Thursday, August 16, 2012

Not Appreciative

On a campaign swing through Ohio, Paul Ryan maintained "The president, I’m told, is talking about Medicare today.   We want this debate (but) what I don't think he'll be telling people is that the president took $716 billion from the Medicare program- he raided it to pay for Obamacare."
Similarly, Mitt Romney contends "President Obama is the one who should be worried, because he has cut $700 BILLION from Medicare to pay for Obamacare."   Republican National Committee chairman Reince Priebus writes "President Obama is the only president who has cut Medicare by $700 billion. And he is the only candidate in this race willing to let Medicare die."    Exhibiting far more experience with alliteration than with class, Priebus also accuses the Obama campaign of "dirty, despicable, and desperate"  tactics.   Try as he might, however, the chairman cannot outdo Rush Limbaugh, who claimed

The money they paid in is now being given to people that have paid nothing. That's what the $700 billion cut is. Money that you've put in is being taken out and given to others. The whole design of Obamaville is to take from people who work and earn and give it to people who don't in the name of fairness, in the name of the people who work are just lucky. The people that have jobs and earn a lot of money, that's just luck. We need to spread the wealth around.

Rush does at least sum up well the GOP's ethos of selfishness.   The Affordable Care Act guarantees health insurance for roughly 35 million people, some of them employed.   We just cannot have that, especially when the party's vice-presidential nominee is a disciple of the Queen of Selfishness, the late Ayn Rand.

But Ryan deserves credit for a little bit of honesty.   Unlike the others- and virtually all other Republicans- the Wisconsin congressman did specify that the $716 billion reduction is in the "Medicare program," which is undeniable, rather than in "Medicare," which falsely implies the cut is in services to recipients.    There is no benefit cut, as illustrated in the pie chart, from Sarah Kliff of Ezra Klein's Wonkblog, below:

Kliff explains

The blue section represents reductions in how much Medicare reimburses private, Medicare Advantage plans. That program allows seniors to join a private health insurance, with the federal government footing the bill. The whole idea of Medicare Advantage was to drive down the cost of health insurance for the elderly as private insurance companies competing for seniors’ business.

That’s not what happened. By 2010, the average Medicare Advantage per-patient cost was117 percent of regular fee-for-service. The Affordable Care Act gives those private plans a haircut and tethers reimbursement levels to the quality of care administered, and patient satisfaction.

The Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion.

The rest of the Affordable Care Act’s Medicare cuts are a lot smaller. Reductions to Medicare’s Disproportionate Share Payments — extra funds doled out the hospitals that see more uninsured patients — account for 5 percent in savings. Lower payments to home health providers make up another 8.8 percent. About a dozen cuts of this magnitude make up the green section above.

The irony, of course, is that the Medicare provisions in "Obamacare" were fashioned to meet the concerns of Republicans and their neoliberal allies.    By their addition to the legislation, the PPCAA is projected not to add to the deficit but to reduce it.    Further, they are designed to "bend the health care cost curve," which is virtually synonymous with the GOP's whine about the need to "strengthen" or "protect" Medicare.   Priebus, echoing the complaints of Republicans the last couple of years, argues "President Obama and Democrats have no plan whatsoever to preserve Medicare for future generations- or protect it for today's seniors and those nearing retirement."     In an effort in part to meet GOP objections, President Obama did in fact add a plan "to preserve Medicare for future generations"- precisely the cuts Republicans are now denouncing.

"What I don't think he'll be telling people is the President took $716 billion from the Medicare program," Ryan coyly told his supporters.   Understandably, what Representative Ryan won't be telling people is that his GOP colleagues in the House voted for the same "raid" on Medicare when they voted for Ryan's 2012, then for his 2013, budget.   His honesty, clearly, has its limits.

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