By Harold Pollack
Before Twitter existed, Saturday Night Live’s fake commercials provided the perfect mix of sexual innuendo and dead-on satire to entrance middle-school boys. (I still swoon with joy recalling the ad demonstrating that Lincoln Continental’s smooth ride and ample interior provided the perfect working surface for ritual circumcision.)
Mitt Romney and Paul Ryan are now pursuing an internally contradictory strategy that includes loud general calls for “adult conversation” about entitlement reform, coupled with demagoguery over the very idea of Medicare provider cuts in Obamacare.
Republicans’ elaborate effort to combine two things that really don’t mix reminds me of an even better SNL advertisement: one for a combination floor-wax nondairy dessert topping.
Romney and Ryan are unlikely Medicare defenders. Just last year, both embraced plans to turn Medicare into a voucher program. Ryan authored two budgets that included the same $716 billion in Medicare cuts he attacks Obama for implementing. They’ve backed away from the most extreme proposals. Both still endorse deep cuts to safety-net programs. The word “Medicaid” didn’t appear in Ryan’s convention speech. His own House budget would sharply cut it over the next decade.
Romney and Ryan may succeed politically. Seniors are understandably nervous about health reform. Given the inherent complexity of Medicare policy, the profusion of Republican plans, and the GOP’s sheer stonewalling about critical details, it’s easy for reporters to throw up their hands and throw four Pinocchio’s in all directions. There’s legitimate debate regarding whether it’s fair to say that the GOP would really convert Medicare into a means-tested voucher program.
I go back and forth myself. So do Republicans in their sales pitch.
Speaking to seniors, Romney and Ryan sell their plan as a non-dairy dessert topping that preserves Medicare and that shields people born before 1957 from $716 billion in ObamaCare cuts. That’s not accurate. It also doesn’t match their sales pitch to the Tea Party and to fiscal hawks. To these groups, Romney and Ryan hawk “adult conversation” on entitlement reform. The GOP draft platform presents its Medicare plan as a great floor wax to polish up our long-term budget picture:
“The first step is to move the two programs away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model.”
That one sentence offers both the textbook definition of a voucher and a textbook justification for what such a defined contribution approach seek to achieve. They seek to reduce costs by limiting government obligations, and by giving recipients greater incentives to seek cheaper competing private plans. It’s a feature not a bug that seniors would face escalating costs if medical costs continue to rise more rapidly than inflation. (Experience in other countries and in Medicare Advantage provides little evidence that insurer competition appreciably reduces costs, but that’s another matter.)
Romney and Ryan have backed away from this politically self-immolating approach. When I noted the defined-contribution language on Twitter and on the Incidental Economist, I got instant pushback from conservatives. Romney outside advisor Avik Roy tweeted back “platform <> candidate, obvs.” Reihan Salam, another smart conservative cautioned me not to equate the Republican platform with the candidate.
I don’t know what to make of this. The platform’s unambiguous language matches previous plans that Representative Ryan developed and that Governor Romney had previously rhetorically endorsed. Romney had ample opportunities to influence that platform. He didn’t do so.
The Romney campaign website has posted an 899-word Medicare link, which endorses “a generous defined contribution, or ‘premium support’.” Traditional Medicare would still be offered. However, “if it costs the government more to provide that service than it costs private plans to offer their versions, then the premiums charged by the government will have to be higher and seniors will have to pay the difference.” That’s a change.
Reihan points to a useful Romney campaign policy memo, which notes that “Governor Romney has proposed no cap on premium support in his own plan.” That is, if the cost of health care goes up faster than inflation, the value of Medicare vouchers can rise faster, too. Claims that Romney would raise seniors’ Medicare premiums by $6,400 don’t match Romney’s current proposals.
That’s important. It still leaves things pretty vague. When I click on the memo’s provided link describing the Romney plan, I’m sent to that same 899-word summary rather than something meaty with supporting details. Romney’s “own plan” is a slightly expanded and changing press release rather than a well-articulated proposal capable of external scrutiny. It’s nothing like the wonked-out Democratic proposals developed before the 2008 election that provided the foundation for health care reform.
It’s not just that details are missing. Romney and Ryan offer contradictory accounts for a reason. As Jon Chait observes, their intellectual dishonesty reflects a fundamental gap between the radicalism of their agenda and what’s minimally acceptable in American politics.
There’s a matter of trust, too. Independent fact-checkers note the Romney campaign’s repeated untruths in areas ranging from deceptive editing of Obama speeches to the whole “you didn’t build that” thing. When asked why Romney keeps running welfare ads identified throughout the media as deceptive, Romney pollster Neil Newhouse noted with some understatement: “We’re not going to let our campaign be dictated by fact-checkers.” Paul Ryan’s convention speech included important falsehoods, as well. Their campaign has earned little benefit of the doubt on the ambiguous details.
If Romney wins, I fear these missing details will be crafted by the same conservatives who wrote the platform and who voted in the House for a Ryan budget that would sharply cut social programs while promoting another round of supply-side tax cuts. Compared with that, a nondairy floor wax seems much more appealing.
We do need adult conversation about how to keep Medicare on a sustainable and disciplined fiscal path. We need the same adult conversation about reckless tax cuts. Democrats wrestled with these matters in crafting health reform. ACA kept the promise of a universal, comprehensive defined Medicare benefit, while implementing effective, sometimes unpopular measures to control costs.
That’s what fiscally responsible progressive policymaking looks like. It’s not perfect or pretty. It just moves the country in a more humane direction without giving away the store.
Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has written about health policy for the Washington Post, New York Times, New Republic, The Huffington Post and many other publications. Previously, he wrote
Health reform: it’s about having each other’s back and A clarifying voice for the Health Insurance Resource Center.
Posted August 31, 2012
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