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Posts Tagged ‘medicare’

Saturday’s lead editorial in the Wall Street Journal poignantly identifies the problem with the President and the liberal elite’s mindset in today’s politics: let’s focus on new programs and bury any discussion of how we’re going to pay for them or the current ones we already can’t afford. The WSJ says it best:

“Maybe the most unknowing moment from President Obama’s debt-limit press conference the other day was when he said that, ‘I’d rather be talking about stuff that everybody welcomes, like new programs.’ Define everybody—and, please, let us know when the new programs are going to stop.”

Yes, Mr. President, please tell us when we can finally start addressing the record debt and deficits. Or the impending bankruptcy of Medicare. Or the several trillion dollar shortfall in the Social Security Trust Fund. Or the rising interest that we have to pay to service our massive debt to foreigners (41 cents of every dollar we spend is borrowed!). Or a handful of other disastrous budgetary issues we have ignored over the past several years (like pensions, for starters).

In light of this deep hole we are in as a country – and the very real display in Greece of what our future might look like if we stay on this current path – it is absolutely stunning to think we are still pondering new government programs. Just a cursory look at the several thousand federal programs and agencies that we have now should put to rest the thought that we need any more government or that the government we currently have is somehow cost-effective.

Yet this is the guiding light of modern day liberalism. As Thomas Sowell recently put it when discussing President Obama’s advocacy for a new high-speed rail program, “One of the most successful political ploys is to promise people things without having the money to pay for them. Then, when others want to cut back on the things that have been promised, blame them for lacking the compassion of those who wrote the checks without enough money in the bank to cover them.”

Nevertheless, with an ever increasing percent of the American population paying no federal income taxes, receiving government-run health care and cashing in on welfare programs (e.g., unemployment benefits, food stamps), the argument for a fiscally sane federal government is becoming a more difficult sell.

Sadly, it might take a default on the national debt before Americans realize we are on an unsustainable path. In the meantime, it appears the conductor (President Obama) will be sitting in the caboose figuring out how to add more cars to the train.

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Senator Obama Was Right

   Posted by: Pat    in Budget/Economy, Congress, entitlements, health care   Print Print

Senator Barack Obama, March, 2006:

“The fact that we are here today to debate raising America’s debt limit is a sign of leadership failure,” he said. “It is a sign that the U.S. Government can’t pay its own bills. It is a sign that we now depend on ongoing financial assistance from foreign countries to finance our Government’s reckless fiscal policies. … Leadership means that ‘the buck stops here.’ Instead, Washington is shifting the burden of bad choices today onto the backs of our children and grandchildren. America has a debt and a failure of leadership. Americans deserve better. I therefore intend to oppose the effort to increase America’s debt limit.”

Senator Obama was right. Too bad, he’s now the President and appears to have not meant a word of that statement above. Too bad for all of us. President Obama has tried to portray himself as the adult in this debt ceiling debate, but when it comes to taking care of our nation’s fiscal well being his administration has made a drunk teenager in love look responsible and mature. Just months ago he released a budget so unserious that his own party and the entire Senate disowned it 97-0. He came into office to lead a country facing massive debt and managed to make the situation even worse as our debt has sky rocketed in the past 3 years. He not only has failed to do anything to rectify our coming entitlement crisis, he has actually made them even worse by passing a new health care entitlement and vilifying anyone who is willing to address Medicare, Social Security, and Medicaid, all of which are facing major funding shortages.  Barack Obama is many things, a good leader, he is not.

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The accepted post-election narrative in NY-26 is that the Republicans overreached on Ryan’s Medicare reform plan and the voters socked it to them. Make no mistake, this is the Democrats’ narrative that the media was anxious to adopt. However, there appear to be some inconsistencies with this story.

First, why did the newly-elected Democrat Kathy Hochul denounce support for Obama’s health law? If this was such a victory for the Democrats’ protection of Medicare and their new health law, why would the Democratic candidate not only steer clear of it but even voice her disapproval?

Second, the Tea Party candidate was a wealthy, liberal Democrat that for all intents and purposes seemed to be an impostor trying to co-opt and sully the Tea Party brand. This might be a successful strategy for Democrats going into 2012 but it doesn’t say much about the Ryan Medicare plan.

Third, a steady rule in politics is once you own something, you better defend it. This holds true even more so if it is a bold reform plan – taxes, immigration, entitlements, for example. George Bush got clobbered for his attempts to create private accounts for Social Security when he was unable to rally Republican support. This occurred despite the fact that it was solidly a Republican idea. His failure to rally, and Republicans’ failure to engage in the debate, left the party open to attack on the issue without a real defense of their position. Similarly, John McCain did not invest enough time and energy learning his health care plan in 2008 and got beat up at every turn because of it. This was not because it was a bad plan. In fact, it was a very good one. But it took explanation and impassioned defense. The Republican candidate needed to more forcefully own and defend the Medicare reform plan in NY 26, not present a mealy-mouthed defense for what her party is trying to do.

This is the future Republicans face in 2012 if they do not choose to embrace their own ideas. They don’t have to applaud every detail and say it’s perfect but right now the Ryan plan is the only game in town. And it’s pretty good compared to what the other side has, which basically lets Medicare become either insolvent or vastly rations care.

Democrats have 756 days without presenting a single budget proposal. Moreover, to the extent the Democrats have a plan to save Medicare, it can be found in “Obamacare” and its rationing board made up of 15 bureaucrats (IPAB). It is the ultimate fatal conceit to think that 15 health care professionals are going to be able to effectively and humanely make health care decisions for all of America’s seniors. But this is the current law! So why aren’t Republicans out there making sure America knows that until another alternative plan is presented, this treatment denial board, IPAB, is set to make their health care decisions for them in a few short years? We can be sure America has no clue of this board’s existence right now, nor that this is the new “status quo.”

So to recap, yes, yesterday’s election had a lot to do with Medicare and its need for reform. But the lesson is not that Republicans need to run from Paul Ryan. Rather, they need to put their running shoes on and JOIN Ryan as he defends his plan to save Medicare. Republicans will abandon him at their peril. Or to quote Ben Franklin, “We must all hang together, or assuredly we shall all hang separately.”

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The Medicare Trustees report was released last Friday and it wasn’t good news for the program’s future. It showed Medicare – already running on IOUs from the Treasury Department, which increases the deficit daily – will be insolvent 5 years earlier than expected (2024 rather than 2029). This is the second sharpest annual decline in Medicare’s solvency ever. So much for the idea that Medicare isn’t in trouble (a major talking point of opponents of the Ryan plan) or that Obama’s health law is somehow going to place it on a sustainable path. The program’s cash flow deficit of $32 billion is the worst its ever been both in terms of absolute dollars and percentage of taxable payroll. Simply put, Medicare is in serious trouble.

Now this is nothing new but it is important for Americans following the entitlement discussion in Washington to realize the reality of the program’s future under current law.

Another point worth noting is the Trustees’ affirmation of their finding last year that under the new Obama health law millions of Americans will not be able to keep their current plan. Yes, Mr. President, this means your promise heard over and over during the health care debate has once again been proven egregiously inaccurate. For Obama supporters, this may be difficult to hear but stick with me because it’s true.

The Trustees report discusses the new law’s impact on Medicare Advantage plans. Prior to the Obama health law, employers received a tax credit for providing retiree drug plans. Thanks to the law, however, employers will face a major tax increase if they maintain coverage and will overwhelmingly make the rational decision to drop coverage once the provision kicks in. The Trustees report projects the 6.8 million enrollees in these drug plans will drop to 800,000 by 2016. I’ll do the math for you – that’s a 90% drop in coverage!

Alas, the political consultants realize the importance of the senior voting bloc and have acted to blunt the impact until after the 2012 election. The Administration has granted waivers to some employers offering these plans and has increased payments to insurers offering Medicare Advantage plans to delay projected rate increases. Voila, seniors won’t realize the consequences of the Obama health law until after the president is safely in office for another four years. Of course, this means after the election when rate increases do kick in and employers do face this tax increase, the cliff will be an even steeper one for seniors to fall from. 

At that point Mr. Obama can confidently turn over the cost-control duties to IPAB – Independent Payment Advisory Board – the rationing board of 15 unelected bureaucrats created in last year’s health care overhaul. (Keep in mind this is the Democrats’ alternative to the Ryan plan. This board will make all the hard decisions about whose care to cut and which procedures to deny without ever having to take a politically sensitive vote or seek public approval. And if they screw up, don’t call your attorney just yet because they have been granted legal immunity from your claims. So unlike an insurance company that denies care, you not only cannot change providers, you also have no legal recourse against their errors.)

Generally ignored by the mainstream media, the Trustees yet again show the Obama health law to be disastrous for seniors and the future of Medicare. It also backs up what Cong. Ryan has been saying for some time – Medicare is on an unsustainable path and it’s time to get serious about how to fix it.

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The President Refuses to Engage

   Posted by: FMFP    in Budget/Economy, health care   Print Print

Before the President delivered his much anticipated budget speech on Wednesday, my fellow GPP blogger asked, “Where are our leaders?” He’s right to ask the question, particularly after watching the President talk. For those looking for a detailed response to Cong. Paul Ryan’s budget plan, this was not the speech for you. The details were replaced with high-minded rhetoric about why government is needed to fix all of society’s ills and was basically just another campaign speech for Obama 2012.

The President also took the occasion to excoriate Mr. Ryan and his plan, claiming it will all but take food out of children’s mouths and kick grandma to the curb. Of course, Mr. Ryan graciously sat just a few feet away taking these blows because the President insisted he be there. And to think, this is the bipartisanship President Obama had in mind when he was talking about change.

Yesterday Mr. Ryan had a chance to respond to the President in the Washington Post. Here’s an excerpt:

“It [the GOP budget] offers a contrast in credibility. Unlike the president’s speech, which was rhetorically heated but substantively hollow, our budget contains specific solutions for confronting the debt and averting the most predictable crisis in our nation’s history. It also offers a contrast in visions. Unlike the speech, our budget advances a vision of America in which government both keeps its promises to seniors and lives within its means…

If you are someone who agrees with the president that we cannot avoid this outcome without resorting to large tax increases, know this: No amount of taxes can keep pace with the amount of money government is projected to spend on health care in the coming years. Medicare and Medicaid are growing twice as fast as the economy — and taxes cannot rise that fast without a devastating impact on jobs and growth.

If you believe that spending on these programs can be controlled by restricting what doctors and hospitals are paid, know this: Medicare is on track to pay doctors less than Medicaid pays, and Medicaid already pays so little that many doctors refuse to see Medicaid patients. These arbitrary cuts not only fail to control costs, they also leave our most vulnerable citizens with fewer health-care choices and reduced access to care.

And if you believe that we must eliminate waste, fraud and abuse in these programs, know this: Eliminating inefficient spending is critical, but the only way to do so is to reward providers who deliver high-quality, low-cost health care, while punishing those who don’t. Time and again, the federal government has proved incapable of doing that.”

Well said, Mr. Ryan. Now if only the President and Democrats would join the conversation.

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Let’s All Agree, Medicare Needs Fixin’

   Posted by: FMFP    in Budget/Economy, health care   Print Print

Medicare is in serious trouble. This is not propaganda nor is this a secret. And this is also not a surprise. This is so for three very simple reasons. First, when Medicare was first created, the average American male was living into his 60’s and the average American female was living into her 70’s. Today, men are living into their 70’s and women are living into their 80’s and even 90’s. Second, when the program was created the Baby Boomers were just that – baby boomers. Today, they are retiring at a faster rate than there are young workers to support them.

Third, when Medicare was created its cost was expected to rise with inflation. It didn’t take long to realize how absurd this notion was, having grown at several times the rate of inflation for decades now. For example, at its inception in 1966, the program cost about $3 billion a year. The House Ways and Means Committee projected that in 1990 it would cost about $12 billion (a figure that accounted for inflation). What was the real price tag in 1990? $107 billion. And the out-of-control growth of the program has continued at a rapid rate. Today, the program consumes almost 15% of the federal budget. (Remember, this is separate from the additional funds spent on other big entitlements like Medicaid, SCHIP and of course, Social Security which have their own budget issues).

So it’s clear something needs to be done to alter the structure of the program. That is, if we are to have any faith that it will be around for us below 55 years old or that we will be able to honor its commitments to those over 55.

Unfortunately, for many Americans, it’s a struggle to get this far in the conversation.

Moreover, once we get this far, we have only just acknowledged the problem. The trickier part is what follows – the conversation over how to put the program on a sustainable path. This is what Cong. Ryan’s aggressive budget proposal tries to do and why he should be lauded. Ryan’s plan attempts to springboard the political discussion past the question of whether we have a Medicare problem and demands that legitimate participants in the discussion talk about actual solutions for the way forward.

I’ll save for another post an analysis of Ryan’s budget and the Medicare solutions on the table but first, it’s important that we all at least acknowledge what has been glaringly obvious for far too long – Medicare as currently structured is unsustainable.

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Since passage of Obamacare, Democrats of all stripes have been interested in talking about almost any subject other than health care. Put aside talk of a signature achievement, this has been a Pandora’s box of bad policies and politics that Democrats have had to either defend at their peril or run from without directly insulting their party’s leadership and President. At this point, it’s almost a contest to see what claim proved the most outrageous, non-sensical or downright not true.

One of the first claims to fall apart was President Obama’s oft-repeated promise, “If you’ve got health insurance, you like your doctors, you like your plan, you can keep your doctor, you can keep your plan.” Since passage, health care providers have begun consolidating to avoid business-killing taxes and regulations. Insurance companies have been forced to raise premiums to account for scores of new benefit mandates and restrictions on what types of plans they can offer. And small businesses are looking to cut costs by dropping coverage for their employees who will now have to look to the expanded Medicaid program and the state exchanges to cover them. All of these adding tremendous costs and weight to a system that was supposed to become more efficient and cost-effective.

What this has mean for the private sector so far is an effort to get out. And one year out, over 1,000 waivers have been granted by the Department of Health and Human Services (HHS) to unions, non-profits and companies negatively affected by the legislation. Ironically, a cursory review of the waiver list shows a disproportionate number of unions, whom you may remember, were some of the bill’s loudest proponents while it was being debated. Unsurprisingly, when forced to comply with its provisions, unions demonstrated their special status with the Obama Administration and demanded to be saved from this very expensive law.

And it’s not just the basic health care plans that are being altered. Millions of Americans who rely on their FSA’s (Flexible Spending Account) to pay for their child’s special education schooling or HSA’s (Health Saving Account) to pay for over-the-counter medicines will have to find other, likely more expensive options , to get these benefits or pay for these services. Unfortunately, those seeking to actually restrain health care costs are the real losers because it was programs like HSA’s, FSA’s and Medicare Advantage – which also took a major hit under Obamacare – that sought to inject competition into the process and more importantly, give more control over health care costs to the consumer.

Strangely, Nancy Pelosi’s statement that “we have to pass it to find out what’s in it” has proven quite prescient. Slowly but surely, as more of the law’s thousands of provisions are painfully unearthed, we are forced to deal with the explosion of costs, rosy revenue projections, overly burdensome nature of the regulations, and generally unconstitutional nature of the bill’s central provision. I could go on – and I plan to in future posts – but I feel each (broken) promise and corresponding reality deserves its own special attention.

Perhaps next time I’ll discuss what I think could be the biggest whopper of them all, “Obamacare is going to add 30 million people to the insurance rolls AND save billions of dollars doing it.” I know, try not to laugh too hard.

So, what’s your favorite broken promise of Obamacare?

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This picture cost the Pentagon $25 million dollars

My blogging colleague FMFP’s recent writings on the ongoing struggle for the US government to agree on a budget for this coming year highlighted the discrepancy between mandatory (entitlement programs such as Social Security, Medicare, and Medicaid) and discretionary funding, basically everything else the government pays for, including defense spending. FMFP cited a poll that showed that far too many Americans are unaware of the fact that entitlement spending is what is really driving our country toward insolvency and another poll by WSJ/NBC also portrays an American populace unwilling to give up any ‘significant’ portion of these program’s benefits to fix the budget. FMFP, after using Tarrance Group poll results showing that a majority of Americans think the government spends more on defense than on entitlements, accurately pointed out defense/security procurements take up roughly 20% of the budget while Social Security and Medicare take up almost twice as much and are expected to explode in coming decades.

It is this context, that I recently read Robert Kagan’s article ‘The Price of Power‘. Here’s his intro:

The looming battle over the defense budget could produce a useful national discussion about American foreign and defense policy. But we would need to begin by dispensing with the most commonly repeated fallacy: that cutting defense is essential to restoring the nation’s fiscal health. People can be forgiven for believing this myth, given how often they hear it. Typical is a recent Foreign Affairs article claiming that the United States faces “a watershed moment” and “must decide whether to increase its already massive debt in order to continue being the world’s sheriff or restrain its military missions and focus on economic recovery.”

This is nonsense. No serious budget analyst or economist believes that cutting the defense budget will aid economic recovery in the near term—federal spending on defense is just as much a job-producing stimulus as federal spending on infrastructure. Nor, more importantly, do they believe that cutting defense spending will have more than the most marginal effect on reducing the runaway deficits projected for the coming years. The simple fact is, as my Brookings colleague and former budget czar Alice Rivlin recently observed, the scary projections of future deficits are not “caused by rising defense spending,” and even if one assumes that defense spending continues to increase with the rate of inflation, this is “not what’s driving the future spending.” The engine of our growing debt is entitlements.

Kagan is a strong believer in the US global military presence being a source of public good not only for the United States, but also for the world in general. His position on defense cuts is unsurprising, but nonetheless, persuasive. He later in the lengthy article details the main reasons to keep a strong, active US military, with global terrorism and rising great power instability as the key two reasons. Kagan also warns against the assumption that substantial cuts to the defense arena will be without much cost…

In fact, the only way to get significant savings from the defense budget—and by “significant,” we are still talking about a tiny fraction of the cuts needed to bring down future deficits—is to cut force structure: fewer troops on the ground; fewer airplanes in the skies; fewer ships in the water; fewer soldiers, pilots, and sailors to feed and clothe and provide benefits for. To cut the size of the force, however, requires reducing or eliminating the missions those forces have been performing.

In other words, if the US really wants to cut down on our defense spending we are going to have to change or adjust our strategic posture. To some, specifically Jeffersonians and domestic liberals, a smaller US military would be overall beneficial: more money for social programs/less military adventures abroad. For others, a lessening of our international presence will lead us and the world down a potentially dangerous path (great power war, global instability) that will cost us much more than 20% of our budget to get out from under.

I have to admit, though I’m clearly in the ‘US military and global presence is a source for good’ camp, I have to admit that our modern defense industry is bloated and could use some trimming. Greg Scoblete of Real Clear World rightly points out that overall the US currently finds itself in more sure security surroundings compared to the Cold War, WW II, etc. I believe the US needs a strong presence in East Asia to combat a growing China and keep allies such as Japan, Indonesia, and South Korea secure. The scourge of Islamic terrorism is as real as ever and demands a secure homeland and strong military, diplomatic, and intelligence network in numerous hot spots around the globe to deter and defeat. Global trade, which still depends largely on maritime travel, demands safe passage through the earth’s oceans and seas and there is no better guarantor of that than the US Navy. The Middle East, which includes a menacing regime in Tehran, a Turkey posturing away from the West, a vulnerable ally in Israel, oil supplies and pathways up the wazoo, is cauldron of instability and no one knows where these popular uprisings may lead. I could go on…

So in short, yes, I do think the United States could sustain some cuts in our defense spending, but we have to admit that this will come with some costs. which we must choose wisely. and we must not let these cuts distract us from our real budget calamity, ever expanding entitlement programs. This country and the world need a strong American presence and for this to be maintained now and in the future we need not only a capable military, but a fiscal future that doesn’t look so much like present day Greece.

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Budget Politics: Defense vs. Entitlement Spending

   Posted by: FMFP    in Budget/Economy   Print Print

As I wrote yesterday, the Continuing Resolution (CR) likely to arrive at the President’s desk today or tomorrow will grant the government a two week reprieve from what many people were preparing for – a government shutdown. Rightly criticized for simply kicking the can down the road, I’m curious to see what will happen in two weeks considering the broader divide between the Senate Democrats and House Republicans has not really been addressed. In fact, all sides knew this deadline was coming since the 111th Congress passed their CR back in December. So passing this two week CR doesn’t exactly inspire confidence that an agreement to fund the government through September is imminent.

Like many major budget battles, much of the dispute (and ultimately, the resolution) resides in the varying effectiveness of each side’s public relations effort. The Republicans’ position is that America’s high debt and stagnant economy are symptoms of the larger problem – a government that is bloated and spending at unsustainable levels. Therefore, we need to cut the size of government starting with discretionary spending (as opposed to entitlement spending that is considered mandatory). The Republicans claim these cuts are both a down payment on further spending reforms to come and a fulfillment of their campaign promise to rein in our debt (roughly $14.3 trillion) and deficit (projected at $1.6 trillion for 2011).

The Democrats’ position is that our economy is fragile right now and any major cuts like the ones proposed by the Republicans will deflate our current recovery (see yesterday’s reference to Goldman Sachs and Moody’s analysis claiming a loss of 700,000 jobs if Republicans plans to cut $61 billion are adopted). In a nutshell, their argument is that now is not the right time for cuts (without necessarily stipulating that cuts in the future are altogether necessary).

So who’s right and perhaps more importantly for our current discussion, who is winning the public relations battle? Well that’s obviously a complicated question but it just might be the Democrats. On one hand, we see a sustained interest among the public in reining in government spending – cutting the Republicans’ direction.

But on the other hand, we see a real misunderstanding among the public over the composition of government outlays (spending in real people language). For instance, a recent poll released by Tarrance Group shows:

“A majority of voters incorrectly believes the federal government spends more on defense/foreign aid than it does on Medicare and Social Security (63%). Also, a similar majority (60%) incorrectly believes problems with the federal budget can be fixed by just eliminating waste, fraud and abuse. Voters do not casually agree with these untruths- at least 40% strongly agree. Further, less than half (44%) believe Medicare and Social Security costs are a major source of problems for the federal budget (49% disagree).”

These numbers should hearten Democrats because they cut against (factually correct) claims made by Republicans that 1) entitlements/mandatory spending remains the biggest budgetary problem and 2) spending on non-defense discretionary programs (where most of the stimulus dollars were allocated) is also out of control. I’ll back up the assertions just made in a second, but first one more point for the Democrats. The poll demonstrates the prevalence of a long-standing liberal position among the public. Specifically, the claim that defense spending is at least as much – or more, depending how liberal you lean – to blame as entitlements for our budget problems.

Now for the facts. Discretionary spending – including defense – is roughly 1/3 of the federal budget. The other 2/3? You guessed it – mandatory spending, made up primarily of the big three: Social Security, Medicare and Medicaid.

Even if we were to take the poll’s findings head on, we would still find the public’s beliefs dubious. Defense/security spending equals roughly 20% of the federal budget. Social Security and Medicare? Roughly 35%. And even scarier, mandatory spending is growing nearly five times the pace of discretionary spending. So it’s really not even a close call. (Btw, I used a liberal-leaning think tank for these numbers in case you were wondering – the Center on Budget and Policy Priorities).

Since I’m trying to keep these posts at a manageable length (and not really succeeding), I’ll close with my main points. The Democrats seem to be in a strong position if they can sell their position that the real problem is defense spending and the fragile economic recovery is dependent on maintaining government’s current level of support.

Meanwhile, Republicans have a long road uphill to educate the average American on the serious budget problems facing the country and the relatively minor impact the discretionary cuts they’re proposing will have on the economy. Ultimately, they need to convince Americans that the problem lies not just in eliminating waste, fraud and abuse, but rather setting priorities on what we can afford as opposed to what we would like to be able to pay for.

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