Posts Tagged ‘ Medicare ’

Blue Dogs Only Chasing Their Tail

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.

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The Tea Party’s Retreaded “Ideas”

Friday, March 5th, 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

For all the talk about the Tea Party Movement and its demands that America’s political system be turned upside down, it’s always been a bit hard to get a fix on what, exactly, these conservative activists want Washington to do.

To solve this puzzle, it’s worth taking a look at the Contract From America process — a project of the Tea Party Patriot organization, designed to create a bottoms-up, open-source agenda that activists can embrace when they gather for their next big moment in the national media sun on April 15. The 21-point agenda laid out for Tea Partiers to refine into a 10-point “Contract” is, to put it mildly, a major Blast from the Past, featuring conservative Republican chestnuts dating back decades.

There’s term limits, naturally. There are a couple of “transparency” proposals, such as publication of bill texts well before votes. But more prominent are fiscal “ideas” very long in the tooth. You got a balanced budget constitutional amendment, which ain’t happening and won’t work. You got fair tax/flat tax, the highly regressive concept flogged for many years by a few talk radio wonks, that has never been taken seriously even among congressional Republicans. You’ve got Social Security and Medicare privatization (last tried by George W. Bush in 2005) and education vouchers. You’ve got scrapping all federal regulations, preempting state and local regulations, and maybe abolishing some federal departments (an idea last promoted by congressional Republicans in 1995). You’ve got abolition of the “death tax” (i.e., the tax on very large inheritances). And you’ve got federal spending caps, which won’t actually roll back federal spending because they can’t be applied to entitlements.

My favorite on the list is a proposal that in Congress “each bill…identify the specific provision of the Constitution that gives Congress the power to do what the bill does.” This illustrates the obliviousness or hostility of Tea Partiers to the long string of Supreme Court decisions, dating back to the 1930s, that give Congress broad policymaking powers under the 14th Amendment and the Spending and Commerce Clauses. This illustrates the literalism of Tea Party “original intent” views of the Constitution; if wasn’t spelled out explicitly by the Founders it’s unconstitutional.

We are often told that the Tea Party Movement represents some sort of disenfranchised “radical middle” in America that rejects both major parties’ inability to get together and solve problems. As the “Contract From America” shows, that’s totally wrong. At least when it comes to policy proposals, these folks are the hard-right wing of the Republican Party, upset that Barry Goldwater’s agenda from 1964 has never been implemented.

Photo credit: http://www.flickr.com/photos/bisongirl/ / CC BY 2.0

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The Bunning Blockade Ends

Wednesday, March 3rd, 2010
Elbert Ventura



Elbert Ventura is the managing editor of the Progressive Policy Institute.

by Elbert Ventura

Sen. Jim Bunning (R-KY), who had held up Senate passage of a $10 billion short-term benefits extension for days, finally relented yesterday and allowed the measure to come for a vote. Bunning’s objection to unanimous consent to pass the package resulted in the elapsing of funding for a host of federal programs, including infrastructure projects, unemployment benefits, and Medicare payments.

The Kentucky senator, who is retiring after this year (with a helpful nudge from his fellow Republicans), had demanded that Democrats find offsets in the budget for the legislation. Democrats retorted that the bill was a short-term emergency measure that did not fall under “pay-go” rules. (Democrats, on a party-line vote, reinstituted “pay-as-you-go” rules in January.)

The Bunning blockade proved to be a heaven-sent illustration of Republican obstructionism and heartlessness. McClatchy came up with a handy graphic depicting its state-by-state effects:

Even as the blockade stretched over the first couple of days of this week – leaving about 1.2 million unemployed people high and dry, 2,000 Department of Transportation workers furloughed, and numerous projects halted – some of Bunning’s colleagues actually voiced their support for his actions. Sen. John Cornyn (TX) said:

It’s not fun to be accused of having no compassion for the people who are out of work, the people for who these benefits should be forthcoming, and I believe will be forthcoming. But somebody has to stand up, finally, and say enough is enough, no more inter-generational theft from our children and grandchildren by not meeting our responsibilities today.

Meanwhile, Sen. Jon Kyl (AZ), in response to Bunning’s filibuster of unemployment compensation, helpfully noted: “In fact, if anything, continuing to pay people unemployment compensation is a disincentive for them to seek new work.” Even newly minted Sen. Scott Brown gave Bunning’s efforts a thumbs-up:

The perception in Massachusetts and other parts of the country is that Washington is broken. And if it takes one guy to get up and make a stand, to point out that we need a funding source to pay for everything that’s being pushed here, I think that speaks for itself.

Here’s the best part: Bunning, along with every Republican in the Senate, voted against “pay-as-you-go” legislation. Republicans had thundered that the pay-go bill was a political fig leaf and that Democrats weren’t really serious about budget sanity. Considering that previous pay-go rules elapsed in 2002 under the Republicans’ watch, and that they also presided over the ballooning of the deficit, I suppose they’re experts on the subject.

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President Obama’s Letter: Setting up the Final Push

Tuesday, March 2nd, 2010
Elbert Ventura



Elbert Ventura is 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.

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What We Talk About When We Talk About Health Care

Monday, March 1st, 2010
Elbert Ventura



Elbert Ventura is the managing editor of the Progressive Policy Institute.

by Elbert Ventura

Regardless of the outcome of the Democratic health reform push, one point is obvious: at every turn, they lost the messaging battle to Republicans and the Tea Party. The latest reminder came this morning, as the umpteenth story on budget reconciliation came on the radio. These days, to talk about health care reform is to talk about process — exactly where the GOP wants the conversation to be.

Over the last few weeks, a new narrative has taken hold in health care news: that of a partisan Democratic Party determined to “ram” a bill through Congress. It’s a frame that the GOP has been relentless and disciplined in perpetuating. Some have even taken to calling it the “nuclear option,” which in its previous political incarnation was the name Trent Lott gave the Republican effort in 2005 to change filibuster rules for judicial nominations.

The “nuclear option” as shorthand for budget reconciliation is not only a misnomer, it’s flat-out misleading. Hardly unprecedented, budget reconciliation has been used 22 times since the process was established in 1974. As Jackie Calmes wrote in the New York Times last week, 16 of those times, it was the Republican Party that used it to “ram legislation through on a one-party vote” (at least that’s how House GOP Leader John Boehner describes its use today).

Moreover, reconciliation has been used several times to pass health care legislation. NPR’s Julie Rovner, who has done superb work on the health care story, pointed out that health care provisions ranging from COBRA (it even says so in the name — COBRA stands for Consolidated Omnibus Budget Reconciliation Act) to the Children’s Health Insurance Program (CHIP) to changes in Medicare and Medicaid have come via reconciliation.

But efforts by reporters like Rovner notwithstanding, the Democrats have already lost this battle as the media have taken the GOP’s cue and fixated on process. The unwarranted magnification of reconciliation is not unlike the media frenzy over Sen. Ben Nelson’s “Cornhusker Kickback,” a bit of horse-trading that was hardly unusual in writing bills, but somehow became the equivalent of a legislative high crime by the time the GOP and the media were done with it.

More than any other piece of legislation in recent memory, health care reform has been debated, negotiated, and written under the unforgiving attention of the 24-hour cycle. This is as close a view as the American public has had to the sausage-making in Washington. They don’t like what they see. Republicans are well aware of this, and continue to point the spotlight on the frequently ugly process.

And so we are now at the current pass. One party has made unprecedented use of the filibuster to prevent anything from being done. The other party is now thinking of using a procedural tactic used nearly two dozen times since 1980, including to pass health care legislation, to break the impasse. While there certainly has been more attention on the abuse of the filibuster of late, that the use of reconciliation is even a story is a problem for Democrats. That Democrats are playing defense on a matter of process speaks volumes about their PR ineptitude, the Republicans’ messaging cohesion, and the media’s ongoing failure to go beyond stenography.

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GOP Complaints on Health Care Process Ring Hollow

Wednesday, February 24th, 2010
Will Marshall



Will Marshall is the president of the Progressive Policy Institute.

by Will Marshall

Republicans are warning of ominous political consequences if the Democrats use budget reconciliation rules to help pass health care reform. It would be “a huge mistake,” averred Sen. Olympia Snowe, the chief object of Senate Democrats’ unconsummated quest for bipartisan cooperation on health reform.

Evidently, for the Democrats to resort to reconciliation would be an intolerable abuse of congressional rules, whereas the Republican habit of filibustering everything in sight is perfectly within bounds. Passing health measures by a simple majority vote, the GOP maintains, would be the political equivalent of nuclear war: It would pulverize what little remains of comity and good will in Washington.

It’s a little late for the GOP to be worrying about that. Nor are Republicans more convincing when they complain that it’s somehow illegitimate for President Obama to start the bidding in tomorrow’s health care summit with a plan derived from bills that have passed both houses of Congress.

“I don’t think the people like this any more than…the approach that came down the pike earlier,” House Republican Whip Eric Cantor said. “People are incredulous. I just think they are wondering, does the White House not get it?” He was referring, of course, to polls showing majority opposition to the main health care proposals before Congress.

Cantor seems to be arguing that shifting public attitudes matter more than election results, and that Congress shouldn’t pass legislation that doesn’t poll well. Does the House minority whip not get representative democracy? (It was a good thing he wasn’t around when Lincoln pushed Congress to enact a draft to win the Civil War.) And if Republicans really are so sure Democrats will self-destruct politically by passing Obamacare, why not lash them on?

One reason might be that the health care summit will highlight the embarrassing fact that Cantor and company offer no serious alternative to the president’s approach. (House Republicans last year labored mightily to produce a mouse of a bill that would cover just three million of America’s 40-plus million uninsured.) The real choice is between the president’s far-from-perfect health care reform, and none at all.

And in a way that’s too bad, because if we had a serious opposition, it might help the president push back against some of the bad ideas coming from his own party. An example: under pressure from labor and liberals, Obama has drastically scaled down and delayed an excise tax on expensive employer-paid health plans. Not only does that reduce revenue needed to pay for health reform, it also barely grazes an open-ended federal tax subsidy that economists believe contributes greatly to medical cost inflation. Rather than insist on limiting that government subsidy, many Republicans claim it’s a violation of Obama’s pledge not to raise taxes on the middle class.

In a similar vein, the Republicans have lambasted Obama’s proposal to cut hundreds of billions from Medicare to defray the expenses of expanding coverage. And so in its blindly partisan attacks on Obama’s push for health reform, the GOP has managed to 1) shred its credibility as a force for fiscal responsibility; 2) thwart efforts to rein in runaway health care costs; and 3) reinforce their well-deserved reputation as a party that measures compassion by the thimble-full.

On health care, the Republicans have hit the trifecta of demagoguery – which is why their complaints about parliamentary foul play ring hollow.

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Don’t Tread on My Medicare

Tuesday, February 23rd, 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

To continue some thoughts about the growing contradiction between conservative policy predilections and the GOP’s violent anti-spending rhetoric, there’s a specific political factor that’s intensifying the dilemma: the heavy, heavy reliance of Republicans on support from seniors.

Several smart commentators (ChaitDouthat, and Larison) have drawn attention to a new Pew survey on generational political attitudes which shows the exceptionally geriatric nature of the Republican Party’s current base of support. That’s a good thing for Republicans in the very short term, since seniors tend to vote at disproportionately high levels in midterm elections. But it’s not easy to be the Party That Hates Government Spending when your most important constituency is receiving Medicare and Social Security benefits. Here’s how Ross Douthat puts it:

[Y]ou can win an awful lot of elections just by mobilizing the over-65 constituency — they’re well-informed, they turn out to vote, and there are more of them every day. But the easiest way to do it, as the Democrats proved for years and years and years, is to defend Medicare and Social Security like McAuliffe at Bastogne. This means that while the energy of activists may be pushing the Republicans to the right on size-of-government issues, the concerns of their central constituency could end up pulling them inexorably leftward on entitlements….

This wouldn’t be a terrible thing if Social Security and (especially) Medicare accounted for, say, ten percent of the federal budget. But where the size of government — and if we ever want to cut the deficit, the burden of taxation — is concerned, they’ll be the whole ballgame soon enough. And if the Republican Party depends too heavily on over-65 voters for its political viability, we could easily end up with a straightforwardly big-government party in the Democrats, and a G.O.P. that wins election by being “small government” on the small stuff (earmarks, etc.) while refusing to even consider entitlement reform.

Now that’s how it looks if you are simply considering the fiscal numbers. But from a psychological point of view, there’s another problem for conservatives: how to rationalize a posture of maximum defense of Social Security and Medicare with a general hostility to transfer payments. The only obvious way to do that is to treat senior entitlements as benefits earned by virtuous old folks, as opposed to unvirtuous younger folks whose demands for “welfare” are to be resisted and demonized at all costs. You don’t have to hold a negative view of conservative motives to see how this can lead to highly invidious, and perhaps semi-racist, political appeals. Indeed, the current position of Republicans all but demands that they encourage seniors to view public life as a struggle to keep their own public benefits and their own private wealth against rapacious efforts by “elitists” and welfare “looters” to reduce their share of federal spending while increasing their taxes. And that’s a temptation Republican politicians don’t seem inclined to resist, illogical and immoral as it might be.

It’s not clear how long GOPers will continue to maintain this odd mixture of pro-government policies and anti-government rhetoric (a contradiction that extends, of course, to conservatives lust for ever-higher defense spending and foreign policy adventurism). But at present, they might as well emblazon on their Tea Party banners the legend: “Don’t Tread On My Medicare!”

Update: One obvious way around the GOP’s dilemma on entitlements is simply to “grandfather” current beneficiaries and introduce radical changes for younger generations. That’s how Rep. Paul Ryan’s Medicare Voucher proposal — central to the congressional Republican “plans” for both health care and the budget — operates. And that’s explicitly what Tim Pawlenty is talking about doing with both Medicare and Social Security.

It remains to be seen if this approach, which for all the talk about “keeping promises to seniors” sure looks like a cynical effort to buy off a demographic group that favors Republicans at the expense of groups less inclined — will fly with seniors or with anyone else. It does nicely comport with the “I’ve got mine! To hell with the rest of you!” spirit that Republicans are carefully cultivating among older white voters.

This item is cross-posted at The Democratic Strategist.

Photo credit: http://www.flickr.com/photos/roebot/ / CC BY-SA 2.0

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A Push Into the Abyss

Tuesday, February 23rd, 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

Glenn Beck’’s weird tutorial that ended this weekend’s Conservative Political Action Conference seems to have been a big hit among attendees. Yes, it’s a bit ironic that he expressed views highly similar to those of Ron Paul, whose student-driven victory in the CPAC straw poll was heavily panned and booed by the “regular” conservatives at the conference. Yes, some may have been put off by his constant use of Alcoholics Anonymous metaphors (people who need any form of government assistance are apparently just like alcoholics who haven’t “hit bottom” yet). But there really didn’t seem to be much dissent in this crowd with the idea that “progressivism” dating all the way back to Wilson and TR has been demonic, or that Republicans have to repudiate all forms of activist government if they want to get back on the paths of righteousness.

I was particularly struck by John Fund’s analysis of Beck’s appearance for the Wall Street Journal, which treated it as a constructive warning to Republicans against the temptations of governing.

It’s true that people like Beck and Paul, and most obviously the Tea Party Movement, are encouraging Republican politicians to take an ever-more-rigid position against government spending which, in combination with perpetual demands for both fiscal discipline and major new tax cuts, suggest a level of government retrenchment far beyond anything Americans have experienced since Hoover. But it’s surprising how few observers on the Right seem to be aware of the exceptionally perilous political direction of such talk.

Chris Bowers recently offered a useful summary of recent polling on specific cuts in government spending. And the bottom line is that Americans really, really don’t want them except in small categories like NASA and non-defense foreign assistance. And this is why symbolic anti-spending measures like never-to-be-enacted constitutional balanced budget amendments (Tim Pawlenty’s favorite panacea) and various “freezes” have always been so popular among GOP politicians. It’s probably poetic justice for conservatives that decades of anti-government demagoguery have convinced so many people that it would be easy to slash spending by attacking “waste” or “bureaucrats” or “welfare” or “foreign aid,” but the reality is that any serious attack on federal spending will have to include major cuts in defense; very popular domestic entitlement programs; or very popular domestic discretionary programs like public education and law enforcement.

So all the white-hot rhetoric about spending you hear from GOPers these days carries some pretty interesting implications, particularly for the bulk of Republicans who also favor a big escalation of the Afghanistan War (and perhaps a new war with Iran), and who have no prescriptions for economic growth other than still more tax cuts. I’m sure that Beck and Paul would have no problem calling for the abolition of Medicare and Social Security as they exist today, but are GOP politicians ready to follow? I don’t think so. And this is the real reason they struggle to articulate a governing agenda for 2010 and beyond.

Maybe John Fund thinks it’s good for Republicans to regularly get a kick in the pants from right-wing figures whose own views, if put to a vote, wouldn’t get support from more than a quarter of the electorate. But it looks to me more like a push into a political abyss. Maybe they can get away with fierce-but-vague rhetoric and opposition to Democratic initiatives for a while, but ultimately they will have to come right out and admit that the fiscal arithmetic of their own “thinking” would lead to a federal government more like that of the Coolidge administration (Beck’s favorite) than that of the Reagan administration. If they do, it won’t be Beck or Paul who has to pay the political price.

This item is cross-posted at The Democratic Strategist.

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Obama’s Deficit Commission

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.

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Bring On the GOP Health Policies!

Monday, January 25th, 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

I’m with Steve Benen on this one: after listening to Republicans say all weekend that the president needs to surrender on health care reform and start embracing theirpolicy ideas, maybe it’s time to draw a lot more public attention to all that fine GOP thinking on the subject.

So where to begin? I guess that would be with the “plan” that drew 176 Republicans votes in the House in a test vote in November of last year, the so-called “Boehner plan.” Dissed by an official Congressional Budget Office analysis that suggested it would cover almost none of the uninsured, while controlling costs far less effectively than the House Democratic proposal, this plan followed the usual conservative template of focusing on tort “reform,” “interstate markets” for private heath insurance (e.g., elimination of state regulations), elimination of the entire employer-based system, and a two-pronged strategy of subsidizing high-deductible individual health plans for healthy people, and state-run risk pools for sick people. It was, as Matt Yglesias put it, an “un-insurance” plan that would take health policy, in some respects, back to the 1950s.

Another example of Republican “thinking” on health care policy is the idea of “voucherizing” Medicare, which was the central health policy element of the official House GOP “alternative budget” offered last April by Rep. Paul Ryan of WI. While “Medicare voucher” proposals vary, they all at the very least aim at transforming Medicare into a system of federal subsidies for purchasing private health insurance, while capping expenditures regardless of the impact on benefits. To put it simply, seniors would march through the streets with torches to protest any such plan if it were taken seriously.

And then there’s the most fully developed Republican health care plan, the one developed and implemented by the front-runner for the 2012 GOP presidential nomination, and recently promoted by the party’s maximum “new star”: the Massachusetts health reform plan. How about allowing a vote on that in Congress? Oh, yeah, sorry, that’s pretty much the plan already passed by the U.S. Senate without a single Republican vote! It’s socialist!

Suffice it to say that while Democrats have been materially hurt by endless scrutiny and confusion about the substance of their ideas on health care, Republicans have massively benefitted from a total lack of accountability for their own ideas. Best I can tell, Republicans would probably be politically destroyed if people truly paid attention to GOP health proposals. So Democrats should find ways to help their GOP colleagues publicize their ideas.

This item is cross-posted at The Democratic Strategist.

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Why Republicans Deserve to Lose the Health Care Reform Debate

Thursday, January 14th, 2010
Bryan Dowd



Bryan Dowd is a professor in the Division of Health Policy and Management, School of Public Health, at the University of Minnesota.

Roger Feldman



Roger Feldman is a professor in the Division of Health Policy and Management, School of Public Health, at the University of Minnesota.

by Bryan Dowd and Roger Feldman

As Congress makes sausage out of health care reform, Republicans have complained bitterly that they have been excluded from the process. As health economists whose work generally reflects a market-based perspective, it might be surprising to hear us say that exclusion is just what the Republicans deserve. There are three reasons why.

Private health insurance works best for Americans who get it in groups through their employers. But virtually all such Americans know they are only one layoff away from losing their health insurance. If they have a pre-existing medical condition, they will have to pay astronomical premiums for an individual insurance policy, if they are lucky enough to get coverage at all. Those who are turned down can face financial ruin from the cost of illness. Any rational person would want to insure against the risk of losing his or her health insurance, but that is virtually impossible to do in the current health insurance marketplace.

This is a clear case of market failure and it has persisted for decades, yet Republicans simply don’t recognize this as a problem that needs to be solved. The individual insurance market is the source of most of the horror stories that plague and sully the health insurance industry, yet Republicans, who say they want to preserve private insurance, have proposed nothing that would address the problem.

The obvious solution is to impose some type of structure (i.e. “insurance exchanges”) on the individual insurance market, including a guarantee that affordable coverage would be available to anyone who shops in the individual market. State governments would be the natural entities to manage this market, but government involvement, even in the face of clear market failure, is anathema to Republicans. In addition, the Democrats’ mandate requiring individuals to purchase insurance is too much for many libertarian-oriented conservatives to bear, especially if costly subsidies are tied to the mandate. But at least they’re attempting to solve a complex problem, something Republicans can’t seem to do.

The second Republican failure is their criticism of the Democrats’ proposed cuts to Medicare. Part A of Medicare (which pays for hospital care) is scheduled to run out of money in 2017, or sooner if the recession continues to depress federal tax revenues. Young Americans have not mismanaged the Medicare program and don’t deserve to pay the bill for that policy failure. Drastic cuts in the cost of Medicare (coupled with higher premiums and a dramatic increase in price competition at all levels) will be necessary to solve this problem, and the sooner the better. The cuts proposed by congressional Democrats – mainly in payments to hospitals, other providers, and private Medicare Advantage plans – are a tepid attempt to deal with this problem. Like many Democratic proposals, they go hand in hand with a misplaced distaste for private health insurance plans. But vilifying the Democrats on that score, without offering alternatives to shore up the program, is fiscally irresponsible.

The third Republican failure is their knee-jerk criticism of “comparative effectiveness” research. This research aims to discover which medical treatments work better than others. It’s perfectly acceptable to worry that comparative effectiveness research in the wrong hands (like the government’s) could lead to rationing. But blanket condemnation of comparative effectiveness research leaves the impression that the current level of ignorance regarding the effectiveness of medical treatments is an inconsequential feature of the health care system. This is an embarrassment to the party that claims to be a prudent steward of the public’s money.

Republicans need to start listening to their constituents and propose innovative, conservative remedies to the numerous problems that plague the U.S. health care system. People who truly are market-oriented should be able to see market failure when it exists and propose corrections, even when those corrections include a role for government. Since the insurance industry has failed to fix itself, Republicans should have proposed a new set of products that protect people from losing insurance coverage. They should have proposed remedies including regulatory constraints that would lead to more stable and affordable health insurance coverage without the need for government subsidies. Finally, Republicans should have promoted their own proposals to fix Medicare, instead of demagoguing the issue. The Republicans’ silence on these fronts has been deafening – and explains why they deserve to lose the health care debate.

Bryan Dowd and Roger Feldman are professors at the University of Minnesota. They split their votes between Barack Obama and John McCain in the 2008 presidential election.

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Ross Douthat’s Agenda

Monday, January 4th, 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

I don’t know exactly what it is about being a “conservative columnist” at The New York Times, but now the young-un on that beat, Ross Douthat, is exhibiting the same habits as his older colleague, David Brooks. Brooks, of course, has mastered the art of looking down at the squabbling major parties from a great height, condemning them both, and somehow always coming down in the conclusion with recommendations that coincide with the short-term positioning of the Republican Party.

In his first column of the new year yesterday, Douthat performs a similar pirouette, with some interesting twists. His own skywalk begins with an Olympian view of America’s position in the world after the aughts–we’re now just a superpower, not a “hyperpower”–then predictably cites political polarization as one of the threats to our competitive position.

Warming to his task, Ross criticizes conservatives of the Bush era for a failed experiment in reduplicating Reaganomics, but then equals the score by accusing “Obama Democrats” of “returning to their party’s long-running pursuit of European-style social democracy — by micromanaging industry, pouring money into entitlement and welfare programs, and binding the economy in a web of new taxes and regulations.”

Aside from that very questionable characterization of the Democratic agenda, you will note that Douthat does not observe any causal relationship between one party’s “sins” and the other’s. Any “micromanaging industry” that’s going on presently is, rather obviously, the result of an economic calamity introduced under the previous national management. I don’t know if by “pouring money into entitlement and welfare programs” Douthat is referring to stimulus legislation used to counteract the disastrous effects of the economic calamity, or to the resolutely centrist health care reform proposal that is struggling through Congress after being signficantly compromised along the way. Any “new taxes” in prospect are part of said centrist plan, or part of the broader Democratic objective, announced not this year but as early as 2002, of reconfiguring the tax system to resemble what it looked like before the failed Republican exercise in Reaganomics that Douthat denounced earlier in his column.

All this is rather ho-hum High Broderism, but then Douthat gets more interesting when he proposes his own “center-right agenda” to replace the horrific move to the left essayed by Democrats. He begins with a tout court endorsement of the agenda recently laid out by Manhattan Institute wonk Jim Manzi, which is all the rage right now in what’s left of the non-Tea Party conservative commentariat:

Manzi’s National Affairs essay, a tour d’horizon of our socioeconomic situation, provides a solid place to start. He proposes a fourfold agenda: Unwind the partnerships forged between Big Business and Big Government in the wake of the 2008 crash; seek financial regulations that “contain busts,” by segregating high-risk transactions from lower-risk enterprises; deregulate the public school system, to let a thousand charter schools and start-ups bloom; and shift our immigration policy away from low-skilled immigration, and toward the recruitment of high-skilled émigrés from around the globe.

To this list, I would add tax reform and entitlement reform. The former should broaden the tax base while cutting taxes on work, childrearing and investment. The latter should means-test both Social Security and Medicare, reducing both programs’ spending on well-off retirees rather than questing fruitlessly for their privatization.

Now Manzi’s agenda has some virtues, but not so much as a Republican agenda. The Obama administration hopes to “unwind the partnerships” between government and business as fast as it can, and it, too, seeks to re-regulate the financial system in order to “segregate” high-risk transactions. For all the perennial conservative caterwauling about teachers’ unions holding a veto over good education policy, Obama, too, is a big fan of charter schools. This only looks like a “center-right agenda” if you buy the earlier Douthat premise that Obama is hell-bent on Swedenizing America.

Shifting the immigration system to favor higher skills (a very old “idea” also embraced today by Michael Barone) is not, as Douthat seems to think, a way to buy off conservative hatred of high levels of immigration; it may make the corporate community happy, but won’t do a thing for rank-and-file conservatives who dislike any wage competition from immigrants, and who want not a calibration of policies but wholesale expulsion of immigrants already in the country.

As for Douthat’s own supplementary ideas for a “center-right agenda,” he offers “tax reform” and means-testing Medicare and Social Security. Now “tax reform” as he is apparently discussing it is either one of two things: a continuation of the Bush-era failed experiment in Reaganomics involving deficit-financed tax cuts, however well-targeted they happen to be to workers and families, or a redesign of the system involving tax increases on some to pay for tax cuts for others. As Douthat knows, the constituency within the Republican Party for any tax increases on anybody could be comfortably accomodated in his own office.

Moroever, at a time when Republicans are shrieking about mean old Obama’s euthanasia-inspired efforts to cut Medicare benefits, Douthat is proposing the one “entitlement reform” — means-testing — that’s even less popular than privatization. It ain’t happening, and thus, like most of the rest of Ross’s “center-right agenda,” it’s not a serious contribution to the actual debate.

Now you could give Ross Douthat credit for thinking outside the box and proposing things that his own party would never embrace, which is tempting since he is a decent, thoughtful man. Or you could conclude, as many of us have simiilarly concluded about David Brooks’ MO, that by condemning Democratic policies without offering anything realistic to replace them, he’s simply ratifying the “Party of No” agenda of killing Obama’s policy intiatives and then figuring out later what to do once Republicans are back in the saddle again. It all adds up to an endorsement of Republican victory in 2010 and 2012, even if that would predictably return the country to the conservative policies that so distressed Ross Douthat, in retrospect of course, over the last ten years.

This item is cross-posted at The Democratic Strategist.

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