may not be enough to get you anything, and good luck to you being dumped back into the private market. Medicare is gone.
That's the difference.
As for our debt - blame Republicans for that. The major contributing factors are the unfunded Bush tax cuts, the unfunded wars, the unfunded Medicare Part D, the unfunded expansions on military and defense spending (aside from the wars), and the economic downturn which was in part caused by deregulation and lack of oversight. But at least, thanks to the stimulus (the effects of which on our deficit are tiny compared to the Bush tax cuts), we're on the road to recovery. Or were, until Republicans refused to extend measures like unemployment benefits. Still, we're in far better shape than Europe, which chose the opposite path of austerity.
So yeah. We have some tough decisions to make. We need to increase revenue by letting the tax cuts expire, cut spending on defense (even the Pentagon says that, but Congress is afraid to look soft to their constituents, and the contracts to build expensive weapons go to large companies with well-funded lobbyists), and encourage more long-term growth by investing in our sadly-neglected infrastructure (creating jobs and getting money moving in the process).
Medicare isn't the problem. And you can't blame it for the flaws in our system which should have been fixed, if only Republicans hadn't held the ACA and other provisions back through unprecedented levels of obstructionism.
And please, when you're going off on a tangent, don't put words in my mouth.
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From:
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Paul Ryan's plan is to scrap the entire program and replace it with coupons for private insurance. Coupons which would, in many cases, be insufficient to purchase coverage. Medicare, which provides efficient coverage to all seniors, and which has drastically reduced the poverty rate in our elderly population, would cease to exist. There would be a program called Medicare, but it would have none of the functionality, structure, or benefits of Medicare.
TPM has a good quick overview of the differences.
It's also worth noting that while Ryan wants to repeal the ACA, his plan is to keep the Medicare cuts.
From:
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Nobody who actually thinks about it for a long time can possibly believe that Medicare can stay the way it is longterm without big changes in the way we fund it. Fundamentally, either that means raising taxes or cutting service. "Medicare as we know it" is an unsustainable, ever-growing beast. It's a service that does a great amount of good for a lot of people, but its costs are a problem that both thinking Democrats and thinking Republicans have to acknowledge.
From:
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But yes, doctors and hospitals are getting squeezed, and it's not good. We need serious health reform, and we couldn't get it through Congress. Cutting private insurers out of the system would have gone a long way towards fixing a lot of problems.
And, again, Ryan's plan keeps all the cuts in the ACA (while throwing the rest of the bill out). At least until he does away with all of Medicare.
Medicare needs some changes. The ACA is a start. Our entire health care system needs even more changes. As a nation, we're spending a higher portion of GDP on health care than just about any other first world country, and we're getting a lower quality of care for it. While Medicare's costs are rising, they're doing so more slowly than private insurance. There are things which can be improved with Medicare, but it's the whole system that needs to be overhauled. Throwing Medicare away, as Ryan wants to do, is not the solution.
As for Medicare's costs - are you including the giant unfunded Part D prescription coverage passed by Republicans?
Oh, and let's not forget that Medicare's imminent doom has been cried for decades, and yet it's still functioning as well as ever. Not everyone agrees it's going bankrupt now.
Yes, it needs serious, thoughtful review. Not just taglines and not just politics. I hope we can get that.
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I'm not sure why you think that arguing that Ryan also keeps the cuts in the ACA is an effective argument to me. I have never argued that Ryan supports 'Medicare as we know it'. In fact, it reinforces my point that neither Obama nor Ryan is committed to 'Medicare as we know it.' They're both committed to squeezing providers to save money on health care costs.
This argument needs to take place on its merits of two alternate plans. Claiming that Obama is committed to preserving 'Medicare as we know it" while Ryan is committed to destroying it is as ludicrous as Obama's consistent claims that anyone with pre-Obamacare health insurance would be able to keep their exact plan. These are two different plans for how to pay for healthcare. One pushes more cost onto individuals, and the other attempts to push more costs onto rich people. Both squeeze health care providers. Both attempt organizational cost-saving changes. Either way, the fundamental is unchanging- if a person wants better healthcare, somebody at some point has to pay for it.
As far as the root question of whether Medicare really needs saving, the economic arguments here are deep, complicated, and entangled. The US can keep borrowing money indefinitely to sustain spending programs- until the moment it can't. I can't tell you when that will be. Everybody in Italy and Spain and Greece knew that their spending programs were fundamentally unsustainable, also, but nobody there knew when the piper would come calling. It might be that we get lucky and are able to sustain our super-cheap borrowing rates until we get out of the recession, that the moment of truth won't come until we're in better economic shape and able to confront it less painfully. But if that moment of truth comes and the dollar collapses while we're already in tough economic times, it'll be a lot harder to dig out of if we don't start cutting back now.
My gut suspicion is that because of Europe's trouble, we're good to keep borrowing like this for a few more years. The US treasury bond is going to be considered the safest place to park money as long as China's government is unpredictable and dangerous to Western corporations and the Euro Zone can't figure out how to unify their monetary policy. My desperate hope is that Obama or Romney, we'll be out of the woods in three or four more years. So maybe you're right. Maybe we can keep borrowing like this and just rely on the natural turns of the economic cycle and the US's prime position on the world stage to bull ourselves through our inflating debts until we're in a better position to depreciate them.
But I find that proposition hella scary. Especially since when I try prognosticating further than three or four years down the line, I invariably end up with China more liberal and more economically dominant and the US no longer in a position to keep amassing debt.
From:
no subject
My original point was that Ryan wants to get rid of Medicare. Your response was that Obama wanted to cut Medicare. So, among other things, I pointed out that Ryan isn't on any better footing because, even as the Romney/Ryan campaign criticizes Obama for those cuts, they've adopted those very cuts in their own plan... and then taken them much, much further.
I feel like every time I've responded to you here I've had to carry on two simultaneous conversations - the one I thought we were having and the one where you move off on a new and different tangent.
"Medicare as we know it" is a system which provides health care to seniors through a government-run plan. A very popular and successful plan which has drastically reduced the poverty rate amongst our seniors. The ACA made some back-end changes to it, but preserves the seniors' user experience. They still get their same plan, still get their same benefits.
The Ryan plan is to scrap that entirely. No more benefits from the government. No more publicly backed guarantee. Instead, you get a coupon, which may or may not be enough to get you anything, and good luck to you being dumped back into the private market. Medicare is gone.
That's the difference.
As for our debt - blame Republicans for that. The major contributing factors are the unfunded Bush tax cuts, the unfunded wars, the unfunded Medicare Part D, the unfunded expansions on military and defense spending (aside from the wars), and the economic downturn which was in part caused by deregulation and lack of oversight. But at least, thanks to the stimulus (the effects of which on our deficit are tiny compared to the Bush tax cuts), we're on the road to recovery. Or were, until Republicans refused to extend measures like unemployment benefits. Still, we're in far better shape than Europe, which chose the opposite path of austerity.
So yeah. We have some tough decisions to make. We need to increase revenue by letting the tax cuts expire, cut spending on defense (even the Pentagon says that, but Congress is afraid to look soft to their constituents, and the contracts to build expensive weapons go to large companies with well-funded lobbyists), and encourage more long-term growth by investing in our sadly-neglected infrastructure (creating jobs and getting money moving in the process).
Medicare isn't the problem. And you can't blame it for the flaws in our system which should have been fixed, if only Republicans hadn't held the ACA and other provisions back through unprecedented levels of obstructionism.
And please, when you're going off on a tangent, don't put words in my mouth.