Krugman: Medicare and Mediscares, Amy G: Vermont, a Healthy First

http://www.nytimes.com/2011/05/27/opinion/27krugman.html?nl=todaysheadlines&emc=tha212

 

Medicare and Mediscares

Paul Krugman

NY Times: May 27, 2011

 

Yes, Paul Ryan, the chairman of the House Budget Committee, is a sore loser. Why do you ask?

To be sure, Mr. Ryan had reason to be upset after Tuesday’s special election in New York’s 26th Congressional District. It’s a very conservative district, so much so that last year the Republican candidate took 76 percent of the vote. Yet on Tuesday, Kathy Hochul, a Democrat, took the seat, with a campaign focused squarely on Mr. Ryan’s plan to dismantle Medicare and replace it with a voucher system.

How did Ms. Hochul pull off this upset? The Wisconsin congressman blamed Democrats’ willingness to “shamelessly distort and demagogue the issue, trying to scare seniors to win an election,” and he predicted that by November of next year “the American people are going to know they’ve been lied to.”

You can understand Mr. Ryan’s bitterness. He has, after all, experienced quite a comedown over the course of the past seven weeks. Until his Medicare plan was rolled out in early April he had spent months bathing in warm approbation from many pundits, who had decided to anoint him as an icon of fiscal responsibility. And the plan itself received rapturous praise in the first couple of days after its release.

Then people who actually know how to read a budget proposal started looking at the plan. And that’s when everything started to fall apart.

Mr. Ryan may claim — and he may even believe — that he’s facing a backlash because his opponents are lying about his proposals. But the reality is that the Ryan plan is turning into a political disaster for Republicans, not because the plan’s critics are lying about it, but because they’re describing it accurately.

Take, for example, the statement that the Ryan plan would end Medicare as we know it. This may have Republicans screaming “Mediscare!” but it’s the absolute truth: The plan would replace our current system, in which the government pays major health costs, with a voucher system, in which seniors would, in effect, be handed a coupon and told to go find private coverage.

The new program might still be called Medicare — hey, we could replace government coverage of major expenses with an allowance of two free aspirins a day, and still call it “Medicare” — but it wouldn’t be the same program. And if the cost estimates of the Congressional Budget Office are at all right, the inadequate size of the vouchers — which by 2030 would cover only about a third of seniors’ health costs — would leave many if not most older Americans unable to afford essential care.

If anyone is lying here, it’s Mr. Ryan himself, who has claimed that his plan would give seniors the same kind of coverage that members of Congress receive — an assertion that is completely false.

And, by the way, the claim that the plan would keep Medicare as we know it intact for Americans currently 55 or older is highly dubious. True, that’s what the plan promises, but if you think about the political dynamics that would emerge once Americans born a year or two too late realize how much better a deal slightly older Americans are getting, you realize that this is a promise unlikely to be fulfilled.

Still, are Democrats doing a bad thing by telling the truth about the Ryan plan? “If you demagogue entitlement reform,” says Mr. Ryan, “you’re hastening a debt crisis; you’re bringing about Medicare’s collapse.” Maybe he should have a word with his colleagues who greeted the modest, realistic cost control efforts in the Affordable Care Act with cries of “death panels.”

Anyway, the underlying premise behind statements like that is the assumption that the Ryan plan represents a serious effort to come to grip with America’s long-run fiscal problems. But what became clear soon after that plan was unveiled was that it was no such thing. In fact, it wasn’t really a deficit-reduction plan. Once you remove the absurd assumptions — discretionary spending, including defense, falling to Calvin Coolidge levels, and huge tax cuts for corporations and the rich, with no loss in revenue? — it’s highly questionable whether it would reduce the deficit at all.

What the Ryan plan is, instead, is an attempt to snooker Americans into accepting a standard right-wing wish list under the guise of deficit reduction. And Americans, it seems, have seen through the deception.

So what happens now? The fight will shift from Medicare to Medicaid — a program that has become an essential lifeline for many Americans, especially children, but which in the Ryan plan is slated for a 44 percent cut in federal aid over the next decade. At this point, however, I’m optimistic that this initiative will also run aground on popular disapproval.

What of Mr. Ryan’s hope that voters will realize that they’ve been lied to? Well, as I see it, that’s already happening. And it’s bad news for the G.O.P.

 

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http://www.truthdig.com/report/item/vermont_the_land_of_healthy_firsts_20110524/

 

Vermont, the Land of Healthy Firsts

By Amy Goodman

Truthdig: May 24, 2011

Vermont is a land of proud firsts. This small New England state was the first to join the 13 Colonies. Its constitution was the first to ban slavery. It was the first to establish the right to free education for all—public education.

This week, Vermont will boast another first: the first state in the nation to offer single-payer health care, which eliminates the costly insurance companies that many believe are the root cause of our spiraling health care costs. In a single-payer system, both private and public health care providers are allowed to operate, as they always have. But instead of the patient or the patient’s private health insurance company paying the bill, the state does. It’s basically Medicare for all—just lower the age of eligibility to the day you’re born. The state, buying these health care services for the entire population, can negotiate favorable rates, and can eliminate the massive overhead that the for-profit insurers impose.

Vermont hired Harvard economist William Hsiao to come up with three alternatives to the current system. The single-payer system, Hsiao wrote, “will produce savings of 24.3 percent of total health expenditure between 2015 and 2024.” An analysis by Don McCanne, M.D., of Physicians for a National Health Program pointed out that “these plans would cover everyone without any increase in spending since the single payer efficiencies would be enough to pay for those currently uninsured or underinsured. So this is the really good news—single payer works.”

Vermont Gov. Peter Shumlin explained to me his intention to sign the bill into law: “Here’s our challenge. Our premiums go up 10, 15, 20 percent a year. This is true in the rest of the country as well. They are killing small business. They’re killing middle class Americans, who have been kicked in the teeth over the last several years. What our plan will do is create a single pool, get the insurance company profits, the pharmaceutical company profits, the other folks that are mining the system to make a lot of money on the backs of our illnesses, and ensure that we’re using those dollars to make Vermonters healthy.”

Speaking of healthy firsts, Vermont may become the first state to shutter a nuclear power plant. The Vermont Legislature is the first to empower itself with the right to determine its nuclear future, to put environmental policy in the hands of the people.

Another Vermont first was the legalization of same-sex civil unions. Then the state trumped itself and became the first legislature in the nation to legalize gay marriage. After being passed by the Vermont House and Senate, former Gov. Jim Douglas vetoed the bill. The next day, April 7, 2009, the House and the Senate overrode the governor’s veto, making the Vermont Freedom to Marry Act the law of the land.

Vermont has become an incubator for innovative public policy. Canada’s single-payer health care system started as an experiment in one province, Saskatchewan. It was pushed through in the early 1960s by Saskatchewan’s premier, Tommy Douglas, considered by many to be the greatest Canadian. It was so successful, it was rapidly adopted by all of Canada. (Douglas is the grandfather of actor Kiefer Sutherland.) Perhaps Vermont’s health care law will start a similar, national transformation.

Anthropologist Margaret Mead famously said: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Just replace “group” with “state,” and you’ve got Vermont.

Denis Moynihan contributed research to this column.

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 900 stations in North America. She is the author of “Breaking the Sound Barrier,” recently released in paperback and now a New York Times best-seller.

© 2011 Amy Goodman

Distributed by King Features Syndicate