Posts Tagged ‘
Medicaid ’
Wednesday, October 20th, 2010
Will Marshall
Will Marshall is the president of the Progressive Policy Institute.
by Will Marshall
It’s crazy, I know, but imagine that U.S. political leaders after the midterm election called a truce in the partisan tong wars to work out a compromise solution to the nation’s fiscal dilemmas. The result would probably look a lot like a new fiscal reform blueprint drawn up by two canny policy veterans, Bill Galston and Maya MacGuineas.
In The Future Is Now: A Balanced Plan to Stabilize Public Debt and Promote Economic Growth, Galston and MacGuineas map a radically centrist course to fiscal discipline that demands equal sacrifice from the left and the right, and that doesn’t impede economic recovery. Here’s hoping that President Obama’s deficit commission, which is groping for a politically feasible formula for fiscal restraint, will give this plan a close look.
Reducing America’s swollen deficits and debts is fast becoming an urgent national priority. Since President Obama took office, we’ve added three trillion dollars to the public debt, largely thanks to emergency spending to rescue the banking system and goose a faltering economy. But it’s the zooming growth of health care and retirement spending that really threatens to drown the federal government in debt. For decades, we’ve ignored warnings about the growing funding gaps in Medicare, Medicaid, and Social Security, but with the first wave of baby boomers now reaching retirement age, the future really is now.
We’ve dug ourselves more than a hole – it’s a canyon. So any talk now about balancing the federal budget is pure fantasy. The best we can hope for is to arrest the runaway growth of public debt and bring it back down to a sustainable level.
The administration’s forecasts show public debt, 40 percent of GDP two years ago, rising to more than 100 percent in 2012. The Galston-MacGuineas plan would bring that down to 60 percent of economic output by the end of this decade. It also would slash annual budget deficits from a projected five-to-six percent to around one percent, ensuring that our debts don’t grow faster than the economy.
Inevitably, the plan envisions a 50-50 split between spending reductions and tax hikes. It’s hard to image any other way forward considering liberal resistance to spending cuts, especially for the big entitlements that are driving our long-term debt problem, and the conservative allergy to tax increases of any kind. The hacking and lifting, however, would be phased in gradually to give the economy room to breathe and recover.
More specifically, the plan would:
- Make sizeable cuts in defense spending, and impose a war surtax should our current conflicts extend beyond mid-decade.
- Freeze discretionary spending for three years, such that increases in spending in one area would have to be made up by cuts elsewhere.
- Modernize Social Security by indexing the retirement age to longevity, and trimming benefits for affluent retirees in the future. It would also raise the minimum benefit, strengthening the program’s anti-poverty effect, cut the payroll tax and add a new, mandatory savings account.
- Supplement the cost-containment features of President Obama’s comprehensive health plan, by raising Medicare premiums, reducing subsidies and adding tort reform.
- Prune tax expenditures (which cost more than one trillion dollars a year) by 10 percent and limit their future growth. The proceeds would go to lower tax rates and deficit reduction.
- Enact a carbon tax, both to “buy down” the payroll tax and cut deficits.
Many of these proposals, of course, are deemed politically radioactive now, even if they are familiar fixtures on the wish lists of serious fiscal hawks. So why should we expect a package stuffed with political non-starters to advance?
Because the habit of evading even modestly tough choices has allowed the debt problem to reach such ginormous proportions that it can’t be solved in any other way, say Galston and MacGuineas. And if it isn’t solved, it will slow down U.S. economic growth, transfer our wealth to overseas creditors, and limit the federal budget’s fiscal capacity to respond to future emergencies.
The big question is: what impact will the midterm election have on the politics of fiscal evasion? Republicans say cutting taxes is the way to shrink government, but showed little stomach for cutting spending when they were in office. Result: huge public debts. Some Democrats believe deficits should be closed mostly by tax hikes, but aren’t really willing to propose them. Result: huge public debts.
As the Galston-MacGuineas plan shows, solving our fiscal problems doesn’t have to be a political zero sum game. The question is whether our political leaders can rediscover the lost arts of compromise and risk-sharing to advance vital national goals.
Photo credit: Steve Rhodes
Tags: anti-poverty, baby boomers, banking system, big entitlements, Bill Galston, carbon tax, centrist, compromise solution, deficit commission, deficits and debts, discretionary spending, economic recovery, faltering economy., federal budget, fiscal discipline, fiscal hawks, Fiscal Reform, Fiscal Responsibility, fiscal restraint, growth, health care and retirement, liberal resistance, longevity, Maya MacGuineas, Medicaid, Medicare, midterm election, minimum benefit, nation’s fiscal dilemmas, new fiscal reform blueprint, overseas creditors, payroll tax, Politics and politicians, President Obama, Progressivism, public debt, radical center, retirement age, savings account, Social Security, spending reductions, tax expenditures, tax hikes, The Future Is Now: A Balanced Plan to Stabilize Public Debt and Promote Economic Growth, tort reform, U.S. political leaders, war surtax
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Monday, July 26th, 2010
Adriana Sanchez de Lozada
Adriana Sanchez de Lozada is an intern at the Progressive Policy Institute.
by Adriana Sanchez de Lozada
The Congressional Budget Office’s long-term budget forecasts on the national fiscal health are highly educated guesswork, but guesswork just the same. The 2030s are pretty far off, and the degree of forecasting uncertainty is higher than it once was. As CBO explains “the current degree of economic dislocation exceeds that of any previous period in the past half-century, so the uncertainty inherent in current forecasts probably exceeds the historical average.” But let’s imagine that the 2030s have arrived, and that CBO’s budget projections have come true. What would America look like?
For starters, Social Security would be flat broke. All U.S. Treasury’s IOUs to Social Security will have been cashed in. Since the Social Security trust funds will be completely depleted and, because Social Security is barred by law from borrowing from the federal government, the program will be unable to meet its obligations. Thus, by the end of the 2030s, payable benefits would have to be cut by 20 percent. Is it possible to imagine that the government will suddenly cut 20 percent of the benefits it hands out? That seems unlikely — the law would be changed and borrowing would resume.
In fact, Social Security’s problems would start much earlier. In 2016, according to CBO, its outlays would begin to regularly exceed its revenues, and consequently Social Security would first start to regularly call in its IOUs. Thus, the Treasury Department would need to borrow billions of dollars each year to pay back what it borrowed from Social Security’s trust funds.
If Social Security is expected to be in bad shape by the 2030s, the big public health care programs, Medicare and Medicaid, would be doing even worse. The culprits being an aging population and expanding health care costs, which are scheduled to grow faster than the U.S. economy. By the 2030s the number of people over the age of 65 — the beneficiaries – will have increased by 90 percent while those between 20 and 65 — the contributors — will have grown by a meager 10 percent.
In the 2030s, federal spending on mandatory health care programs accounts for 11 percent of GDP, about twice the level in 2010. Add in Social Security, and the big three entitlements cost about 16 percent of GDP. Keep in mind that primary spending for the 40 year period before 2010 averaged 18.5 percent of GDP. This means that in 2030, the U.S. government will either be unable to direct resources to other priorities (like education,) or will have to increase a tax rate by roughly double that of 2010.
Finally, America in the 2030s will groan under mind-boggling public debt, assuming the country’s fiscal fortunes are calculated by the CBO under what’s called a “current policy” scenario. In this case, the CBO assumes that no major public policy innovations will occur throughout the lifetime of its projection. This scenario reflects the political reality we face today. For example, congress is currently debating whether to extend the Bush tax cuts and “patch” the Alternative Minimum Tax. If political inaction prevails, debt-to-GDP ratio would exceed 200 percent by the 2030s, even with an economic recovery.
It is true that the U.S. holds a privileged position by virtue of the dollar’s role as the world’s reserve currency. But we have no idea how a debt of this magnitude would affect our ability to invest in future growth, and to keep borrowing from abroad. Moreover, in the 2030s, interest payments on the national debt are nine percent of GDP, from just one percent of GDP in 2010. If we continue borrowing at the projected rates beyond 2030, interest spending would exceed total federal revenues 15 years thereafter.
Finally, this grim fiscal portrait of America in the 2030s rests on optimistic assumptions. CBO projections assume that revenue will average around 19 percent of GDP and that long-term interest rates remain low. They also assume away the strong likelihood that America will face another economic crisis or armed conflict between 2010 and 2030.
The key for policy-makers, of course, is to envision a different fiscal future for America – and to act on it just as soon as the economy recovers.
Photo Credit: Alancleaver_2000′s Photostream
Tags: Alternative Minimum Tax, AMT, budget deficit, Bush tax cuts, Congressional Budget Office, Medicaid, Medicare, Social Security
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Monday, July 12th, 2010
Ed Kilgore
Ed Kilgore is a PPI senior fellow, as well as managing editor of The Democratic Strategist, an online forum.
by Ed Kilgore
Seyward Darby has an amusing piece at the New Republic‘s site with some of the loonier provisions found in state Republican Party platform documents.
It’s all good clean fun, but does this craziness matter? No, suggests the CW; party platform committees these days, at any level, are a sandbox dominated by ideological activists, producing turgid documents that candidates feel free to ignore.
Fair enough, I guess, but what about those states where ideological activists have an unusually important role? How about, say, Iowa, whose caucuses often all but dictate one or the other party’s nominating process?
I strongly suggest a reading of the Iowa Republican Party Platform by anyone who accuses “liberals” or “the media” of exaggerating the extremism of today’s conservatives.
This 367-plank, 12,000-word document, adopted just last month at the Iowa State Republican Convention, is relentlessly kooky. Right up top, before the “statement of principles,” the platform features a long, ominous quote from Cicero about “traitors.” It’s not made clear whether said traitors are Democrats, RINOs, or Muslims, but treason sure seems to be a major preoccupation for Iowa Republicans.
Once you get to the “statement of principles,” it’s hard to miss principle number seven, which would have satisfied Ayn Rand even on one of her crankier days:
The individual works hard for what is his/hers. Therefore, the individual will determine with whom he/she will share it, not the government. No more legal plunder. Legal plunder is defined as using the law to take from one person what belongs to them, and giving it to others to whom it does not belong. It is plunder if the law benefits one citizen at the expense of another by doing what that citizen himself cannot do without committing a crime.
Given that principle, it’s not surprising that elsewhere the platform flatly calls for the abolition of Social Security, Medicare and Medicaid (along with minimum wage laws), and of the federal departments of Agriculture (!), Education and Energy. It also appears to oppose any anti-discrimination laws of any sort.
Beyond such basics, the Iowa GOP Platform is essentially a compilation of every right-wing consipracy theory-based preoccupation known to man. In a nod to Glenn Beck, the statement of principles mentions “Progressivism” along with “Collectivism, Socialism, Fascism, [and] Communism” as ideologies incompatible with the Founding Fathers’ design. There’s a birther plank. There’s a plank about the “NAFTA Superhighway.” There’s a plank about ACORN. There’s a plank about the “fairness doctrine.” There’s plank after plank after plank opposing the nefarious activities of the United Nations. There’s a plank calling for abolition of the Federal Reserve System. Needless to say, there are many, many planks spelling out total opposition to abortion and same-sex marriage in excrutiating detail, and attacking any limitation on campaign activities or use of tax dollars by religious organizations.
The very end of the platform holds that Republican candidates should be denied party funds if they don’t agree with at least 80% of the platform, as determined by questionnaires asking about every single crazy plank. This is something we should all be able to get behind; I’d love to see not only Iowa Republican gubernatorial candidate Terry Branstad, a notorious fence-straddler on many issues, but the entire 2012 GOP presidential field, have to check boxes next to solemn items like:
We oppose any effort to implement Islamic Shariah law in this country.
If all this madness is really out of the mainstream of Republican thinking, then perhaps the adults of the GOP should expend the minimum effort necessary to say so very explicitly.
Photo credit: Mike Licht, NotionsCapita.com’s Photostream
This item is cross-posted at The Democratic Strategist.
Tags: Ayn Rand, Clean energy and technology, Conservatism, Democratic Party, Education, Glenn Beck, Iowa, Iowa Republican Party Platform, Medicaid, Medicare, Muslims, New Republic, Politics and politicians, Progressivism, Republican Party, RINO, Seyward Darby, Social Security, Terry Branstad, United Nations
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Wednesday, April 28th, 2010
Will Marshall
Will Marshall is the president of the Progressive Policy Institute.
by Will Marshall
Politicians, especially at the national level, have little credibility on matters of fiscal discipline. Bill Clinton is an exception.
As president, Clinton inherited fast-rising budget deficits that threatened to capsize an economy emerging from recession. He made deficit reduction a top priority, incurring the wrath of liberals who accused him of governing like an Eisenhower Republican. Such complaints evaporated as jobs and economic growth surged in the late 1990s, and Clinton handed his successor budget surpluses.
In an act of monumental political irresponsibility, George W. Bush promptly squandered the surplus on big tax cuts and a $1 trillion-plus Medicare prescription drug entitlement that Republicans simply added to the nation’s charge account.
So it was worth listening to Clinton speak about the fiscal challenge facing President Obama, as he did today at a big “fiscal summit” in Washington sponsored by the Peter G. Peterson Foundation.
“I think this is a national sovereignty issue,” said Clinton, noting that foreign creditors hold 48 percent of America’s debt. As that debt grows –- Clinton’s treasury secretary, Bob Rubin, cited projections that it could reach 130 percent of GDP by 2030 –- so will the influence over U.S. policy of foreign bondholders.
As America grows older, Clinton said, “delivery systems” like health care and education become rigid and society in general tends to put a premium on security. It’s no accident that the government’s biggest programs are defense, Medicare, Medicaid and Social Security. By letting this programs continue to eat up a greater share of national output, politicians put a severe squeeze on discretionary programs that invest in the well-being of children and families.
“The future always has a smaller constituency than the present,” the former president said. “We’ve got to be a tomorrow country. We can’t do it if we mortgage our future to people in other countries.”
Clinton also noted that Congress is not organized to deal with America’s fiscal crisis. Congressional committees expand programs and mint new ones; none is charged with putting America back on a sustainable fiscal course.
Since Congress also punted on forming a deficit reduction commission, President Obama has been forced to empanel his own. As it met yesterday at the White House for the first time, Obama vowed that “everything will be on the table.”
Thanks to the cost of bailing out the financial sector and mitigating a severe recession, Obama faces a bigger fiscal challenge than Clinton’s. Budget deficits are now running at about $1.3 trillion a year, a whopping nine percent of GDP. The president’s commission needs to come up with a plan for whittling deficits down to size. But it’s even more important, as Clinton argued, to attack the structural roots of exploding debts, lest America lose control of its own economic destiny.
Photo credit: http://www.flickr.com/photos/bestrated1/ / CC BY-NC-ND 2.0
Tags: Barack Obama, Bill Clinton, Budget, Deficits and debt, Economy, Fiscal Responsibility, George W. Bush, Medicaid, Medicare, Peter G. Peterson Foundation, Robert Rubin, Social Security, spending
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Monday, April 19th, 2010
Ed Kilgore
Ed Kilgore is a PPI senior fellow, as well as managing editor of The Democratic Strategist, an online forum.
by Ed Kilgore
With all the obsessive focusing on congressional races that is natural to Washington, it’s not a bad time to take a more comprehensive look at the 37 governors’ races that will be decided in November (if you happen to have a subscription to the Cook Political Report, their wizard on gubernatorial and Senate races, Jennifer Duffy, has a new overview out).
It’s quite an even playing field between the two parties: Democrats are defending 19 governorships and Republicans 18. More importantly, thanks to a combination of term limits and retirements, 22 of the 37 races are “open.” And quite a few of those are in states where the party controlling the governorship has not been the dominant party generally (thus creating a particularly ripe climate for a switch this year), ranging from “red states” with Democratic governors like Wyoming, Kansas, Oklahoma and Tennessee to “blue states” with Republican governors like Vermont, Connecticut, Minnesota, Hawaii and California. Absent a really massive Republican wave, we will probably see both major parties gain and lose more than a few governorships.
The other factor lending instability to governors’ races is, of course, the fact that state governments as a whole have been roiled by recession, revenue losses and automatic counter-cyclical increases in spending even more than the federal government (at least in all but a few fortunate, recession-resistant states), and nearly all have constitutional or statutory balanced budget requirements. It didn’t get much national attention at the time, but states didn’t really receive a lot of help from the 2009 economic stimulus legislation, with the exception of a temporary “super-match” for Medicaid (which is, along with mandates for expanded coverage, being continued by the new health reform legislation).
Most of the states are dealing with chronic budget shortfalls. And it’s all taking a toll on public confidence. A major new Pew survey just out today shows that the drop in the percentage of Americans saying government has a “positive impact” on their lives has dropped even more for the states (from 62 percent to 42 percent) than for the federal government (from 50 percent to 38 percent) since 1997. With voters viewing past state administrations somewhat nostalgically, it’s not surprising that there are no less than five former governors running for their old jobs this year (which, as Duffy points out, is really an unusual number): Democrats Jerry Brown of California, John Kitzhaber of Oregon, and Roy Barnes of Georgia; and Republicans Terry Branstad of Iowa and Bob Ehrlich of Maryland. All but Ehrlich have been out of office for at least eight years (Branstad for 12 years, and Brown for 28 years). Another wild card: there are presently three viable independent candidates for governor, all in New England (Maine, Massachusetts and Rhode Island), where weak Republican parties make indies a preferred alternative to Democrats for many voters.
Add it all up, and it’s very difficult to discern big national trends in governors’ races, aside from the fact that turnout patterns are likely to boost Republican prospects generally. Duffy currently rates an astonishing 17 races — close to half — as “toss-ups,” including seven governorships held by Democrats and ten by Republicans, with another seven races looking competitive. Some could be real barn-burners, with close, expensive races likely in big states like California, Texas, Florida, Illinois and Ohio. Others could produce upsets if the “wrong” candidate wins large, multi-candidate primary fields. This is particularly true on the Republican side, where the conservative/Tea Party upsurge could beat more electable Republican candidates in primaries ranging from Iowa to Alabama.
So buckle up the seat belts for a wild ride in gubernatorial elections this year.
Poll Watch
The most interesting polls to come out in the last few days involve highly competitive governor’s races. A new Quinnipiac survey shows Democrat Alex Sink significantly reducing Republican Bill McCollum’s lead in Florida; the race is now within the margin-of-error in that particular poll. Rasmussen now has incumbent Republican Rick Perry locked in a close race with Democrat Bill White in Texas. And Western New England College shows a close three-way race in Massachusetts among Democratic incumbent Deval Patrick, Republican Charles Baker and independent Tim Cahill.
Ed Kilgore’s PPI Political Memo runs on Mondays and Fridays.
Photo credit: http://www.flickr.com/photos/jstephenconn/ / CC BY-NC 2.0
Tags: Alex Sink, Bill McCollum, Bill White, Campaigns and elections, Charles Baker, Democratic Party, Deval PAtrick, Jennifer Duffy, Jerry Brown, John Kitzhaber, Medicaid, Politics and politicians, Public opinion, Republican Party, Rick Perry, Robert Ehrlich, Roy Barnes, stimulus, Terry Branstad, Tim Cahill
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Tuesday, March 9th, 2010
Will Marshall
Will Marshall is the president of the Progressive Policy Institute.
by Will Marshall
It often seems that Blue Dog Democrats, along with a handful of Senate moderates, are the only people in Washington who are serious about fiscal responsibility. Chasing the will-o-the-wisp of a balanced budget amendment, however, seems more likely to distract from than advance that essential cause.
The idea is seductively simple: The only way to restrain deficit spending in Washington is to make it unconstitutional. That’s how the states keep their books balanced, and there’s no reason the federal government shouldn’t do the same.
In fact, there are several. Consider that today’s federal deficit is about 12 percent of GDP. It’s going to go down as the economy recovers, but the spending and tax adjustments that would have to be made to get it all the way down to zero would be unduly draconian and disruptive. Also, unlike state mandates, a federal balanced budget amendment for accounting reasons would not distinguish between capital investment and consumption. But government borrowing to invest in public infrastructure or higher education, for example, makes economic sense, because it will generate more economic activity and amortize itself over time.
What’s more, the federal government acts as the nation’s fiscal safety valve, or strategic reserve. During severe economic downturns, the only way many states can provide services while preserving their fiscal virtue is to get counter-cyclical assistance (or revenue sharing) from Washington. A constitutional ban on deficits could prevent Washington from responding to emergencies of all kinds.
In truth, we don’t need a balanced federal budget — we need a disciplined federal budget. Congress would be better off adopting Sen. Mike Bennett’s (D-CO) sensible suggestion that federal deficits be held first to four percent, then to three percent of GDP each year. At that level, they’d be gradually whittled down by economic growth, and the government could borrow without swelling the national debt.
A balanced budget amendment, moreover, is a blunter instrument than we need to deal with overspending and undertaxing in Washington. It doesn’t hone in on the real problem, which is the automatic and unsustainable growth in entitlement spending. A better idea, from the Brookings-Heritage Fiscal Seminar, is to bring Medicare, Medicaid and Social Security on budget, which would require Congress to periodically reconcile income and spending to keep the programs solvent.
Finally, a balanced budget amendment is just too damn difficult to enact. Congress has to approve Constitutional amendments by a two-thirds vote, well nigh inconceivable given how hard it is to muster the 60 votes needed to break a filibuster. Then three-fourths of the states would have to approve an amendment.
Demanding a balanced budget amendment thus is more of a symbolic gesture than a real solution to America’s fiscal crisis. Recall that it was a key plank in the GOP’s 1994 Contract with America, but Republicans quickly lost interest once they won control of Congress. Nonetheless, Newt Gingrich has endorsed the amendment in a bid to recapture the old magic for this year’s midterm elections.
Unlike the Republicans, of course, the Blue Dogs have real street cred when it comes to fiscal rectitude. They fought successfully to resurrect “pay go” rules that require Congress to offset new spending with tax hikes or budget cuts. And key Blue Dog leaders like Rep. Jim Cooper (D-TN) have led the charge for a bipartisan commission to get entitlement spending under control.
It’s vital, though, that progressive deficit hawks not let the holy grail of a constitutional amendment deflect them from the gritty, day-to-day battles in Congress to get America’s exploding deficits and debts under control.
Tags: Blue Dogs, Brookings, Budget, Democratic Party, Fiscal Responsibility, Jim Cooper, Medicaid, Medicare, Michael Bennet, moderates, Newt Gingrich, Social Security
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Tuesday, March 2nd, 2010
Elbert Ventura
Elbert Ventura is the managing editor of Democracy: A Journal of Ideas. He formerly served as the managing editor of the Progressive Policy Institute.
by Elbert Ventura
The White House today released a letter from President Obama pointing a way forward for passing health care reform. True to the course that he set at the Blair House summit last week, he stressed the areas of agreement between the two parties, even as he acknowledged some unbridgeable differences.
A considerable portion of the letter — and the part that has gotten everyone’s attention — goes into detail about four GOP ideas that the president said he would like to see in any final package. The president writes:
1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.
2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.
3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.
4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.
None of those suggestions should surprise anyone who saw the summit or has been paying attention to the president on health care the last few months. Three of the four touch on cost control, which is also not a surprise considering that’s the one area that both sides agree needs to be addressed (although only one party seems to be willing to actually pass legislation to do something about it). As TNR’s Jonathan Cohn rightly points out, the fraud and Medicaid payment proposals should win Democratic support, while the other two might have more trouble.
The key part of the letter, however, comes at the end:
I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.
The president, who is scheduled to speak tomorrow to chart his way forward for passing reform, here seems like he’s laying the groundwork for Congress to go down the path everyone has already discussed: passage by the House of the comprehensive bill that the Senate has passed, and a sidecar reconciliation bill to “fix” parts of the bill that House members find objectionable.
What’s important, too, is the language that he uses to justify the continued push. If cost control was the issue on which he could reach out to Republicans, coverage and affordability for ordinary families are the talking points as far as selling reform to the public and to the Democratic caucus. Ending exclusions based on pre-existing conditions, lowering out-of-pocket costs, keeping coverage even after losing your job: these are all hugely popular and marketable ideas. The Democrats have thus far done a poor job of explaining the kitchen-table benefits of reform. But those benefits are real, and they will redound to the benefit of the party who can make reform happen, something Obama seems to understand.
Tags: Barack Obama, bipartisanship, Chuck Grassley, Harry Reid, Health care, John Barrasso, John Boehner, Medicaid, Medicare, Mitch McConnell, Nancy Pelosi
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Monday, February 22nd, 2010
Ed Kilgore
Ed Kilgore is a PPI senior fellow, as well as managing editor of The Democratic Strategist, an online forum.
by Ed Kilgore
So, it’s finally out there: the “President’s Proposal” for health care reform which Obama will explain and defend in the “summit” with bipartisan congressional leaders on Thursday.
It’s unclear to what extent this plan reflects completed House-Senate negotiations on various sticking points between the bills each chamber has already passed. But it certainly addresses many of them. Think Progress has a useful chart comparing House, Senate, and Obama provisions. The biggies in terms of “improvements” to the Senate bill that would be enacted via reconciliation include a significant watering-down of the excise tax on high-cost insurance plans; bigger subsidies for insurance purchases; a sizeable increase in the federal share of costs associated with Medicaid expansion (accompanied by elimination of the special deal for Nebraska that the Senate included to get Ben Nelson on board); and the closing of the so-called “donut hole” in Medicare prescription drug coverage. These do represent the most often cited problems House Democrats have cited in the Senate bill, aside from the more fundamental failure to include a public option.
The two “surprises” in the proposals were that it did not authorize national health insurance exchanges (probably because of fears that such a step could trigger an adverse parliamentary ruling as non-germane to a reconciliation bill), which could be a serious issue for some House members; and a new provision that would enable federal regulators to stop large health insurance premium increases, which was almost certainly motivated by the recent big Anthem premium increases in California.
Republicans, of course, have immediately denounced the proposal as “partisan,” and appear ready for total war at the summit. Interestingly, the only spurned Republican “ideas” specifically mentioned in House Minority Leader John Boehner’s official response to the Obama proposal were interstate insurance sales and a total ban on private abortion coverage for people receiving federal subsidies (the Obama proposal tracks the Senate bill on abortion, which requires separate accounts for supplemental abortion insurance, but doesn’t try to outlaw it outright like the House bill’s Stupak Amendment does).
For those readers most concerned with a late revival of the public option, it should be noted that this possibility remains strictly contingent on progress towards getting 50 Democratic senators signed on. At this point, including it in the Obama proposal would have probably been counter-productive, even among Senate Democrats, while creating a new distraction going into the summit.
So we’re now ready for some serious Kabuki theater on Thursday. Obama’s objective will be three-fold: to rekindle some momentum for final action on health reform; to explode some of the Republican “ideas” like interstate sales; and to force Republicans to show the back of their hands while identifying them with potentially very unpopular proposals like voucherizing Medicare.
This item is cross-posted at The Democratic Strategist.
Tags: Barack Obama, bipartisanship, Health care, Medicaid, Republican Party
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Thursday, February 18th, 2010
Will Marshall
Will Marshall is the president of the Progressive Policy Institute.
by Will Marshall
The present era of polarization may have reached its nadir on January 25, 2010. That was the day Senate GOP leader Mitch McConnell led a filibuster to kill a deficit reduction commission — something he’d loudly demanded earlier. All it took was President Obama’s endorsement to turn McConnell and the six Senate Republicans who co-sponsored it against the bill.
Senate Republicans, have you no shame? Well, keep in mind that this is the same gang that’s now posturing as the saviors of Medicare, which Obama proposes to cut to help pay for health care reform.
Undeterred by the flight of the GOP’s fiscal chicken hawks, President Obama today unveiled an 18-member special commission to tackle the nation’s budget crisis. Named to lead the panel were Democrat Erskine Bowles, chief of staff to President Clinton, and former Senate Republican leader Alan Simpson.
It’s easy to be cynical about such “blue ribbon” commissions. They are supposed to signal that political leaders are serious about solving intractable problems, but often convey the opposite — a craven desire to punt tough decisions to retired dignitaries who don’t have to face the voters.
And setting up a commission by executive order is distinctly inferior to enacting one into law, since the president can’t compel Congress to give his panel’s recommendations an up-or-down vote. Speaker Nancy Pelosi has offered distinctly unenthusiastic assurances that the House will consider the commission’s suggestions.
Still, such commissions are sometimes the only way to break a political impasse — recall the 1983 Greenspan Commission for Social Security reform, or the congressionally mandated military base-closing commission. Such action-forcing mechanisms give politicians just enough bipartisan cover to embolden them to vote for reforms everyone knows are necessary if unpopular.
In a bow to political reality, the president’s commission will report its recommendations after the midterm election, before the end of the year. Presumably, that will tee up the debate for the next Congress, while giving the economy this year to gain strength and whittle down the unemployment rate.
That’s the right timing, and it belies claims by Obama’s liberal critics that highlighting the urgent need to put America on a more sustainable fiscal course is antithetical to economic recovery. After all, only about $300 billion of Obama’s $800-plus stimulus package has been spent, and Congress is crafting a jobs bill intended to give a smaller but more targeted boost to employment.
But here’s what really irks Obama’s critics on the left: they see the commission setting the stage for an assault on entitlement programs. They are not entirely wrong: it’s the unsustainable growth of Medicare, Medicaid, and Social Security that’s driving America’s long-term fiscal woes. But progressives ought to have more confidence in Obama’s ability to take a balanced approach to reforming the Big Three. It’s better, and safer, to do that now rather than risk handing off the job to some future Republican president who may be hostile to the idea of social insurance.
The president’s commission must do what lawmakers in Washington won’t — craft a balanced program of benefit cuts and tax increases to slow the growth rate of health and retirement benefits and move them toward solvency. Otherwise, those programs will consume the equivalent of every penny Washington now raises in taxes, necessitating unprecedented tax hikes, or borrowing at levels that will jeopardize America’s growth and fiscal stability.
But the commission shouldn’t just look at the Big Three, it should also look at the federal government’s massive spending on tax entitlements. Washington spends over $1 trillion a year on tax breaks and subsidies, including such popular items as the mortgage interest deduction and exclusion of employer-paid health benefits, crop subsidies, and a raft of special bennies for politically influential industries, aka, corporate welfare. There are also lots of important breaks for low-income Americans, like my own favorite, the earned income tax credit. All of these tax expenditures have rationales and constituencies, none should be regarded as sacrosanct.
This will raise hackles among Republicans, just as talk of benefit cuts (which should be focused on upper income beneficiaries) makes Democrats nervous. Both the left and the right will have to give ground to cut a responsible, and politically sustainable, deal that can restore out nation’s fiscal health.
Tags: Barack Obama, bipartisanship, Budget, Deficits and debt, Earned Income Tax Credit, Fiscal Responsibility, Medicaid, Medicare, Mitch McConnell, polarization, Republican Party, Social Security, Taxes
Posted in
Daily Fix, Fiscal Responsibility, Priority 1 |
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Tuesday, December 29th, 2009
Ed Kilgore
Ed Kilgore is a PPI senior fellow, as well as managing editor of The Democratic Strategist, an online forum.
by Ed Kilgore
If you’re interested in the broad outlines of what House and Senate conferees will be grappling with in reconciling their health care reform bills, take a look at Paul Waldman’s American Prospect piece on the top ten conference issues.
What’s most interesting about the less visible but important issues at stake is that several have big implications for the future shape of health care in this country. One is pretty much settled: the bill if enacted will almost definitely put a final stake in the heart of Medicaid’s vast inequalities between states in eligibility (unless, of course, some sort of general state opt-out is authorized). Another is the collateral attack on the employer-based system of private health insurance via the Senate’s excise tax on high-cost plans, and its small opening to Sen. Ron Wyden’s proposal to let some employees covered by particularly bad employer plans to join the new health insurance exchanges. And still another is the principle, all but gutted in the Senate bill but still maintained by the House, that the health care system, beginning with Medicare, should finally begin separating the sheep from the goats in terms of effective and ineffective treatments.
It’s very likely that media coverage and public controversy over the conference will continue to focus on total public costs, new taxes, subsidy levels, the individual mandate, and the ghost of the public option. But in the long run, other deals may represent the real deal on health care reform.
This item is cross-posted at The Democratic Strategist.
Tags: Health care, Medicaid, Medicare, Taxes
Posted in
A New Framework for Growth and Equity, Daily Fix |
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Wednesday, December 16th, 2009
Ed Kilgore
Ed Kilgore is a PPI senior fellow, as well as managing editor of The Democratic Strategist, an online forum.
by Ed Kilgore
The latest intra-progressive dustup over health care reform displays a couple of pretty important potential fault lines within the American center-left. One has to do with political strategy, and the role of the Democratic Party and the presidency in promoting progressive policy goals and social movements. I’ll be writing about that subject extensively in the coming days.
But the other potential fault line is ideological, and is sometimes hard to discern because it extends across a variety of issues. To put it simply, and perhaps over-simply, on a variety of fronts (most notably financial restructuring and health care reform, but arguably on climate change as well), the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results. This approach was a hallmark of the so-called Clintonian, “New Democrat” movement, and the broader international movement sometimes referred to as “the Third Way,” which often defended the use of private means for public ends. (It’s also arguably central to the American liberal tradition going back to Woodrow Wilson, and is even evident in parts of the New Deal and Great Society initiatives alongside elements of the “social democratic” tradition, which is characterized by support for publicly operated programs in key areas.)
To be clear, this is not the same as the conservative “privatization” strategy, which simply devolves public responsibilities to private entities without much in the way of regulation. In education policy, to cite one example, New Democrats (and the Obama administration) have championed charter public schools, which are highly regulated but privately operated schools that receive public funds in exchange for successful performance of publicly-defined tasks. Conservatives have typically called for private-school vouchers, which simply shift public funds to private schools more or less unconditionally, on the theory that they know best how to educate children.
Now clear as this distinction seems to “New Democrats,” there are a considerable number of progressives who think it’s largely a distinction without a difference, in education policy and elsewhere. And we are seeing that fundamental divergence on opinion on other, more prominent issues right now. On the financial front, the Obama administration reflexively pursued a strategy of regulation and subsidies for the financial sector, without modifying the fundamental nature of financial institutions, even as critics on the left argued for nationalization (at least temporarily) of key financial functions. At the more popular level, critics of TARP from the left joined critics of TARP from the right in deploring “bailouts” of failed financial institutions, even though the two groups of critics held vastly different views of the right alternative course of action.
Similarly in the health care reform debate, the Obama administration pursued legislation that utilized regulated and subsidized private for-profit health insurers to achieve universal health coverage. This approach was inherently flawed to “single-payer” advocates on the left, who strongly believe that private for-profit health insurers are the main problem in the U.S. health care system. The difference was for a long time papered over by the cleverly devised “public option,” which was acceptable to many New Democrat types as a way of ensuring robust competition among private insurers, and which became crucial to single-payer advocates who viewed it as a way to gradually introduce a superior, publicly-operated form of health insurance to those not covered by existing public programs like Medicare and Medicaid. (That’s why the effort to substitute a Medicare buy-in for the public option, which Joe Lieberman killed this week, received such a strong positive response from many progressives whose ultimate goal is an expansion of Medicare-style coverage to all Americans).
Now that the public option compromise is apparently no longer on the table, and there’s no Medicare buy-in to offer single-payer advocates an alternative path to the kind of system they favor, it’s hardly surprising that some progressives have gone into open opposition, and are using the kind of outraged and categorical language deployed by Marcy Wheeler yesterday. As with the financial issue, there’s now a tactical alliance between conservative critics of “ObamaCare,” who view the regulation and subsidization of private health insurers as “socialism,” and progressive critics of the legislation who view the same features as representing “neo-feudalism.”
To put it more bluntly, on a widening range of issues, Obama’s critics to the right say he’s engineering a government takeover of the private sector, while his critics to the left accuse him of promoting a corporate takeover of the public sector. They can’t both be right, of course, and these critics would take the country in completely different directions if given a chance. But the tactical convergence is there if they choose to pursue it.
For those of us whose primary interest is progressive unity and political success for the Democratic Party, it’s very tempting to downplay or even ignore this potential fault-line and the left-right convergence it makes possible. It’s also easy to dismiss critics-from-the-left of Obama as people primarily interested in long-range movement-building rather than short-term political success; that’s true for some of them. But sorting out these differences in ideology and perspective is, in my opinion, essential to the progressive political project. And with a rejuvenated and increasingly radical right’s hounds baying and sniffing at the doors of the Capitol, we don’t have the time or energy to spare in dialogues of the deaf wherein we call each other names while getting ready for the elections of 2010 and 2012.
This item is cross-posted at The Democratic Strategist.
Tags: Banking, Barack Obama, Bill Clinton, conservatives, Democratic Party, Health care, Medicaid, Medicare, New Democrats, Politics and politicians, progressives, Progressivism, TARP, Third way
Posted in
A New Framework for Growth and Equity, Daily Fix, Fixing Our Broken Politics |
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