Chairman of the House Budget Committee, Paul Ryan released his 2012 budget proposal yesterday and apparently we are all supposed to believe that this budget is "courageous" and "gutsy". I'm sorry but I'm not impressed. This budget is mostly a less detailed rehash of his previous roadmap which is rigidly ideological and intellectually dishonest. Here are a few things Chairman Ryan could have done that would have been courageous.
1. Include some provisions that would actually impact your supporters and funders.
Predictably, Mr. Ryan's plan will be bad for people who don't support Republicans (poor people, children, young people), and good for (or neutral for) those who do help Republicans keep their grip on power (seniors, rich people, corporations). Seniors vote, and it just so happens that they are exempt from the provisions of this bill. As far as rich people and corporations go, does anyone else find it morally repugnant that Ryan proposes massively cutting health care coverage to poor children in order to finance more tax breaks for people who just got a tax break and who didn't need a tax break in the first place? I know that is an oversimplification, but not by much. The cost savings in this plan come primarily from draconian cuts to Medicaid and Medicare in the name of decreasing our national debt and providing further tax cuts to the wealthiest Americans.
2. Admit that your plan doesn't have a prayer of working without the success of the Affordable Care Act
Let's talk about Medicare. Ryancare would basically (in the words of one health care consultant) say to seniors: "Here's the voucher and there's the market." The amount of the voucher would be tied to GDP growth despite the fact that health care costs have risen much more rapidly than GDP growth. Ryancare would also repeal the recently passed Affordable Care Act which is the only serious attempt made in decades to reign in rising health care costs. In other words, seniors will get stuck with an ever increasing bill for their health care unless health care costs are brought into line with the rate of increase in GDP. Ryan's plan makes no provision for reducing health care costs and repeals the only instrumentality we have to try to reduce health care costs. Even beyond that, seniors tend to have preexisting conditions. Without the Affordable Health Care Act, many seniors will literally be unable to buy health care coverage in the private market. Here's what Howard Gleckman says about it:
"For vouchers to work, insurance companies would have to sell coverage at an affordable price to all, regardless of health status. Seniors would need a way to shop for insurance. To keep premiums reasonably priced, consumers would have to be required, or at least very strongly nudged, to buy coverage before they got sick. Finally, since premiums would still be expensive for older buyers, the government would have to provide seniors with a significant subsidy to make the product affordable."
All of these prerequisites for a voucher system to work are met by the Affordable Care Act. Repealing it completely undermines the possibility of a workable voucher system that we could live with.
3. Do something other than shift the burden of rising costs to those least able to pay for them.
Ryancare essentially does two things: First it caps the amount that the federal government will pay for health care for vulnerable populations thereby shifting the risk of rising costs to the individuals themselves. Did I say risk of rising costs? I meant virtual certainty. Second, it waves a magic wand and expects the market to fix everything. There is literally no empirical evidence to suggest that turning more of our health care sector over to the private sector with absolutely no reforms will yield a good result by any measure other than the profits of health insurance companies. In fact, if you look at the example of Medicare Advantage and at our lousy current private health insurance market, there is quite a lot of evidence to suggest that the results are going to be bad. Medicare Advantage was an experiment started in the 80s which was intended to save the government money by allowing private insurers to compete in the Medicare market. Initially, there was about a 5% cost savings to taxpayers of insuring seniors through Medicare Advantage. Over the years however that savings has turned into a premium and taxpayers now pay about $1,000 more to insure seniors on Medicare Advantage than on traditional Medicare. These plans also cherry-pick only the healthiest seniors and provide coverage that is no better than traditional Medicare.
4. Use the broader budget picture as leverage to avoid a government shutdown.
Our budget deficit is $1.5 trillion. Our entire government is about to be shutdown because Republicans want to cut about $30 billion more from than Democrats want to cut. Paul Ryan could be instrumental in avoiding a shutdown by reminding everyone that our fiscal woes are not going to be solved by cutting $400 million from NPR and $300 million from Planned Parenthood. Here we are, taking nutrition programs away from infants and flirting with a default in our sovereign debt, over a difference in budget cuts that amounts to less than 2% of the deficit. It's ridiculous and could be ended by someone with the clout of Paul Ryan, who could reframe the budget debate in terms of the bigger picture, swallow a compromise, and move on. That would actually be courageous and would display a willingness to take some heat with the GOP base in order to move on to the substance of meaningful, long-term deficit reduction.
5. Be honest.
Virtually the entire proposal has been crafted and presented in a highly misleading way. First of all, "Premium Support" sounds like a new bra from Playtex. What Paul Ryan is proposing for Medicare is a voucher system. Vouchers are extremely unpopular, so he had to come up with a new term and premium support does give the illusion of some sort of enhanced coverage. The attempt to specify any substantive differences between premium support and vouchers is dishonest.
Second, Paul Ryan's plan is supposed to magically bring unemployment down to 4%. 4% is actually below the natural rate of unemployment. I'm sure that's realistic though. The Heritage Foundation is always reliable and unbiased, right?
Despite his claims to the contrary, this plan cuts Medicare and Medicaid in a huge way. Medicaid would be cut by more than a third over the next decade. The CBO says that seniors will shoulder about twice as much of their own health care costs. According to The Economist: "Mr Ryan rather disingenuously says his proposal would "strengthen" Medicaid. I guess you could call it that, if your idea of strengthening your son is to throw him out of the house at age 16 to fend for himself."
So you'll have to excuse me if I don't praise Paul Ryan's great courage in advancing this proposal. When did shamelessly pandering to your base while shrouding your real intentions in feel-good language and fuzzy math become courageous?