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Richard (RJ) Eskow

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Three Hidden Time Bombs in the GOP's Medicare Budget

Posted: 03/21/2012 10:04 pm

By now most people have heard some of the worst things about the Republican budget proposal -- commonly called the "Ryan plan" and unironically described by the GOP as "the Path to Prosperity": That it decimates programs for middle class and lower-income Americans while giving even greater tax breaks to the rich -- $3 trillion worth, in fact. That it guts education, research, and transportation while preserving tax breaks for Big Oil. That it undercuts Medicare with a voucher system that will be worth less and less with each passing year.

And that, despite all that, it would actually increase the deficit.

You'd think that pretty much covers it -- but it doesn't. When it comes to Medicare, there are three more ugly facts about this plan that have yet to attract widespread attention -- mostly because the Republicans have done their best to keep them secret:

1. They're secretly planning to raise the Medicare age.

It's not in House Budget Chair Paul Ryan's Wall Street Journal editorial, the one where he sneered at "some who would distort for political gain our efforts to preserve programs like Medicare" and said "our plan provides guaranteed coverage options financed by a premium-support payment." It's not in the summary description of the GOP budget, which claims it "strengthens health and retirement security by taking power away from government bureaucrats and empowering patients instead with control over their own care." It's not even in the full budget document itself, which is 99 pages long and contains a section entitled "Strengthening Health and Retirement Security."

So how do we know that the GOP wants to raise the Medicare eligibility age from 65 to 67? Because that's what Ryan and his staff told the Congressional Budget Office when they asked the CBO to calculate the impact of their plan. It's right there in the CBO report on the budget.

Here's the key sentence: "In addition, the eligibility age for Medicare would increase by two months per year beginning in 2023 until reaching age 67 in 2034."

That's right: When Ryan and his staff instructed the CBO to calculate the impact of the Republican budget, they told its analysts that the GOP plan included an increase in the eligibility age for Medicare. Apparently they didn't have room to mention that fact anywhere in their 99-page document, and didn't see fit to bring it up while they were spouting all that rhetoric about "preserving entitlement programs for the future."

The Republican Party intends to raise the Medicare age for people as they approach the costliest years for receiving health insurance, and they're keeping it a secret from the public. This change alone would indirectly cut Social Security benefits by as much as 45 percent, by forcing seniors to spend that much of their benefit check on additional health care costs.

And remember, the GOP wants to raise the eligibility age for Social Security, too. The net effect of these two changes means that older Americans would be forced to keep working -- or looking for work -- at an age when their medical expenses would make hiring them prohibitively expensive for employers who offer health insurance. They would be forced to try purchasing health insurance on the open market.

Which gets us to our second dirty secret ...

2. Insurers will get to set their own rates.

The Ryan plan lets private, for-profit health insurers set their own rates -- rates which, according to the Ryan plan, will determine the Federal budget for senior health. It doesn't say that, of course, but that's how it would work.

According the the GOP's proposal, "All plans... would participate in an annual competitive bidding process ...The second least expensive approved plan... would establish the benchmark that determines the premium support amount... Program growth would be determined by the competitive bidding process..."

What does that mean in English? That Medicare goes away, to be replaced by a system of private health insurance companies who'll be paid to provide services that are supposed to (but won't) resemble the level of coverage seniors currently receive under Medicare. That health insurers would submit their bids to provide those services once a year.

And then comes the surprising part: The Federal government's expenditures for senior health care will be determined by the private insurers themselves, because the second-lowest bid establishes what the government is willing to pay for health insurance.

How crazy is that? Private health insurance rates have been climbing at three and four times the rate of today's Medicare. They've shown no ability to restrain costs -- and have no motive to do so, since they make money the old fashioned way: on the mark-up. And now they -- or the lowest bidder among them -- will dictate what the government must pay.

The plan says so, very clearly. "As opposed to pegging the growth rate to a predetermined formula," the GOP document say, "competitive bidding offers the ideal means of harnessing the power of choice and competition to control costs, while also securing guaranteed affordability for patients." In other words, the Republican Ryan plan places budgetary control for a major government program in the hands of the very insurance companies that profit from it.

At least that's what it would do, if they didn't contradict themselves in the very next paragraph.

3. The GOP plan radically cuts per-person spending for Medicare.

Remember that sentence we just quoted, the one about not pegging the growth rate to a predetermined formula? They totally lied about that. The plan does peg the growth rate to a predetermined formula, and Ryan's staff were very specific about it in their instructions to the CBO: "Total spending would grow in subsequent years," the CBO was told, "with nominal growth in per capita GDP plus 0.5 percentage points per year."

That's a "predetermined formula." And it's important to note that "nominal growth in per capita GDP" is not the same as the the growth in per capita health care costs, which have risen much more quickly than general inflation or GDP. That amounts to a major cut in benefits every year.

It gets even worse. The "per capita GDP" applies to everybody in the nation, not the ever-swelling ranks of Medicare-eligible seniors. This gets technical, but here's what it means: After this formula takes effect in 2023, there will be much faster growth in the Medicare-eligible age group than in the overall population. By structuring their formula this way the Republicans have ensured that there will be dramatic benefit cuts, especially as the "age wave" of Baby Boomers retires in the 2023-2030 period.

The "predetermined formula" is itself a secret, since they said there wasn't one. And the way it's structured will lead to dramatic cuts in Medicare.

Three-Pronged Attack

While the contradictions and evasions make exact forecasts difficult, it's clear that the net effect of these three changes would be to create a budget-busting giveaway to rich insurance corporations while at the same time slashing health coverage for seniors. And this isn't some radical ideologue's manifesto: it's the Republican Party's official Medicare proposal.

One terrible plan, three dreadful secrets. Presidential candidate Mitt Romney has said very, very nice things about this budget. In fact, all of the GOP's leaders have been bragging about it. Since they're so proud of it, why don't they tell more people what it really does?

 

Follow Richard (RJ) Eskow on Twitter: www.twitter.com/rjeskow

By now most people have heard some of the worst things about the Republican budget proposal -- commonly called the "Ryan plan" and unironically described by the GOP as "the Path to Prosperity": That i...
By now most people have heard some of the worst things about the Republican budget proposal -- commonly called the "Ryan plan" and unironically described by the GOP as "the Path to Prosperity": That i...
 
 
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givesflack
shrink GOP small enough to drown in bathtub
08:47 PM on 03/23/2012
The GOP is not the answer, the GOP is the problem.
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givesflack
shrink GOP small enough to drown in bathtub
08:46 PM on 03/23/2012
I think the crucial passage is this "And that, despite all that, it would actually increase the deficit." That is how the GOP works
Enact tax cuts and corporate subsides in the name of stimulating the economy and turn over the money that people pay in taxes to the wealthy instead of entitlements. hey have been using this charade for the last 30 years and all I have seen happen to our country is income disparity, revenue declines, bailouts for banks, trillions in lost wealth, attacks on the middle class and poor, and the bankruptcy of our treasury in the name of the market. The Ryan plan is to undo the Safety Net and Ryan calling the net a hammock is intended to get people off their as_ses and into their graves for all the hard work they have done for the 1%.
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HUFFPOST SUPER USER
Mas
Blame has no expiration date
09:32 PM on 03/22/2012
The GOP employs English Majors to re-wrap the same legislation term after term, and then they stand before the mic and introduce their destructive documents like its something new. They are just waiting for the first time the American public makes that mistake and opens that door.....
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CMarks
06:28 PM on 03/22/2012
This budget plan should be looked upon as a Christmas gift in March to any Democrat running for office in November. Those Dems running, either for reelection or for the first time, should make this budget plan the center for their campaign. Whether it become law (highly unlikely) it should be pointed out that this is the 2nd "Ryan" plan to be floated by the Republicans and, assuming they continue in control of the House, should they win the Senate you can expect that there will be a 3rd Ryan plan which could very possibly pass. And, although the Ryan plan has cuts throughout, I see nothing to reduce the salaries and expenditures of Congress - but I'm sure that isn't a coincidence.
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beartrack
Follow the track, find the bear ?
02:23 PM on 03/22/2012
It's all for the insurance companies folks. All the anti talk about Obama's plan and all the cuts to Medicare, all of it is just the marching orders from the insurance companies. If you reasearch all this junk from the Repubs, you will find where the industry benefits.
Single payer takes much of that criminal relationship out of the mix.
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HUFFPOST SUPER USER
jmitch6511
01:30 PM on 03/22/2012
Three Hidden Time Bombs in the GOP's Medicare Budget: Like I said Paul Ryan's budget attacks the elderly, poor, middle class and unemployed, which are the majority of the American Public. Yes; it will continue to protect the rich and give them their tax breaks. In his eyes if you're not rich you do not matter.
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steviebb3
A stranger in a strange land
01:20 PM on 03/22/2012
The GOP never changes; take from those least able to afford it and give the wealthy any financial break. Jeez the Republicans are so owned by their wealthy donors it is amazing to me that more Americans haven't really caught on to whom they owe their allegiance (and it isn't to the welfare of the American people). And all this is so when they leave Congress, they will become a lobbyi$t or get a cushy job from one of their right-wing donors or their wealthy friends (who promised the gig to them earlier when they were in Congress passing legislation to benefit the donor). Where is the "Reform Congress Now" movement?
12:52 PM on 03/22/2012
Just like Medicare Part D being a hand-out to the drug companies, Ryan's budget is a hand-out to the private insurance companies/
Also, why is his plan considered to be bold? It's a cowardly plan that caters to people over 55 while screwing over people under 55 by making them pay for something(subsidizing Medicare for people over 55) they aren't going to get.
Talk about divisive politics!
11:43 AM on 03/22/2012
The republicans have not changed there plan since reagan always the the same nonsense that has never worked ........same old gice more tax breaks to the rick and cuts any program that might offer
any help to the seniors WORKING middle class or the very low income brackets
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realsurfin
Pardon me, can you help out a fellow American
09:26 AM on 03/22/2012
REPUBLICAN CONGRESS HAS BECOME THE HEALTH CARE DEATH PANEL. They have deemed seniors should die unless rich.
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elbzee
Fear is the mind-killer
04:24 PM on 03/22/2012
and are doing their best to ensure that they die as poor and as soon as possible!
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HUFFPOST SUPER USER
sonoflars
Growing old is mandatory, growing up is optional
09:16 AM on 03/22/2012
Anyone who votes for a republican, any republican, deserves every bad thing that will happen to them, their children, their parents and relatives.
10:41 AM on 03/22/2012
True, but I don't, which is what will happen if enough people continue to get duped by these snake oil salesmen and their 1% benefactors.
12:15 PM on 03/22/2012
Wow...you think Democrats really care about you? They will push you into a burning building, throw you under the bus and crush you any way they can then blame it on the Republicans. We're talking 2 years difference here........not a life time like the democrats that destroyed pensions and savings and home values. Yes....they surely did and blamed it on the Republicans.
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BBackSoon
Hello, I must be going.
01:30 PM on 03/22/2012
Wow, that is a stupid comment!
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CMarks
06:33 PM on 03/22/2012
Oops, the destruction of the pension plans, savings & housing market actually are worth blaming on the Republicans - since they were, for the most part, the party responsible. If you honestly consider something totally "arbitrary" like the first six years of the Bush debacle you'll see quite clearly who set the tone for this financial disaster.
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HUFFPOST SUPER USER
Bart DePalma
Bart DePalma
09:14 AM on 03/22/2012
1. Yes Virginia, folks in their 20s now will have to retire two years later because they will live longer than the current cadre of retirees. There is no evidence that medical bills skyrocket between 65 and 67 and that private insurance would be cost prohibitive after 65. Under Obamacare, Medicare goes insolvent before the age increase under the Ryan plan.

2. Like every other market, health insurance has both supply and demand, not just supply. In a premium support model, insurers will adjust their coverage and premiums to the ability of retirees to pay under Medicare and retirees get to choose among multiple insurance plans. Under Obamacare, the IPAB board will determine what coverage you are permitted and you have no alternatives.

3. There are no cuts in Medicare spending under the Ryan plan. Rather, spending simply increases at a slower rate based upon the growth of the economy and the tax revenues necessary to pay for it. The alternative of borrowing $1.3 trillion per year is national insolvency in about five years.

The truly terrifying alternatives are proceeding under the current course.
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HUFFPOST SUPER USER
lrobb
Gold Standard = four paws and a tail
09:27 AM on 03/22/2012
The fact that should be shouted from the housetops until all voters thoroughly understand it is that Democrats consider any reduction, no matter how slight, in the increase of funding for a program to be a "cut." In the Alice and Wonderland world of Washington, a word means only what the speaker wants it to mean. A government enclave--state or federal--is the only place where an increase can be called a cut.
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Brian Gilmer
Good citizens make good citizens.
09:51 AM on 03/22/2012
1. Medicare costs are driven by rising health care cost. The GOP approach adddress how much of a financial comittment that the Federal Government will take as oppose to actually attempting to get the cost under control. Currently the Federal Government pays for health care for about 30% of the population through Medicare, Medicaid, Veterans Health, Federal employee and retiree health insurance and the active military. So the GOP plan to "save" Medicare is really a plan to "save" the government money.
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HUFFPOST SUPER USER
Bart DePalma
Bart DePalma
10:05 AM on 03/22/2012
Medicare costs are driven by a lack of limits on coverage and roughly 14% fraud.

Among the savings that Ryan did not list is a massive reduction in Medicare fraud moving to private insurers who effectively root out fraudulent claims.

The GOP plan does not save the government money because Medicare is supposed to be self funding. The problem is that Medicare is already spending more than it receives in taxes because of Mr. Obama's hogtied economy and this shortfall will only get progressively worse.

Medicare as it is presently structured is undeniably unworkable. Mr. Obama's solution is to keep you on Medicare and have his unaccountable IPAB board cut coverage.

Under the Ryan plan, you have a choice of insurance plans including Medicare from which to choose.

I would much rather have the Ryan options when I retire.
11:23 AM on 03/22/2012
You're right, Brian. The Ryan approach simply shifts the costs of health care more heavily onto seniors who won't be able to afford it, and thus will die earlier than they would have otherwise for lack of affordable care.
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kamachanda
Mr. President, Tear this Wall Street down!
09:11 AM on 03/22/2012
Tax cuts for the wealthy is nothing less than the GOP's 72 virgins in heaven, it's a religious doctrine being used to justify the criminal abuse of other human beings.
11:28 AM on 03/22/2012
The Ryan budget is a clear look into the black heart of the Republican party.
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lrobb
Gold Standard = four paws and a tail
09:00 AM on 03/22/2012
When Social Security was first enacted in 1935, the average lifespan in America was -- surprise! -- 65 years. The only way the law could have passed is if it was clearly a safety net for only those who were too elderly to work productively and support themselves.

Fast forward to 2011. The average lifespan in America is now 78 years, and you wonder both Social Security and Medicare are going broke? We are funding 13 year golf vacations for the active middle-aged instead of a safety net for the aged and infirm.
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JustMeinNJ
09:05 AM on 03/22/2012
yeah I am not at all clear why raising the age cannot even be discussed without people flipping out. It's purpose was NOT to be a retirement plan - it was a safety net. Now people behave like this is supposed to fund their current lifestyle for 30 years.
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FullFrontal
01:31 PM on 03/22/2012
it's the fact that the GOP doesn't tell us this information up-front. the fact that we have to discern it for ourselves makes them untrustworthy. i think most of us wouldn't care about the increase one bit BUT not telling us about it and doing back-room calculations makes me think twice about accepting ANYTHING they have to say to me
11:30 AM on 03/22/2012
It's too bad so much of what people "know" simply isn't true.

"As Table 1 shows, the majority of Americans who made it to adulthood could expect to live to 65, and those who did live to 65 could look forward to collecting benefits for many years into the future. So we can observe that for men, for example, almost 54% of the them could expect to live to age 65 if they survived to age 21, and men who attained age 65 could expect to collect Social Security benefits for almost 13 years (and the numbers are even higher for women).

Also, it should be noted that there were already 7.8 million Americans age 65 or older in 1935 (cf. Table 2), so there was a large and growing population of people who could receive Social Security. Indeed, the actuarial estimates used by the Committee on Economic Security (CES) in designing the Social Security program projected that there would be 8.3 million Americans age 65 or older by 1940 (when monthly benefits started). So Social Security was not designed in such a way that few people would collect the benefits."

http://www.ssa.gov/history/lifeexpect.html
08:48 AM on 03/22/2012
Who are the voters who support legislators like Ryan? Why is he even possible?

I am trying to figure out who the voters are who support the Republican efforts to enrich the rich 1% at the expense of the 99% non-rich. Of course the rich support it, but who else is supporting this exploitation? I think there are a lot of gullible people who believe whatever story Fox wants to tell, and there are evangelicals who think God will provide for them if they can just force their religious ignorance upon everyone else, but who else?

Who in the 99% is so willing to vote against their own best economic interest to impose this destruction?

Are there masses of government workers, or retired ones, who imagine they have secure benefits and don't want to be taxed for others to have them? Are there racists and bigots so driven by hate that they care less about their own economic security, and so they vote with the party that is willing to legislate racism and bigotry? Are they people who are too undereducated or uninformed or too deluded by Fox to understand what is being perpetrated by the Republicans onto the American public?

Life in the US for anyone not rich is being degraded by the right wing and their compliant deluded voters. It is a greed driven class war, enabled by widespread ignorance on the part of Republican voters. Is there any hope of fixing this?
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lrobb
Gold Standard = four paws and a tail
09:31 AM on 03/22/2012
I would be one of those voters who supports the plan because it is a politically viable alternative to becoming Greece. I have no intention of letting my grandchildren be placed into involuntary servitude to pay federal taxes.
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pmoschetta
Where are the Jobs, Speaker Boehner?
01:11 PM on 03/22/2012
part of why Greece became well Greece was due to increased spending and lack of revenues to make up the difference
Pretty much what caused this economic nightmare to begin with

That and tax cuts to the wealthy
11:32 AM on 03/22/2012
Very well said. Those are all the right questions. I'm afraid the answer in most cases is ignorance, propaganda, brainwashing, and a complete lack of understanding of the issues.