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"Entitlement Reform" Is a Euphemism For Letting Old People Get Sick and Die

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George Orwell would be proud. The latest Washington catchphrase deserves a place of honor in the 1984 lexicon, right between "War Is Peace" and "Love Is Hate." It's a virus of the language that's spreading faster than the stomach flu.

"The President's budget punts on entitlement reform," reads a statement by House Republicans. "Our budget will lead where the President has failed, and it will include real entitlement reforms." "You have to do entitlement reforms if you are serious about this budget," says Rep. Paul Ryan.

Reality check: Nobody's proposing 'entitlement reform.' That term is a cloaking device for some very ugly intentions. It's a meaningless manufactured phrase cooked up by some highly-paid consultant, and it diminishes the sum total of human understanding every time it's used. The phrase is a euphemism for deep cuts to programs that are vital and even life-saving for millions of elderly and poor people, but it's politically unpalatable to say that. So it became necessary to come up with yet another cognition-killing term designed to numb us from the human toll of our political actions. "Entitlement reform" is the new "collateral damage."

But this time the collateral damage is us.

Orwell's Children

Gotta hand it to 'em. This phrase is a masterstroke that's successfully concealing a brutal plan to slash funds for Social Security, Medicare, and Medicaid. Whoever crafted it did a hell of a job. "Reform" carries positive overtones of courage, and change, improvement, while the word "reformer" has been applied to great heroes like Teddy Roosevelt or Lincoln Steffens who fought for the powerless and the victimized.

And the term "entitlement" resonates with that word's other meaning - selfishness and the greedy assumption that one deserves to be served by others (as in "he acts so entitled)." It even appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose psychiatric problems, as one of the characteristics of "Narcissistic Personality Disorder":

"Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations."

It's number five on the list of diagnostic criteria, right between "requires excessive admiration" and "is interpersonally exploitative i.e., takes advantage of others to achieve his or her own ends." Besides being the perfect description of a politician, it's also the ideal rhetorical fit for a crowd that says the elderly are "greedy geezers" for wanting to receive the Social Security benefits they've paid for all their lives -- or for not wanting to die because they can't afford medical attention.

Every time the phrase is used a subliminal message is transmitted: Americans who oppose cuts to Medicare or Social Security - a group which includes 75% of Republicans and 76% of Tea Partiers - meet the clinical criteria for a serious emotional disorder (It's DSM-IV-TR, diagnosis 301.81, in case you're wondering.)

Got it, America? The Republicans and the media aren't just saying you're selfish. They're subliminally implying you're mentally ill.

More Copy, Less Filling

Given this phrase's slanted messaging and misleading overtones - not to mention the fact that it's, you know, completely inaccurate - it was probably inevitable that it would quickly become a stock journalistic catchphrase:

"Geithner played down the need to move instantly on entitlement reform ..." "... "Pawlenty made a few comments about entitlement reform after the book-signing." "Boehner joined a chorus of Republicans in criticizing Obama's failure to take on entitlement reform ..." "Christie said it had become a "political strategy" for Republicans to ignore reforming entitlement programs."

"Entitlement reform" is seventeen characters long, after all. That makes seventeen less characters reporters have to think up for themselves. The headline writers are getting in on the act, too, even though "benefit cuts" takes less precious header space and is far more accurate:

"Obama Hints At Priorities For Entitlement Reform." "Obama: I didn't punt on entitlement reform." "House Republicans announce they'll include entitlement reform in 2012 budget." "Eric Cantor said the Republican `'prescription' on entitlement reform would be included in budget proposals."

On and on it goes. It wasn't long ago that nobody had heard the phrase, and now it's everywhere. Yet nobody stops to wonder where it came from or why its being used. And with each repetition the human stakes in this debate fade further and further from view.

Democrats' Deficit

The Democrats are already waving the white flag in this war to shape perceptions, once again buying into a reality-altering phraseology instead of challenging it. The public is overwhelmingly opposed to cutting Social Security or Medicare, but instead of pointing out the stark reality behind this euphemism Dems are negotiating terms of surrender.

Rather than unabashedly defending government's role, the President has too often effectively conceded that it's grown too big. He created a Deficit Commission (not, for example, a Jobs Commission) and appointed two stalwart "entitlement" haters (Bowles and Simpson) to co-chair it. When the Commission became hopelessly gridlocked and collapsed under its own weight, failing to produce a report, the co-chairs produced a Potemkin proposal that the media continues to obligingly (and falsely) describe as "the Deficit Commission plan."

Recently the Administration's made some very welcome moves to back away from politically poisonous "entitlement" cuts. But the co-chairs' draconian proposal lurches on like a legislative Frankenstein, indifferent to whatever its creator's current wishes may be and helped by a few Democratic Senators intent on making the brutal implications of "entitlement reform" a reality.

"Senate Democrats began drafting a plan Thursday to slice billions of dollars from domestic agency budgets over the next seven months, yielding to Republican demands to reduce the size of government this year," reports the Washington Post. And some are pushing the right-wing wagon harder than others. Reports indicate that Sen. Dick Durbin is fighting hard to include Social Security cuts in budget negotiations.

If you can't beat 'em, join 'em. And even if you can beat 'em, because the public overwhelmingly wants these programs preserved, what the hell. Join 'em anyway.

A humanitarian disaster

The Administration now says that discussion of Social Security should be separated from deficit talks. While they're still leaving far too much room for an unnecessary and unfair deal, they're absolutely right. The President should be commended for reinforcing the fact that Social Security doesn't present a threat to the government's budget. It's a self-funded program that's forbidden by law from increasing the deficit.

Medicare and Medicaid are the real long-term deficit threat. Unfortunately, all that's being proposed are cuts, not reforms. There's a big difference. Republican proposals mimic those that have been circulating in the Bowles/Simpson crowd (which includes other recipients of billionaire Pete Peterson's largesse like economist Alice Rivlin), taking three basic forms: a "voucher" system, caps on spending, and benefit changes like higher co-payments and premiums that shift more cost back to individuals. The "voucher" would force people to use government chits of ever-diminishing value to purchase private health insurance on the open market, while spending caps and benefit changes would place an ever-increasing financial burden on already strained household budgets.

The human toll of these proposals would be terrible. Medicare saves millions of lives every year and keeps millions of people healthy and active. How do we know that? One of the best studies of Medicare's impact on the health of the elderly found "strong support for the hypothesis that Medicare increased the survival rate of the elderly by about 13 percent." Medicare serves 45 million Americans as of 2008, of whom 38 million are elderly. That means that nearly five million people didn't die last year because they had Medicare. What's more, the study found that Medicare led to "a reduction in days spent in bed of about 13 percent."

Health care costs are skyrocketing in this country. Shifting more of those costs onto retired people with fixed income (and poor people) would be an economic catastrophe and a humanitarian disaster. A number of studies have shown that people reduce their use of essential as well as non-essential medical care when they can't afford it and that, especially for the elderly, the result is more illness and more death.

That's the Dickensian reality being masked by the innocuous phrase "entitlement reform."

Reform this

Real reform would have to comprehensively address our broken health care system, whose costs are far higher than those of comparable countries. To truly "re-form" US healthcare we would need to address those differences that make it more expensive, which include higher physician incomes, prescription drug usage, and for-profit hospital chains. It would require changing an incentive structure in which health providers make more money doing expensive procedures for people who don't need them than they do providing needed services to others. And it would require addressing the high costs of administration, overhead, and profit caused by our reliance on private health insurance companies.

But nobody wants to take about real change like these, so they use phrases like "entitlement reform" that mask the true agenda: Keeping taxes low for the wealthy and protecting for-profit health corporations by shifting the burden to people with less political clout. And by "people with less political clout," you know who I mean:

Us.

The un-reform

The noun "reform" is defined as "action to improve social or economic conditions without radical or revolutionary change." Entitlement reform" is the mirror image of this definition: It's genuinely radical change that worsens social and economic conditions.

And yet the phrase continues to be repeated thousands of times a day, as if it had real meaning or value. And with each repetition the ugly reality behind it grows fainter and fainter, retreating farther and farther into a misty world of illusion where you won't have to see it again ... until you're old and sick, and it suddenly becomes terribly real.

But by then it will be too late.

[CORRECTION: We originally mistyped "Alice Simpson" for "Alice Rivlin" and have since corrected it. D'oh!)

Richard (RJ) Eskow, a consultant and writer (and former insurance/finance executive), is a Senior Fellow with the Campaign for America's Future. This post was produced as part of the Strengthen Social Security campaign. Richard also blogs at A Night Light.

He can be reached at "rjeskow@ourfuture.org."

Website: Eskow and Associates

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