Entries Tagged as 'Medicare'

What to Watch in the Debt Negotiations

July 7th, 2011 at 1:06 pm 4 Comments

While we await the news from today’s debt ceiling negotiations between Republicans and Democratic leaders, help news outlets are already leaking and reporting on the possible contours of a deal. But which reporting is actually likely to be part of a deal and how much is smoke and mirrors? What developments would be unexpected if they become part of a final deal?

1. Medicare and Social Security are on the table.

Plausibility: Plausible, salve but what about Medicaid cuts?

Senate Majority Whip Dick Durbin has given reporters a broad outline of a deal: $1 trillion in revenue raising by closing tax loopholes, discount with the Democrats conceding cuts to Social Security and Medicare. This deal certainly looks like it could be a “Grand Bargain”.

But curiously, Durbin did not mention cuts to Medicaid. Earlier reporting had suggested that Medicaid cuts were a large part of the negotiations. Medicaid was always the more vulnerable program because the constituency that depends on it (the poor) carries less clout then the constituency that depends on Medicare (the elderly).

If Medicare cuts, and not just Medicaid cuts, are on the table, then it would be politically courageous for politicians to support them.

2. Republicans will accept revenue increase without tax cuts to offset new revenue.

Plausibility: Needs to happen if Republicans are serious about a deal, unknown how serious they are about a deal.

Several news stories are hinting that Republicans are buckling from their previous opposition to revenue increases that are not offset with tax cuts. This has been a key problem with Grover Norquists anti-tax pledge that many Republicans are committed to: it is hard to reduce government deficits over the long term if every time revenue is raised by removing a subsidy (for example, ethanol subsidies) that the revenue raised is off-set by a new tax cut.

Eric Cantor reportedly wants to “talk” about closing some of these tax loopholes which could increase revenue, but he still claims to want tax cuts to off-set them. Senator Kyl has also made comments about increasing “revenue” but its unclear from where the revenue would come.

Ultimately, if Republicans are serious, some sort of significant revenue increase that is not off-set by tax cuts will need to be part of final deal, both to get Democratic votes and to actually reduce the deficit within a reasonable time frame.

It might be that Republicans have no intention of supporting any sort of revenue increase which is what lead to David Brooks column from this week warning that the Republicans “may no longer be a normal party”.

3. Jim DeMint and Olympia Snowe will get a Balanced Budget Amendment as part of the deal.

Plausibility: No. Snowe is positioning to win reelection.

So far, the most out-of-left-field position is an op-ed by Senators Olympia Snowe and Jim DeMint arguing that any solution to the debt crisis must involve a balanced budget amendment being added to the Constitution.

You may recall that Bruce Bartlett referred to the balanced budget amendment as “quite possibly the stupidest constitutional amendment I think I have ever seen. It looks like it was drafted by a couple of interns on the back of a napkin.”

So is this meant to be a serious part of a debt deal? Probably not. What’s more plausible is that Snowe faces reelection next year and her support for the amendment coupled with an op-ed co-authored with DeMint seems designed to try and get her to run to the right of any potential primary challengers.

Here’s How To Get To A Debt Ceiling

June 27th, 2011 at 2:31 pm 7 Comments

The theatrics of the past two weeks aside, click the wink and the nod seem to be already communicated as the President, remedy the Speaker of the House, sale and the Senate Majority and Minority leaders begin the next phase of the drama.

Both sides have now solidified their bases in Congress.  “No new taxes” now balances “The end of Medicare as we know it.”  Neither will happen to any significant degree and the press releases for back home can be written well in advance.

The question arises, then, if the negotiations ignore 70 percent of the problem, what kind of deal could pass muster with a majority in both the House and Senate?

Here’s the dirty little secret—it isn’t that hard to meet the targets set out by either side.

Let’s start with the basics.

To get a debt ceiling increase that will take Congress and the Administration beyond the November, 2012, elections, requires approximately $2.4 trillion.  Speaker Boehner has declared that he wants that much in spending restraint, dollar for dollar.

Selected leaks from the now-defunct Biden meetings crowed about getting as much as $2 trillion.

Can either target be met without confronting the underlying structural changes in entitlements that would truly change the debt trajectory?


Here’s a “back of the napkin” plan to reach the Speaker’s goals and not harm entitlements.

A—accept approximately $1.1 trillion in defense savings over the 10-year period by simply counting the money that will be saved as we draw down troops from Iraq and Afghanistan.

B—freeze non-defense, domestic appropriated accounts for five years, saving $400-$500 billion.

C—make minor changes in small entitlements like agricultural subsidies, change the Cost-of-Living index used to calculate increases in various federal programs, and allow many of the openings in the federal work force the next decade to go unfilled, saving another $100-$200 billion.

D—accept a freeze on new defense spending, outside the troop drawdown savings, for enough time to get $300 billion.

E—close a couple of tax loopholes—like the ethanol subsidy, some of the “tax extenders” for special purposes, and remove the mortgage interest deduction entirely for second homes—and save another $600 billion over the decade.

F—finally, add to these savings the amount of federal interest payments that such savings would produce, another $300-$400 billion.

Lo and behold, you’ve done it.   These changes from the Congressional Budget Office current policy baseline for the next decade amount to even more than $2.4 trillion.  And, better yet, the savings from “cuts” in programs outweighs the new revenues from loophole closings by about three to one.  That is another stated goal of whatever package emerges.

Republicans get to claim that they held on “no new taxes.”

Democrats get to shout that they kept “hands off our Medicare and Social Security.”

And both sides can do all this without having to reduce Medicare payments to doctors, or to expand the reach of the Alternative Minimum Tax (AMT), or to reform almost anything of significance.  Better, if the 113th or 114th Congress confronts a serious international challenge, those folks can always increase defense spending as needed.  One Congress cannot bind another—a basic law of legislation.

No one will notice, except for budget geeks and some cranky media types, that the total indebtedness of the federal government will total $23 trillion ten years from now.  This means that the $2.4 trillion in savings barely achieves 10 percent of anticipated debt.  Worse, such a deal allows Medicare, Medicaid and most other entitlements to continue to climb without restraint.

Why does this outcome seem probable?  Because we have been down this road before.

In the Reagan years, Congress promised a package of deficit cuts that would be three-to-one spending changes compared to tax changes.  When all was said and done, and we looked back a couple of years later at our handiwork, much more was said than done.  The package never achieved three-to-one spending versus taxes and deficits barely budged from projections.

Yes, the package may contain serious process reform and enforcement mechanisms that promise to save more in the future.  But such an outcome will hardly satisfy those who want real fiscal reform and real stabilization of the federal debt.

Kicking a can down the road really is fun.  You watch kids do it all the time.

Gingrich Was Right About Ryan Plan

June 24th, 2011 at 11:41 am 11 Comments

Americans want the deficit reduced, prostate but they aren’t so keen on Paul Ryan’s medicare plan. A new Bloomberg Poll finds that Americans by a 57 percent to 34 percent margin say that they will be individually worse off if Paul Ryan’s Medicare Plan became the law.

The poll reveals trends that pose particular problems for GOP presidential candidates. On one hand, hospital voters consistently say they want the deficit addressed. However the poll also show that 58 percent of independent voters said they would be worse off under the Ryan Plan.

This is a very serious problem: the Ryan budget plan specifically lays out a way to draw down the nation’s debt. But if the elderly and large numbers of independents both oppose the plan strongly, clinic supporting the Ryan plan could singlehandedly drive a candidate out of contention.

What is perhaps most ironic about the results of this poll is that it shows that Newt Gingrich was right about the Ryan plan.

If you remember, Gingrich took heat for his Meet the Press statement, “What you want to have is a system where people voluntarily migrate to better outcomes, better solutions, better options, not one where you suddenly impose it. I am against Obamacare imposing radical change, and I would be against a conservative imposing radical change.”

Gingrich was compelled to apologize. But it turns out Gingrich hit the nail right on the head: Americans do think Ryan’s plan is radical.

Follow Jeb on twitter: @JGolinkin

GOP Must Call Democrats’ Bluff On Medicare Cuts

June 23rd, 2011 at 11:13 pm 26 Comments

Eric Cantor’s withdrawal from the debt talks with Joe Biden may be dominating the headlines for now but, there in the long run, it may not matter much.

More negotiations, probably between President Barack Obama and Speaker of the House John Boehner, will take place and, unless both parties have a death wish, default on the debt isn’t going to happen. (Both parties may resign themselves to a variety of face-saving short-term extensions until the 2012 elections.)

The bigger news — which is pretty meaningful — is that Democrats have apparently floated real short-term cuts in Medicare before talking ended.

If the offer is something more than a political bluff (and that’s what I suspect it is), it’s hugely important.

The cuts the Democrats may have suggested — cuts to provider reimbursements –  are the right ones. Medicare, as the largest medical payer in the country by a large margin, undergirds a medical system that pays workers, regardless of education, job title, or background, more than their counterparts in any other sector the Bureau of Labor Statistics tracks.

Controlling overall costs is going to require controlling labor costs and that, in turn, is going to require medical providers to be more productive or work for less. And cutting reimbursements to providers, if done correctly, won’t necessarily result in much that patients will notice: as much as doctors may complain about it, few are going to stop taking Medicare patients.

Furthermore, provider cuts could take place right away: For all its merits, the Ryan Plan isn’t nearly as much a small government manifesto as many of its acolytes think.

Nearly all of its meaningful Medicare cuts take place well in the future and, if history is any guide, would probably be repealed before taking effect even if they somehow pass into law. (Medicare cuts almost always have.)

Cuts to Medicare provider reimbursements now will take force now ad cut the deficit now. These types of painful but necessary short-term cuts, furthermore, are exactly the ones Republicans will have to go for if they actually want to reduce the deficit without raising taxes.

Although it may seem like good politics to let Democrats propose these types of cuts first–and then as part of a deal that also includes tax increases — it does draw GOP political courage into question.

Even though there are plenty of good reasons to think that the offer is insincere, it may give the Democrats an upper hand in trying to show that Republicans are unreasonable. If Republicans are serious, they need to call Democrats’ bluff and propose even deeper cuts in Medicare and probably Social Security too.

Bitter medicine? Yup. But necessary.

Weinergate Takes the Heat Off the GOP

David Frum June 4th, 2011 at 6:30 am 108 Comments

Did or did not a New York congressman send a photo of a man’s crotch to a Seattle college student?

That’s the question the American political elite has spent the past half-week debating. Silly? Degrading? Check and check. Yet this silly and degrading spectacle is having very serious real world consequences.

Consequence 1: Up until the underwear story, the Democrats were clobbering Republicans in the Washington messaging war. Republicans in the House of Representatives are demanding huge and immediate cuts in federal spending. They are threatening to force a default on federal obligations if they don’t get those cuts. Both the demand and the threat are hugely unpopular: the demand with ordinary voters, the threat with economic elites.

On May 24, the voters got a chance to speak in a special congressional election in western New York state. The district — NY 26 — had once been held by Jack Kemp. It was regarded as one of the safest Republican seats outside the South. This time, the Republican vote collapsed in an election whose main theme was the Republican budget and the cuts it implies for the popular Medicare and Medicaid programs.

The Democrats were looking forward to pounding the Medicare theme all summer. They need to do the pounding fast, before the Republican tactic of refusing to allow new borrowing pushes the federal government into insolvency sometime in August. They cannot afford to lose a day of airtime. Thanks to New York congressman Anthony Weiner, they have just lost a week.

Consequence 2: The big Democratic healthcare law is heading to a constitutionality challenge in the Supreme Court. With a 5-4 conservative majority on the court, many Democrats worry about the outcome of the case. Anthony Weiner had been leading a long-shot campaign to affect the result: demand that one of the five conservatives, Clarence Thomas, recuse himself from the case.

Weiner argued: Clarence Thomas’ wife works for a conservative advocacy group, collecting over $150,000 in salary. The conservative advocacy group opposes the healthcare law. Therefore Thomas has a conflict of interest in the matter and should not rule in the case.

It’s not really a very good argument. Mrs. Thomas will be paid exactly the same whether the healthcare law survives or is struck down. The Thomas household has no financial interest in the outcome of the case. Mrs. Thomas has expressed strong opinions — but who would argue that judge’s spouses are not allowed to express opinions? And does this apply to all spouses equally? For example: Alice Batchelder is chief judge of the U.S. federal court of appeals for the 6th circuit — a very important job. Her husband Wiliam Batchelder has been a member of the Ohio state legislature for 30 years, rising to Republican house leader. Nobody has ever suggested that Mr. Batchelder quit his job. Why is Mrs. Thomas any different?

So the Weiner argument is “out there.” Few Democrats will want to join the combative and abrasive Weiner in his anti-Thomas campaign. Nevertheless, many of them are quietly glad to see Weiner volunteering for the attack dog role. But as long as he is consumed by his own personal troubles, his anti-Thomas campaign goes silent.

Make no mistake: Weiner’s problems are all of his own making. When the underwear story broke over Memorial Day weekend, he had the option: tell the truth at once, no matter how embarrassing, and put the story behind him. Even in the worst case -yes, he sent the picture -it’s not as if any laws were broken. The woman who received the photo was not offended and has issued no complaint. Anthony Weiner would not be the first boorish and juvenile member of Congress in history, and he won’t be the last. Story closed.

Instead, Weiner issued a fog of evasive and absurd statements in a series of self-damning issues. He himself did the most to enlarge and extend the story.

He had his motives: He hopes to run for mayor of New York City in 2013, and so he wants to avoid putting on the record any admissions that could be used against him.

But what Weiner’s fellow Democrats see is that this silly underwear story -and Weiner’s fog-of-evasion strategy for dealing with the story -has cost their party airtime, momentum, and advantage. Why? One senior Democrat I know summed it all up, “Anthony has always been all about Anthony.”

Result: Weiner has done more to aid Republicans this week than anybody on the Republican side. And in a week where the two parties are locked in a struggle as serious and important as any issue since the U.S. went to war in Iraq, Republicans need all the aid they can get.

Originally published in the National Post.

Romney’s Mediscare Defense

June 1st, 2011 at 12:23 pm 6 Comments

Democrats seem to have latched onto an electoral strategy for the 2012 campaign. With an economic slump that is the worst in many a decade, ballooning deficits, the Obamacare debacle, a foreign policy that has not exactly met campaign promises, and a restless populace, Obama and his allies have hit on a three-syllable campaign slogan: Medicare.

The congressional special election in NY-26, a rout for Republicans in a GOP-heavy district, has only fueled Democratic speculation that they can ride Mediscare tactics to victory in 2012. (Yes, a faux-Tea Partier in the race may have influenced the results, but Republican Jane Corwin was leading in polling before Democrat Kathy Hochul went full Mediscare.)

In a striking turn of events, Mitt Romney may find Romneycare more of an electoral advantage than a headache: this legislation could insulate him from Mediscare tactics. Many other Republican candidates (such as Michele Bachmann) voted in favor of Paul Ryan’s budget or have endorsed it; Tim Pawlenty has quibbled with the budget but has said he would sign it under certain conditions. While Romney has said that he is “on the same page” as Ryan, he has not endorsed Ryan’s budget and has said that he will propose his own plan for Medicare reform.

The fact that, under Romney’s watch, Massachusetts implemented a set of health-care policies that gives coverage to over 98% of state residents can protect him from the charge that he wants to finance more tax cuts by leaving seniors out in the cold. By not having endorsed Ryan’s plan, Romney can agree with it in the spirit of market reforms without having to defend its particulars.

This combination could blunt one of the Democrats’ biggest knives. Imagine the following exchange from a presidential debate in the fall of 2012:

Barack Obama: The Ryan budget, overwhelmingly backed by Congressional Republicans, would end Medicare as we know it for all those under 55, who would be left with vouchers to purchase insurance from private companies. These vouchers would only rise in value at the rate of inflation, and health-care costs have risen faster than inflation for decades. Governor Romney and the Republicans want to end our nation’s decades-long commitment to care for the elderly. They would hold our seniors hostage to the whims of private insurance companies.

Mitt Romney: Mr. President, while I have my differences with the Ryan budget, let’s face the facts. When I was governor of Massachusetts, I crafted legislation that ensured health-care coverage for over 98% of state residents. I worked across the aisle with Republicans and Democrats to forge a compromise to expand health-care to all citizens of the Commonwealth. While this compromise was not perfect and cannot be completely adapted to the federal level, it was a step in the right direction of accountability and fairness. Rather then putting health-care under central government control, it unleashed the power of the market to expand health-care access.

Under your health-care proposal, Mr. President, over $500 billion will be cut from Medicare over the next decade. Under your plan, Mr. President, a fifteen-member panel will set price controls for Medicare. Your plan forces a one-size-fits-all mandate model on all fifty states. You’re already cutting Medicare. My record shows that I have not and I will not expand health-care coverage by taking away from our seniors. I believe that market-oriented reforms can eliminate waste and cut soaring costs while also improving care.

Romneycare can give Romney cover to push for market-oriented reforms. If he is a crypto-socialist, as some of his detractors allege, he can’t also be an anarcho-capitalist ready to kill off grannie. Romney can attack Obamacare’s cuts to Medicare while also deflecting the charge that he is a heartless Medicare-cutter himself. Moreover, Romney can distinguish between Obamacare and his own health-care reforms: on Medicare cuts, the federal mandate, centralized government control, and other features.

As only Nixon could go to China, perhaps Romney is uniquely positioned to advance market reforms of Medicare.

(Disclaimer: the debate over entitlement reforms is quickly evolving, so the dynamic noted here might not be found even a few months from now.)

Originally posted at A Certain Enthusiasm.

Hospitals: The New Teachers’ Unions?

David Frum May 31st, 2011 at 8:26 am 18 Comments

Are hospitals the new public-school teachers’ unions?

From the New York Times today:

More generally, [hospitals] are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

Medicare will begin computing performance scores in July, for monetary rewards and penalties that start in October 2012.

The desire to reward hospitals for high-quality care is not new or controversial. … However, adding in “efficiency” is entirely new and controversial, as no consensus exists on how to define or measure the efficiency of health care providers.

One of the truest and most powerful conservative ideas of the 1980s and 1990s was to stop measuring our commitment to “education” by measuring “inputs” (spending per student, class-size)  and instead to measure “outputs” (student learning). Schools and teachers resisted, but were rightly over-ruled. Now the country is heading to a re-enactment of this debate with health. Here’s hoping that Republicans can overcome both political opportunism and also the temptation of donations from the hospital industry and again adhere to the right side of the issue.

NY-26′s Biggest Loser: Medicare Reform

May 25th, 2011 at 11:53 pm 41 Comments

As a life-long Democrat, case I should be celebrating the victory of Kathy Hochul in Tuesday’s special election for the U.S. House of Representatives. And the excitement I feel should be boundless, considering my background as a Democratic operative, including stints as executive director of two of my party’s three major campaign committees (the DNC and the DCCC).

But truth be told, my sense of partisan satisfaction is tempered considerably by what I fear will be the major outcome from yesterday’s results: Hanging any notion of Medicare reform around the necks of Republican candidates will be virtually the entire Democratic playbook in the 2012 Congressional and Senatorial campaigns. The voters’ verdict in the New York 26th race almost ensures that serious discussions about essential entitlement reform are likely to be kicked down the road once again.

Republicans demagogued health care reform relentlessly and shamelessly in the run up to the 2010 midterm elections, and it worked for them. Democrats will do the same on entitlements between now and November of next year, and odds are it will work for them—they will pick up seats as a result.

The list of losers in yesterday’s special election starts with the Republican nominee, Jane Corwin, but House Republicans who embraced Budget Chairman Paul Ryan’s ideas about radical changes to Medicare certainly share that dubious distinction. However, other losers may also include those Democrats, such as Senators Mark Warner (VA), Dick Durbin (IL), and Kent Conrad (ND), who have been trying to nudge their colleagues toward budgetary discipline and fiscal reforms of some sort. They know, as does anyone who is paying the slightest bit of attention, that our current policies and practices—be they spending or revenues—are unsustainable.

Conservative Republicans and Tea Party adherents seem determined to repeal or alter in fundamental ways major sections of the social contract that evolved in the U.S. during the 20th century; the great majority of Democrats—most certainly including its left-leaning base—are committed to resisting such initiatives  as vigorously and as long as they might have to.

However, there are some Democrats—and I put myself in this category—who realize that specific elements of that compact are going to have to be renegotiated and recalibrated. What made sense in the mid-1930s (a retirement age of 65, for example), may no longer work. The current “fees for service” system upon which Medicare is based also will require reform. Paul Ryan’s vouchers may not be the answer, but neither is inaction.

My worry is that important and ultimately inescapable facts and their ramifications may already have been lost among the empty champagne bottles and sparkling confetti of last night’s Democratic victory party. If so, we’re all going to be worse off as a consequence.

Conservatives Scramble To Explain NY-26 Loss

May 25th, 2011 at 12:50 pm 53 Comments

Yesterday the GOP lost an important race in NY-26 when Democrat Kathy Hochul defeated Republican Jane Corwin.  Conservatives are already offering excuses minimizing the importance of this loss. Here are a few of the new ones hitting the blogosphere and talk radio:

Excuse #1: Blue collar voters are easily scared by Democrats. This argument was made by Henry Olsen from the National Review who argues that blue collar voters respond differently to GOP tactics and that “they are also susceptible to the age-old Democratic argument that the secret Republican agenda is to eviscerate middle-class entitlements to fund tax cuts for the wealthy. The truth is, if conservatives and Republicans are to move forward with entitlement reform (as they should), they need to address the real concerns of these pivotal voters.”

Excuse # 2: New York Republicans are way worse than the rest of the party. Erick Erickson was quick to subscribe to this belief. “The truth of the matter is that the Republican Party of New York sucks and has sucked for a while. It is especially terrible at special elections where the out of touch party leaders pick state legislators who everyone hates and runs them”. So, naturally, this loss means nothing.

Erickson later revised his stance and blamed the press, bringing us to excuse #3: media bias. “The press’s ready willingness to believe Democrat spin is yet again driven home this morning by the Republican loss in New York last night,” Erickson said. “Immediately, the press was adopting Democrat spin that this was all about Medicare.”

Excuse #4: Chris Lee’s Craigslist scandal made the GOP loss inevitable. John McCormack from the Weekly Standard writes that the fact that this loss was “precipitated by Republican congressman Chris Lee’s Craigslist sex scandal and ensuing resignation” means that the Democrat win is not “all that impressive or significant”.

Excuse #5: Tea Party candidate Jack Davis split the Republican vote, making a win impossible. W. James Antle III says at the American Spectator, “Unless the “Tea Party” independent is a total non-factor, reading too much into this race would be like exaggerating the impact of the Djou race in Hawaii last year”.

Excuse #6: You can’t read too much into one district. Philip Klein from The Washington Examiner cautioned that “at the end of the day this is just one data point in a single Congressional district out of 435. So it would be silly for Republicans to panic suddenly flee from the Ryan plan.” Don’t give up hope – there are still 434 more chances for the win.

On his show today Rush Limbaugh introduced excuse #7: voters are easily confused. “What happened here is the Republican tea party candidates got confused … and bought the notion that this was a genuine tea party candidate running in NY, ” he said. “The voters actually thought they were voting for something other than what ended up happening.”

Why Voters Aren’t Buying the Ryan Plan

David Frum May 25th, 2011 at 9:15 am 34 Comments

A footnote to the above posting regarding the Ryan budget plan.

The Ryan plan does maximum damage to Republicans because of its insistence on treating entitlement reform and tax reform as two tightly associated problems, rather than two separate issues to be handled at two separate times.

Ryan’s plan cuts the top rate of personal and corporate income tax from 36% to 25% with promises of offsetting revenue raisers to be determined later.

Because Ryan’s tax cuts were specific and his promises of revenue-raising reform ultra-vague, he had no defense to the attack that his tax reform involves massive downward redistribution of the tax burden. And after all, it’s hard to imagine what tax enhancements would counteract the distributional effect of a cut in the top rate of income tax from 36% to 25%. Ending the mortgage interest deduction for mortgages of between $417,000 and $1,000,000 (a good idea!) would not do it. Ending the deductibility of state and local taxes (another good idea) would not do it. A carbon tax (good idea again) for sure would not do it. Ditto a VAT. All of those measures would be good ways to raise additional revenues while leaving the current rates in place. But as offsets to a huge upper-income tax cut, they look like a shift of the tax burden from the upper class to the more affluent parts of the middle class at the same time as the rest of the Ryan budget removes Medicare coverage from the more affluent parts of the middle class – and leaves the remainder of Medicare very probably increasingly inadequate even for poorer Americans.

The one thing that might have enhanced the attractiveness of the Ryan Medicare plan is some kind of assurance of adequacy of the future Medicare vouchers for Americans under age 55.

Remember, under the Ryan plan, not only are Medicare vouchers means-tested, but they are also scheduled to grow in value at a deliberately slow pace. Today’s 40-somethings have good reason to fear that the vouchers will prove inadequate when it comes their time to retire.

Those fears could be allayed to a certain degree if Republicans would support any of the various initiatives to weaken the pricing power of healthcare providers. Some of these initiatives are included in the Affordable Care Act, others are still kicking around the think tanks. But no. Republicans condemn almost all of them as just so many variations on the death panel theme. The result: CBO projects that by 2030 the Ryan vouchers would cover only about 30% of the cost of an insurance policy equivalent to Medicare as it now exists.

And we’re going to ask Americans to vote for that? That’s the thinking that brought us Goldwater in 1964. “You’ll eat your canned peas, goddamnit, and tell us you like them!”

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