Michael Tomasky's Blog, page 5
April 20, 2011
Democrats must draw the line on Medicare | Michael Tomasky
Defending Medicare from the Republicans is not just about healthcare, but the future of America itself
These are depressing times for liberals on both sides of the Atlantic, with the size and scope of the state under assault. But the debate in the US is at least in one way bracing: it has lately become crystal clear that between now and November 2012 we will be having a big ideological argument about what kind of country this is and what sort of future we want – an argument that we've largely avoided for two generations.
When I say "we" have largely avoided them, what I actually mean is that one side has avoided it. Conservatives since Ronald Reagan have argued relentlessly that liberal philosophy is destroying the country. Liberals have not, as a rule, taken on conservative philosophy. They have tended meekly to venture things like: gee, those guys are going a little overboard, don't you think? Bill Clinton, who did more defending of progressive governance than most people give him credit for, was nevertheless the Democratic president who said the "era of big government is over", which meant that the Democrats would launch their insurrections on the terrain of particular policy criticisms, not broad world-view. It was easier that way because the Democrats could speak up for certain specific functions of government without having to explain how they saw the world.
Now, though, the issue is forced. The deficit-reduction plan on offer from Republican congressman Paul Ryan, the chairman of the House budget committee, means that the fight can be put off no longer. The Ryan plan is such a direct assault on the liberal state constructed over the last 70 years – with the support of both parties – that the Democrats have to draw a Maginot line in the forest, as it were, and arm themselves to defend that state and way of life.
The central issue here is Medicare – a sort of American NHS for old people. Medicare was passed in 1965, under a Democratic president (Lyndon Johnson), with the support of strong Democratic majorities in Congress – and, incidentally, just shy of half of all Republicans, back when the GOP had a strong moderate faction.
How does Medicare work? As with any massive scheme it's impossibly complicated, and rife with fraud, overbilling and too many rules. But from the perspective of the individual it's pretty simple. If you are over 65 and need healthcare, generally speaking you get it. You make co-payments, but they're manageable for most people. In 2009, Medicare spent $509bn serving 46.3 million Americans. It is administered with reasonable efficiency, considering that, unlike private insurers, it can't throw anyone off the rolls.
Who pays for it? Every rootin'-tootin' one of us, through good old-fashioned taxes: a payroll scheme by which both employee and employer contribute 1.45% of the employee's wages (up to $107,000) into the Medicare trust fund. The fund, says Medicare's board of trustees, is solvent until 2029. It is the very definition of single-payer healthcare.
And guess what? Americans like it. Beneficiaries love it. Even Republicans. It works so well under normal circumstances that many people can't believe it's run by the government, and the old joke about the little old lady telling her congressman – "Keep the government's hands off my Medicare!" – gets a lot of mileage. Bottom line: it's a government service with millions of satisfied customers.
Enter the Ryan plan. Without getting too deep in the weeds, it would replace what we call "fee for service" coverage with a cash grant to seniors. They can spend it on healthcare, or not. Sounds like freedom, if you believe the GOP spin. But what happens when your healthcare needs exceed the size of the grant? Dramatically exceed the size of the grant, as will happen often in the case of elderly people who need lots of care? The Congressional budget office estimated recently that by 2030 the average senior would go from paying 25% for his healthcare to paying a whopping 68%.
Here is where the Democrats (led of course by Barack Obama, but I mean all of them – from the coastal chardonnay-swilling liberals to the callused dustbowl centrists) have to stand firm. And here is where they must defend Medicare on philosophical grounds. Their first instinct will be to scare old people with stories of the cuts that would happen under Ryan. That will work to some extent, maybe a big extent. That 68% figure is scary to a lot of people, presumably, so it should get quite a workout.
But they need to go bigger. If this is just another debate about how much to cut, it will be a debate conducted on Republican terms, and in a sense the Republicans will win no matter how large or small the cuts are. Democrats must say: no, this is not merely about technicalities about Medicare's solvency. This is about what sort of country we are. Obama, to nearly every observer's utter astonishment, did that pretty aggressively in his 13 April budget address. His fellow Democrats had better pick up on it. It's the only way to change the dynamic of the debate over the long term.
You may have chuckled at my earlier invocation of the Maginot line, but it was intentional. It's not that the Maginot line didn't work. It's just that the Wehrmacht went around it. The Democrats, unlike the French, must extend their cordon to the sea and then push the Republicans back. Medicare is that important.
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William and Kate's hidden secrets | Michael Tomasky
Actually, this post is about spending and revenue as a percentage of GDP, but I figured you might not be all that enticed about a headline saying that.
Tennessee Republican Senator Bob Corker and Missouri Democratic Senator Claire McCaskill have introduced a bill to force drastic cuts in government spending over 10 years by imposing an automatic cap on the various spending categories. Then I see reading Yglesias that he insists on a 20.6% cap on spending, meaning that government spending must be no more than 20.6% of GDP.
You hear endless talk in Washington, especially from conservatives, about spending as a percentage of GDP. Typically over the post-war era, it has been around 19 to 22%. As you would expect, the more conservative the person, the lower the cap should be. Paul Ryan likes 18.5%. The current number, by the way, is indeed higher than the historical average, but not by all that much, at 24.5%.
There's nothing in law or anything that says it needs to be X percent. Situations change and demands on the government change. If we had a war, I mean a real war where we had to create a war economy like in WWII, the percentage would be massive. Short of that, one could well argue that the biggest financial crisis in 80 years should call for some pump-priming of a serious kind, and indeed one heard and still hears liberals say, no, let's get up to 26% of GDP. Which makes sense to me because it's precisely when the private sector is not investing that the public sector should, although I understand that it's impossible to make most people see the sense of that, because of the awful hegemony of this ridiculous "a government budget should be managed just like a family budget" claptrap, which has it exactly backwards economically.
So you hear lots of that talk. Here's something you never hear, though: revenue as a percentage of the GDP. I bet a good chunk of these people carrying on about spending and GDP don't even know what the current number is on revenue and GDP. Why is this? Because we just don't talk about revenue in Washington. In point of fact it's 14.5%, well below a historical average of 18-20%. Typically in recent years, we've run at a small (or not so small) deficit, as we know, and a typical year shows about 19.4% revenue and 21.1% spending, something like that.
Most of this missing revenue is simply a function of the bad economy. But not all of it. It has to do with the taxes paid, too, and those have gone down, dramatically so for the rich. But if you tried to tell Bob Corker, let's have legislation ensuring that revenue as a percentage of GDP never drops below 17.5%, he'd look at you as if you just proposed that everyone should wear their underwear outside their pants.
By the way, in what movie did the new leader of the fictional nation where the movie was set issue a decree when he took power commanding that thenceforth, all citizens must wear their underwear outside their pants?
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The people want the impossible | Michael Tomasky
Today the Washington Post has new poll numbers on what the great American people (that's you, or some of you) think we ought to do to tackle this deficit-debt problem. The answer is, not much.
By which I mean: the Post asked people, okay, to reduce the debt would you support cutting Medicare or military spending; increasing taxes a little bit on all payers and executing modest entitlement cuts; raising taxes on the upper brackets. The only one that scored more than 50% - in fact, 72% - was raising taxes on the wealthy.
To a liberal this is gratifying to some extent. I'm glad to see that cutting Medicare scored only 21%. Cutting Medicaid scored just 30%. People like these things the way they are, more or less.
But the global view, of course, is that the people don't have the answer and don't have a realistic grasp of what has to be done. I think most folks believe that this really can be fixed by cutting out " the ever-famous waste and fraud" but that's a chimera.
What does this mean for Obama and for the GOP? Obviously, these numbers are worse for Paul Ryan than for Obama, because the thing he most wants to do (cut Medicare) is the least popular, while the thing the GOP most opposes (raising taxes on the wealthy) has the highest level of support.
But public opinion and Beltway opinion are two different things. If the Post polled, say, 2,000 experts inside the Beltway, support for cutting Medicare would probably be above 50% and for raising taxes on the wealthy somewhere around 50%. Those numbers, which I admit I made up but trust me are about right, are going to be as important as what the people think, alas maybe more important, because they will create the echo-chamber in which this debate is carried out.
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Donald Trump's Sarah Palin moment | Michael Tomasky
People are guffawing about this one:
In his lengthy interview with NBC's Savannah Guthrie, Donald Trump appeared stumped when asked about the legal principle that served as the cornerstone for the Roe v. Wade decision that legalized abortion. Here's the key part of the interview:
Guthrie: "Is there a right to privacy in the Constitution?"
Trump: "I guess there is, I guess there is. And why, just out of curiosity, why do you ask that question?"
When pressed to explain how his position on the right to privacy "squares" with his anti-abortion position, Trump responded: "Well, that's a pretty strange way of getting to pro-life. I mean, it's a very unique way of asking about pro-life. What does that have to do with privacy? How are you equating pro-life with privacy? "
Guthrie asked, "well, you know about the Roe v. Wade decision." Trump responded, "yes, right, sure. Look, I am pro-life. I've said it. I'm very strong there."
The Roe ruling, in case you don't know, found a right to privacy for women in the 14th amendment that justified abortion on constitutional grounds. That's the whole basis. Right to privacy. It's Constitution 101, akin to not knowing, oh, that revenue bills must originate in the House not the Senate (hmmm, does he know that?). But worse of course because the origin of revenue-producing legislation isn't exactly America's hottest button issue.
I'm glad Guthrie didn't ask him what his favorite amendment was. "Gee...All of 'em!"
Ah, speaking of *. The former half-termer also screwed up the right to privacy question, in the famous Katie Couric interview. Naturally, she has leapt to defend the Donald, although on other grounds (by the way, who among you remembers why he is still sometimes called "the Donald, especially in the New York tabloids?"):
Palin, who's been trading kind words with Trump in recent days, said on Fox News that the real estate mogul isn't pushing the birther issue and would talk about more substantial issues — if only the press would let him. Reporters, she said, are "hammering [Trump] about the one issue that he has brought up and not been shy about — that's the birth certificate. ... He's answering reporters' questions about his view on the birth certificate. And reporters turn that around and say that's all he's got.
"That's not the case," she added. "Trump is running on the issue, bottom line, that President Obama is in so far over his head."
David Brooks weighed in on Trump the other day:
He is riding something else: The strongest and most subversive ideology in America today. Donald Trump is the living, walking personification of the Gospel of Success.
It is obligatory these days in a polite society to have a complicated attitude toward success. If you attend a prestigious college or professional school, you are supposed to struggle tirelessly for success while denying that you have much interest in it. If you do achieve it, you are expected to shroud your wealth in locally grown produce, understated luxury cars and nubby fabrics.
I agree with the first paragraph - this Gospel dates back to the days of Andrew Carnegie and J.P. Morgan and the Rockefellers and then really zoomed into the stratosphere in the specific person of Henry Ford, I would say - but his second makes me think that he and I are watching completely different societies.
I think he's talking there about the near-rich in America, those $250,000 to $300,000 a year a households who have most of it but don't have anything they damn well please, who don't quite lease Benzes and fly first-class and stay in suites. Among that set, yes, demurral is de rigueur.
But at Trump's level, our age is as gaudy as any. Worse maybe, given that we've just been through the biggest financial crisis the US has seen in 80 years and the class that caused the crisis came out of it with the audacity to sing the blues about how Obama was picking on them and they needed their $2 million bonuses to sustain their lifestyle because their actual salary was "only" $400,000.
Trump is the unleashed id of this vulgar set. Which reminds me that Spy magazine, the late great satirical rag, used to have a regular nickname for him: the short-fingered vulgarian. Let's get that one back in fashion, eh?
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April 19, 2011
Democracy and nihilism | Michael Tomasky
Here's a really depressing Ezra Klein post on the debt ceiling situation. He writes:
Raising the debt ceiling may be economically necessary, but it's politically lethal. Only 16 percent of Americans want the debt ceiling raised, according to an NBC/Wall Street Journal poll. Sen. Marco Rubio said he wouldn't vote for an increase unless it included "a plan for fundamental tax reform, an overhaul of our regulatory structure, a cut to discretionary spending, a balanced-budget amendment, and reforms to save Social Security, Medicare and Medicaid" — everything on the conservative agenda, basically.
And this is where things get dangerous. Republicans and Democrats both bear substantial blame for the country's rising deficits. The Bush tax cuts and the Medicare Prescription Drug Benefit and our various wars — none of which have been paid for, and all of which are ongoing — are major contributors to our mounting debt, and all were passed by Republican majorities. The debt ceiling had to be raised seven times during the Bush years, and the policies that helped drive those increases — not to mention the financial crisis that followed them — have not been undone under Obama.
But the GOP wants to pin the debt on the Democrats, and it wants major concessions in return for its vote. Democrats, however, aren't going to agree to the GOP's plan to deny partial responsibility for the country's debt and hold the country's credit rating hostage in order to reshape the government along more conservative lines. Fear over exactly this sort of political gridlock is what led Standard Poor's to downgrade the nation's credit outlook to "negative" Monday.
I hope none of you really thinks Rubio's position deserves to be taken seriously. Tie some further spending cuts to the debt vote? Sure. But ask for a huge grand-bargain kind of thing by June? Ridiculous. Not going to happen. Rubio knows it's not going to happen. It makes him fetching vice-presidential material to say so, though, because he represented the tea party position so aggressively.
I guess they'll raise the debt ceiling. But you don't know with these people. Would they let those bleak things - high interest rates, more foreclosures and so on - happen to the United States over the sake of a debt vote? After the same party raised the debt limit seven times under Bush, all the while spending like drunken sailors and putting costs off the books and walking around telling the American people that they were the party of fiscal probity?
Yes, they would. Some of them. One can't help but suspect that as long as it's bad for Obama and gets them closer to taking back the White House, and as long as they feel they can pin most of the blame on Obama, yes, they'll let it happen.
Our founders assumed a robust political debate and built a system that would accommodate that and soften its barbed edges, if you will, by working slowly. What they did not assume was that one side could become so nihilistic that it could be willing to see the country suffer as long as the blame for the suffering could be fixed on the other guys. I'm not saying I am sure that's what the GOP is doing. They believe what they believe about debt and deficits (again, as long as the Democrats are in the White House; when it was their guy, it was let the might river flow).
It makes it awfully hard to game out just what they might do. At the famous Clay-Liston weigh in back in 1964, Cassius Clay as he was known then hopped around the room like a madman, screaming and frothing and jumping up and down. Shortly after, Howard Cosell saw him in the tunnel, calm as a Buddhist. What was that about, Cosell asked. I wanted to act like a madman, Clay said, because only a fool isn't afraid of a madman.
The congressional GOP right now is Clay at the weigh in. What will they do? Who can be sure?
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Obama, the polls and impatience | Michael Tomasky
I wasn't surprised to see Obama's approval numbers go down in today's WashPost-ABC poll. I read all the polls, and I can see that he's gone from what one might plausibly have called 51% in January to the mid-40s now.
That's a bad drop-off. Here are the terms in which to think of this: set against his 2008 vote. Obama got 53% of the vote. If he's at 50% in a poll, he has lost 5%, or a little more, of his 2008 vote. If he's at 47% or 48%, he's lost 10% of his 2008 vote. If he's at 44-45%, even though he's only lost eight raw points from his 2008 vote, he's lost about 15% of his 2008 votes. Capisce? That would be how the White House thinks of it. And 15% is a lot of vote to lose, and to make up.
The drop-off doesn't surprise me. The degree of sourness of mood about the economy does surprise me a little. From the WP story:
Driving the downward movement in Obama's standing are renewed concerns about the economy and fresh worry about rising prices, particularly for gasoline. Despite signs of economic growth, 44 percent of Americans see the economy as getting worse, the highest percentage to say so in more than two years.The toll on Obama is direct: 57 percent disapprove of the job the president is doing dealing with the economy, tying his highest negative rating when it comes to the issue. And the president is doing a bit worse among politically important independents.
Is this mostly gas prices? Hey, conservative friends, I guess that vast liberal media conspiracy to protect Obama from blame about gas prices isn't working very well!
But seriously. I think gas prices are probably the main factor, but they merely begin a chain of associations in your average America's mind: this damn mess has been going on a helluva long time now, and why aren't we out of this yet?
Everybody knows by now the scenario whereby Obama gets reelected: economy turns around, nothing horrible happens on other fronts, the GOP field stinks, he wins (though not by as many electoral votes as before).
But here's how he loses. The economy is doing...okay, still not great. Gas prices are high. There's no long-term budget deal, i.e., no sense of a leader in charge getting the people's business done. Tax increases loom: remember, if the two parties can't agree on a tax deal, everyone's rates go up on Jan. 1, 2013.
I'm no Nate Silver but I still think that as of today there's about a 61% likelihood of an Obama reelection. But that's lower than I'd have said a week ago.
Sidenote: Who is raising money off of this poll? Michele Bachmann. In matchups against Obama, she outpaces fellow Minnesotan Tim Pawlenty, -12 to -15, respectively.
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The S & P downgrading | Michael Tomasky
My colleague Richard Adams has it right:
Really, S&P? This is the agency that within recent memory assured investors that not only were Bear Stearns and Lehman Brothers blue chip investments but that the various collateral-derivative-swap-trade-debt-obligations were as safe as houses. And let's not talk about the dotcom boom era of the late 1990s.
Given S&P's track record it's probably a good thing if the agency goes ahead and downgrades US sovereign debt – because look what happens when it says everything is fine.
Economist Dean Baker asks some good questions:
Serious people should ask what S&P has done to improve its ratings systems. Have they changed their procedures? Did the S&P analysts who gave AAA or other investment grade ratings to toxic junk get fired or at least get demoted? If not, should we assume that S&P used the same care in assigning a negative outlook to U.S. government debt as it did in assigning investment grade ratings to toxic assets?...
...The markets seem to recognize S&P weak track record in assessing creditworthiness. It downgraded Japan's government debt in 2002. The interest rate on 10-year government debt in Japan is currently under 1.5 percent, the lowest for any country in the world. Does S&P think that investors are mistaken in being willing to lend Japan money at such low rates?
Democrats think the fix is in here, that S & P did this to give the GOP and Paul Ryan greater leverage for more cuts, or maybe to build the case for tying more cuts to the upcoming vote on raising the debt limit. Republicans are spinning it this way.
Alternatively, was it aimed at the GOP, telling them not to play games with the debt-ceiling vote and just raise it? That was the conjecture of one specialist on NPR this morning.
In either case, I have to say that I agree with S & P on one thing - I too consider the prospects for a budget deal grim. I'm not sure I'd telescope the time frame out to 2013, which is the part of the S & P analysis that seems silly to me. Plus, I think the two parties will Scotch-tape something together this September, so as to avoid a possible government shutdown. But as for a long-term deficit-reduction scheme, the Obama and Ryan plans are irreconcilable. Someone's just going to win eventually, and someone's going to lose.
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More on the Pulitzers and the media | Michael Tomasky
I often read through the comment threads and think to myself but...but...that needs rebutted. But I never do, because if I did, that's all I would do all day every day.
But I'll make this one exception re yesterday's Pulitzers post, because there's such a basic misunderstanding of terms. My study from 2003 was about editorials, or leaders as the Brits call them. Unsigned. Some of you don't even know what category we're talking about. Frank Rich doesn't write editorials. Nor do Peggy Noonan and Kimberly Strassel. They write op-eds. The distinction isn't pedantic, but utterly crucial. The editorial is the voice of the newspaper - its institutional and official opinions and beliefs. Frank Rich's are Frank Rich's and Kim Strassel's are Kim Strassel's. If you want to say "The New York Times believes X," you can't go by Rich or MoDo. Only editorials. Get it?
That's number one. Number two, these conservative gripes about coverage of Obama, and if Bush had done X...Sometimes, sometimes, if you bother to go do the research and find the relevant articles or opinion pieces to support your point, these arguments can have merit. But if you just make some blanket assertion, you're only making yourself feel better, you're not persuading anybody.
On Obama and oil prices, I feel like I've read and heard and watched quite a lot of coverage about high gas prices, and I feel like much of that coverage has said that this is partly about Libya. That is, Obama's fault. If it's not totally dominating the headlines, maybe that's just because there's a hell of a lot else going on, and because it's not really vacation season yet. If prices are $4.29 in August when people are heading to the beach, you can believe it'll be a dominant story. And finally, if you think there has been some tacit (or explicit) decision by news outlets to go easy on Obama on the gas price question, you understand nothing about the news business and live on Neptune.
Obama gets a break on some things. Bush got a break on some things, too, especially after 9-11, when significant portions of the major media tried to mold him into the Churchill they thought Americans wanted and needed. These "breaks" usually conform to generally held perceptions about the two parties, meaning that the media will jump on stories about Republicans being mean to poor people, and on stories about Democrats being overly devoted to loopy ideas about diversity. On balance over the years, things probably tilt slightly in the Democrats' direction, but not all that much.
Now, back to my Harvard paper. You can read it here if you like (it's long). I studied editorials only from the NYT and WashPost (liberal papers) and the WSJ and WashTimes (conservative papers). I was scrupulous in my methodology, which you can read about on pages five through 13. Here's a quote from my "results" section on pages 12-13:
1. When it comes to taking policy positions, the liberal and conservative editorial pages studied are more or less equally partisan with regard to criticizing the other side. For example, The New York Times opposed the Bush tax cut about as often, and about as strongly, as The Wall Street Journal opposed the Clinton stimulus package. The conservative papers tended toward more forceful language, as we will see below, but the positions taken were roughly equivalent. However, when it came to dealing with their own side, the liberal papers were far more balanced, which leads into the second conclusion.
2. As a rule, the liberal editorial pages were much more willing to criticize the Democratic administration than the conservative pages were willing to criticize the Republican administration. This happened, to be sure, in the case of Clinton signing the 1996 welfare-reform bill (i.e., going against the liberal papers' beliefs), but it also happened in other instances, leading to the conclusion that the liberal editorial pages were more evenhanded in their treatment of parallel episodes, particularly under the politics/process rubric, where the liberal papers were eight times more critical of Clinton than the conservative papers were of Bush.
3. Also as a rule, the liberal editorial pages were somewhat more willing to give the Bush administration credit where they felt it was due. They were not lavish in their praise of Bush by any means; on the other hand, the conservative newspapers virtually never praised Clinton. In the 148 conservative editorials on the Clinton administration under study here, just four were deemed "positive," and three of those, as we shall see, carry rather meaningful asterisks. (Appendix B shows the numbers that support conclusions 2 and 3.)
Granted, these are fairly limited claims, just about four newspapers. I would not say my findings prove anything global about liberalism and conservatism. But I do think it's interesting. If I had to boil it down to one key set of numbers, it's these, from a study that included 510 total editorials:
*The liberal papers wrote 145 editorials on the Clinton topics under study, 45 of which were negative; a third.
*The conservative papers wrote 99 editorials on the Bush topics under study, and 7 were negative; 7%.
This comports with the reality I see every day. Liberal media back the Democrats in general but are more willing to be critical. Conservative media are total GOP cheerleaders. Each reality fits the mindset, because liberals are anti-authoritarian (even their own authority figures to an extent) while conservatives tend to believe in and defer to authority. Not complicated.
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April 18, 2011
This year's Pulitzers | Michael Tomasky
I once heard it said that in England, journalists turn to drink, and in America they turn to awards. Actually, journalists used to drink in America, and quite heavily, until the Evian-and-stairmaster age, but it is true that Americans love their awards, and so out comes Columbia University today with this year's Pulitzer prizes, America's most prestigious. Yes, shut out again.
They're kind of mysterious, the Pulitzers. You can know who's on the committee if that's of interest to you, but the announcement of the awards themselves is rather strange. Two or three years ago, I think it was, I happened to be having dinner with a Pulitzer winner the very night he snagged his prize. He said no one called him to say he was a finalist, no one alerted him to the fact that he was in the running. He just had to check the web site, like everyone else. It was posted some time after 3 pm, and there his name was.
My reactions are fairly predictable. David Leonhardt of the NY Times for commentary is fantastic. That guy should never be missed. Just always smart.
I'm somewhat less enthused about the prize that went to The Wall Street Journal's Joseph Rago for some editorials (leaders) on Obama's healthcare plan. I consider life too short for me to have spent one second reading a Wall Street Journal editorial on healthcare reform, but I cant imagine they were remotely reality-based.
Oh, all right. Here's one from December 2009, you remember, when the Democratic Senate was on the verge of "ramming" the bill down America's throat overnight (eight months, during which Senate Republicans voluntarily walked away from negotiations and Chuck Grassley started tweeting about killing grandma). It's a long one.
I won't refute it point by point, which would take 3,000 words. It and I disagree, let's just leave it at that. I can say this much about Wall Street Journal editorials in general. I once undertook a pretty rigorous study of American newspaper editorials. What I found was that the leading liberal editorial pages actually had a set of principles on certain issues (transparent government, let's say) that they applied more or less equally to Republican and Democratic administrations. Thus, for example, the New York Times was about equally critical of both the Clinton and Bush administrations on secrecy in government issues, writing a similar number of editorials on each.
The conservative newspapers had a different principle: we crush Democratic administrations and make apologies for Republican ones. And so this self same Wall Street Journal editorial page, on the question of allegations about the secrecy shrouding Hillary Clinton's 1993-94 healthcare deliberations, pounded and pounded and pounded, demanding subpoenas and thumping its chest like an asylum patient. On the question of the allegations of secrecy surrounding Dick Cheney's energy-policy panels, the Journal joked that Democrats, now in the minority, didn't have anything better to do than pry around.
Maybe Brother Rago has brought a new level of disinterested professionalism to that page. If he has done so in the age of Murdoch, more power to him.
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Would you insure a 78-year-old with hypertension? | Michael Tomasky
Some weeks ago, Chris Matthews to his credit started asking a basic question. Under this Ryan plan, under any GOP plan to do away with Medicare, who's going to insure these old people? Someone is 78 and has hypertension, 76 and Type A Diabetes, 81 and has suffered a stroke, or two. They get kicked off their plan. Who's going to insure them?
I asked a couple of health-care experts at the time who said, well, surely Ryan has thought of this and is not going to let something that Dickensian happen. And he has. If you read through his plan, you see language that says "health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare's sickest and highest-cost beneficiaries receive coverage." So he can say, "but my plan says ____," and he'll be telling the truth.
The problem, though, is that these are private exchanges he's talking about, and history at least suggests that private exchanges at some point do start dumping people if they're not making a profit by holding on to those people. Benjy Sarlin explains this well at TPM today. For example:
Take Medicare+Choice, a private exchange for seniors created in 1997 by the GOP Congress. Under the program, the government paid the equivalent it would use to fund Medicare coverage to reimburse private HMOs instead under the theory that the free market would operate more efficiently and produce better results. Instead, insurers found they were unable to sustain a profit and began pulling out en masse. In 2000, more than 900,000 patients were dropped as HMOs deserted the program, citing inadequate federal backing and a lack of a prescription drug benefit.
So in other words, the HMOs (private) were told to insure people but then found they couldn't do that and make money. Ryan may say he'll make them take the patients, but this would seem to raise the question, arguably a constitutional question, can the government force a private company to operate at a loss? That doesn't sound like something a conservative would be for.
That's why...it's easier in the first damn place if the government is the insurer! And Medicare is in fact rather efficiently run. But it's gummint, so it's evil, see.
But to be serious for a moment here: there's always lip service in these plans allowing their authors to say that the nightmare scenario won't happen. But plans are just plans, they aren't legislation. When it comes to writing legislation, the fact will be that the insurers will be in the room, with metaphorical piles of money at their side, and old people with hypertension and diabetes won't be, or will be vastly outspent and outnumbered. And since Ryan's goals are to save money and diminish government rather than to improve or even sustain healthcare, it's not hard to guess who wins that showdown.
Ryan has given the Democrats a huge gift, methinks, if they know what to do with it.
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