With President Barack Obama’s legally required budget proposal arriving two months late (April 10 when it was due February 4), here’s a suggestion to ensure the document is something other than a White House-approved paper weight.
Because of the President’s unprecedented delay, both the Republican House and Democratic Senate have passed budgets, each with only party-line support. Now that both sides have put their opening bids on the table, it would be wise to make the White House version a kind of third way compromise that includes some elements that both sides like.
One example would be to incorporate Paul Ryan’s idea for putting Medicare plans on a state-based, federally-regulated health insurance exchange. Then, make the now obvious point that this plan, coupled with ObamaCare’s exchange for non-seniors indicates bipartisan agreement on a major aspect of health insurance reform. Doing that would help change the focus of the debate on what Republican and Democrats have in common when it comes to moving forward on this issue.
Peter Ferrara, a budget expert at The Heartland Institute, a free market think tank, reminds us where many of Paul Ryan’s ideas on Medicare reform originally came from:
This Medicare reform plan was actually developed by President Clinton’s Medicare Commission, so it had bipartisan support at a time when the Democrat Party had grown ups in influential positions, rather than just adolescent, Marxist, revolutionaries posing in grown up drag. The legislation providing for these reforms was actually introduced in the Senate by liberal Democrat Sen. Ron Wyden of Oregon. It has been endorsed by long time liberal academic Alice Rivlin, the Godmother of the CBO, serving as its first director.
Indeed, the plan was developed from an initial proposal in 1995 by two lifelong liberal scholars, Henry Aaron of the Brookings Institution, and former CBO Director Robert Reischauer. They were the first to propose a premium support system for Medicare in a 1995 article in the journal Health Affairs. The Reischauer/Aaron concept was later embodied in Medicare Parts C and D in the 2003 Medicare reforms, where they have already worked very effectively.
That’s right – Proposed by liberals, passed by conservatives.
With this in mind, who’s out of the mainstream now?
In an interview with CFIF, Sally Pipes, President of Pacific Research Institute, discusses the fate of ObamaCare, Medicare and health care, generally, in the aftermath of the elections.
Rep. Chris Van Hollen (D-MD) told Roll Call what the biggest challenge is while preparing Vice President Joe Biden to debate Paul Ryan:
“I sit next to Paul Ryan in the Budget Committee day in and day out,” he said on his preparation for the role.”So, I know how he presents the Republican case.
“He presents a plan that’s bad for the country with a smile, so I think the challenge is dealing with presentation of the plan, explaining why the plan is bad for the country,” he added.
With all due respect to Rep. Van Hollen, his biggest challenge is helping Joe Biden explain how ripping out more than $700 million from Medicare to pay for ObamaCare is a better policy than Ryan’s idea to convert future Medicare benefits into a fiscally sustainable premium support voucher.
It would take all of Bill Clinton’s rhetorical sleight-of-hand to pull off that feat. Instead, Van Hollen is working with the gaffe-prone Biden.
Good luck overcoming that handicap, Congressman. You’ll need it.
Over at National Review, John O’Sullivan argues that the Romney-Ryan ticket should take a realist tone when it sells its vision of entitlement reform, referencing a familiar example:
Despite all the guff written about him, Reagan was not an optimist. He was a realist who believed in the virtue of hope (which is quite another thing — see below). Realism is a combination of prudence and hope. Realists believe that they can solve problems and win battles, but only by evaluating the dangers accurately and proposing adequate responses to them. Reagan expressed great faith in the future of the American people, but he also warned that their grandchildren might lose that future if the present generation did not defend the U.S. Constitution and traditional liberties. He warned eloquently against the Soviet threat, but instead of looking on the bright side and leaving matters to chance, he drove through — against strong political and media opposition — tough policies on foreign policy and defense.
Hope and prudence are what Ryan has shown with his persistence in speaking the fiscal truth to seniors in his Wisconsin congressional district. It was hope in the power of fact-based arguments that compelled him to spend hours in town hall meetings detailing the chronic deficits afflicting Medicare and Medicaid. And it was from a deep well of prudence that he sought to explain how the continued failure to reform their structure will result in either taxes we can’t afford or cuts in coverage some people can’t endure.
This election will likely turn on whether Ryan’s realistic appraisal of entitlement reform will be interpreted by the public as a blend of hope and prudence or instead an accountant’s excuse to throw granny off a cliff.
At the American Spectator I remind everybody that Paul Ryan’s central Medicare feature has Democratic provenance. I sum up here:
In truth, honest liberals from academia, journalism, think tanks, and political offices alike have consistently supported versions of Personal Health Grants for a decade and a half. There is nothing radical about the idea. Similarly, Ryan’s suggestions for Medicaid are based directly on the successes of welfare reform in 1996 — signed and claimed credit for thereafter by Clinton. Ryan’s proposals for domestic discretionary spending also are perfectly in line with what was envisioned in Clinton’s second-term budgets (adjusted for inflation). Ryan’s ideas aren’t anywhere near the outer edges of mainstream thought; they aren’t penurious, but merely sober.
But wait, there’s more. I also gave some marketing advice, including a better name for “premium support” (either Personal Health Grants” or “Insurance Assistance”). As it turns out, there is even BETTER advice on the same subject from my friends Deroy Murdock and Jim Guirard, more than a year ago:
Jim Guirard, long-time chief of staff to the late Sen. Russell Long (D., La.), runs the TrueSpeak Institute (TrueSpeak.org). He advises the GOP to market “MediChoice.” Unlike the head-scratching that “premium support” inspires, MediChoice signals that Republicans would give seniors choice in medical coverage. Just as the GI Bill helps veterans pay tuition at schools that match their interests, MediChoice would help future Medicare recipients (now 54 or younger) buy coverage that suits their circumstances.
Guirard urges Republicans to call today’s Medicare system “MediCrash.”
Ashton’s post yesterday brings up an important point about the Obama Administration’s handling of Medicare. The worst aspect of the cuts he cites, however, is the complete duplicity of the math involved. Basically, the Administration has attempted to claim the same money both as savings and expenditures. The best interpretation is total mathematical illiteracy. The worst is accounting fraud.
Paul Ryan ripped the Administration for this in his famous showdown with the president at the Blair House health care summit in 2010. For an even more bracing version of this dispute, see this exchange between Congressman John Shimkus (R-IL) and HHS Secretary Kathleen Sebelius, in which the Secretary, having reached a fork in the road, takes it:
I’ll add my voice of support to the chorus here, and say I think Paul Ryan is an inspired choice to be Mitt Romney’s running mate. One of the benefits of selecting Ryan, is that Romney gives conservatives a chance to articulate the dramatically different trend lines between the parties when it comes to reforming Medicare.
Under ObamaCare, $700 million is ripped out of an already teetering Medicare system to pay for new entitlements. By contrast, Ryan’s reform grandfathers current seniors while converting Medicare into a voucher program for younger Americans. Whereas ObamaCare creates new spending commitments with the same pile of money – thus spiking deficits – Ryan’s reform (and by extension, Romney’s) caps Medicare’s subsidy at a level that makes federal spending more sustainable over the long haul.
The campaign just got serious. I’m looking forward to the next 12 weeks.
Count me pleasantly surprised by Saturday’s announcement that Mitt Romney has selected Paul Ryan as his running mate. Given the risk-averse nature the Romney campaign had demonstrated up to this point, I was expecting the choice to be bland and uninspiring — my foremost guesses having been Rob Portman or Tim Pawlenty (for what it’s worth, multiple reports seem to indicate that Romney’s final choice came down to those two and Ryan). Ryan, who truly has been the intellectual leader of the Republican Party for the past several years, is a vastly superior choice to either of those two.
I have no idea how the politics of this play out. It seems to me that the fears that liberal demagoguery of the Ryan budget could cost Romney Florida are well-founded, given the state’s huge population of seniors. Minus the Sunshine State, it’s hard to envision a scenario where Romney becomes the 45th President of the United States in January. I also remain skeptical that, even with Ryan on the ticket, Wisconsin will elude Obama’s grasp this time (I hope I’m wrong about this, but it seems to me that the conservative commentariat has been excessively enthusiastic about prospects for flipping the Badger State ever since the Scott Walker recall).
These are not causes for despair necessarily, but cautionary notes as we begin the campaign in earnest after Labor Day. The Romney campaign — not known heretofore for its exceptional messaging skills — has just given itself perhaps the most daunting communications task in the history of modern American presidential elections. This election will no longer be a backwards-looking discussion about Barack Obama’s stewardship of the American economy over the past four years; instead it will be a 90-day symposium about what the “social contract” (a phrase I loathe, but one that will carry the day) will look like in 21st Century America.
The advantage that Romney and Ryan have is that their vision — reining in spending, empowering individuals, reducing the debt, and reasserting individual responsibility — is the only one that is viable in the long-term. The advantage that Obama and Biden have is that their vision — an unsustainable status quo that cossets Americans from responsibility and hides the calamitous costs of the welfare state — is much less psychologically disruptive, a trait that (sadly) goes a long way in winning over a substantial portion of the electorate.
The stakes of this election have just become enormous. This is no longer about whether Mitt Romney will become president or not. It’s now about whether the conservative vision for arresting America’s decline will receive popular ratification. And there are only 12 weeks to make the case. With the smartest, most articulate defender of the conservative alternative now on the ticket, we’re about to run out of excuses. If we can’t win this time, the resultant chaos will make the aftermath of the 2008 election look like a garden party.
Last week, I posted here about the fact that the growing crisis in the supply of American doctors is driven partially by structural deficiencies in Medicare. A new piece out today in the Wall Street Journal(subscription required)illuminates another key part of the puzzle: the growing tendency of doctors to refuse new patients under Medicaid — the vehicle that the Obama Administration intends to use to insure millions more Americans under Obamacare:
Some 31% of physicians in a sample of 4,326 said they wouldn’t accept Medicaid beneficiaries, economist Sandra Decker of the National Center for Health Statistics reported in an article in the journal Health Affairs published Monday. Most of the doctors cited the low reimbursement from Medicaid.
…
The health law passed by Democrats in March 2010 was supposed to expand coverage to around 16 million low-income people by signing them up for Medicaid. The Supreme Court decision in June effectively gave states the chance to opt out of the expansion. It isn’t yet clear how many will do so, although it’s likely to be a hot political issue. Either way, the coverage gained by low-income Americans could be less useful if they are unable to find a doctor to see them.
There are problems at the macro level too. Consider what Democratic(!) governors have been saying about the Medicaid expansion. Kentucky’s Steve Beshear has said “I have no idea how we’re going to pay for it.” California’s Jerry Brown has called it “devastating.” And Montana’s Brian Schweitzer — a man often touted by Democrats as a potential presidential candidate — has warned, ” I’m going to have to double my patient load and run the risk of bankrupting Montana.”
As Thomas Sowell is fond of saying, one of the hallmarks of liberalism is judging intent rather than outcomes when it comes to public policy. Thus do we get decades-long wars on poverty that do next to nothing for the impoverished, and stimulus programs of which it is always claimed that they would have worked if they only been a little bit bigger.
I’m not sure the abject failures of Obamacare will get a free pass based on good intent though. Theses sorts of consequences — patients unable to find doctors, states teetering on the verge of bankruptcy — are nearly impossible to ignore … no matter how desperately the White House will try.
Wesley J. Smith reminds us why with ObamaCare’s individual mandate safe for now, conservative litigators should focus on striking down the Independent Payment Advisory Board, the unelected, unaccountable group of “experts” charged with controlling costs under ObamaCare.
There’s not much time left:
According to the terms of the Affordable Care Act, IPAB must submit its first draft recommendations to the health and human services secretary by September 1, 2013. Its first Medicare cost-cutting goals must become law by August 15, 2014.
Why did I write “must” become law” instead of “may”? IPAB’s unique “fast track” authority divests Congress of discretion regarding the amount of money to be cut from Medicare once IPAB has submitted its “advice.” Get a load of these legislative handcuffs:
By January 15, 2014, IPAB must submit a proposal to Congress and the president for reaching Medicare savings targets in the coming year.
The majority leaders in the House and Senate must introduce bills incorporating the board’s proposal the day they receive it.
Congress cannot “consider any bill, resolution, amendment, or conference report … that would repeal or otherwise change the recommendations of the board” if such changes fail to meet the board’s budgetary target.
By April 1, all legislative committees must complete their evaluation. Any committee that fails to meet the deadline is barred from further consideration of the bill.
If Congress does not pass the proposal or a substitute plan meeting the IPAB’s financial target before August 15, or if the president vetoes the proposal passed by Congress, the original Independent Payment Advisory Board recommendations automatically take effect.
Not only that, but Congress cannot consider any bill or amendment that would repeal or change this fast-track congressional consideration process without a three-fifths vote in the Senate. And to put the icing on the autocratic cake, implementation of the board’s policy is exempted from administrative or judicial review.
Unlike the rest of ObamaCare, IPAB cannot be repealed easily because its enabling statute “entrenches” it from being altered by later Congresses. Thus, banking on a President Romney and a Republican Congress to get rid of it won’t work.
I’ve written before about the federal case in Arizona challenging IPAB. It was on hold awaiting the Supreme Court’s decision on the individual mandate. With the mandate redefined as a tax, the IPAB litigation will proceed, perhaps with a Supreme Court hearing as early as spring 2013.
Keep an eye on this one. It’s easy to see how an unaccountable board of bureaucrats empowered to control costs could morph into a health care rationing board.
Over the weekend, Newsday’s Lane Filler had a terrific editorial piece on one of the absolute worst trends in modern American politics: Government’s growing tendency towards preventing failure (read: insulating people from the consequences of their actions).
But as Filler correctly points out, this trend isn’t just limited to big financial firms on Wall Street. We only pay special attention to “too big to fail” because it’s a relatively new development. In many ways, our entire social contract has come to be defined by the same ethos. An excerpt:
Every social program, as much good as it might do, strikes a blow against moral hazard. Unemployment insurance, which many people have received for as long as two years during the current recession, helps folks get through tough times, but economists agree it also keeps some of them from taking jobs. Few people would take $300 per week to trim hedges if they can get $300 per week to not trim hedges while they wait for a wage offer they can actually live, or even better, thrive, on. Take away the $300, though, and that bad job starts to look better. Extended unemployment benefits aren’t the only reason there are 3.4 million unfilled jobs in the United States, but they are a reason.
Let people know that if their income is low enough, the government will give them food, and they won’t have nearly as much inclination to earn food money as they would if they were down to carpet-lint soup. Provide shelter to those who can’t provide their own, and folks feel less desire to hustle for housing than they would if an underpass in Cleveland were their winter home.
As Filler goes on to note, the same criticism applies to Social Security and Medicare, both of which provide far more in benefits than beneficiaries ever pay in.
None of this, of course, is to argue against a basic safety net. But as many conservative wags have been noting of late, the safety net is coming to look a lot more like a hammock.
Failure, uncomfortable as it often is, is the finishing school of success. Having weakened its instructive powers, we should not be surprised to find ourselves living in a nation of adolescents.
House Budget Committee Chairman Paul Ryan (R-WI) this morning is releasing the House GOP budget proposal. Ryan previews his budget in an op-ed in The Wall Street Journal here, and outlines the “choice of two futures” — the status quo of more debt and greater decline vs. a path to prosperity that includes less debt, lower taxes and inidividual opportunity — in the web video posted below.
Fred Barnes has a terrific column in today’s Wall Street Journal explaining the origin, structure and philosophy of Paul Ryan’s Medicare reform proposal. The most intriguing paragraph explains how Ryan’s reform ideas went from minority alternative to majority consensus in just two years.
But House passage alone was a milestone. When Mr. Ryan first proposed premium support in 2008, 14 House Republicans signed on as co-sponsors. But when his budget cleared the House in 2011—with Medicare reform its most controversial provision—only four of the 241 Republicans voted against it. Of the 87 GOP freshmen, only one voted no. In the Senate, all but five of the 47 Republicans declined to back Mr. Ryan’s plan.
After weathering some resistance in the beginning:
Premium support is now Republican orthodoxy. But absent a GOP landslide this fall, that’s not sufficient to win congressional approval. Besides, entitlements are best enacted on a bipartisan basis. Otherwise, they may wind up like ObamaCare—unpopular, under legal challenge, and the target of endless partisan attacks.
Barnes is right that entitlement reform is best enacted on a bipartisan basis, but there’s every indication that a conservative victory this year that keeps the House and wins the Senate, supplemented with smart liberal support from the likes of Senator Ron Wyden (D-OR) and others, would certainly be considered bipartisan.
According to Barnes, a handful of Democrats in the Senate and House have told Ryan they are willing to go public with their support for Medicare reform after the 2012 elections. Momentum is building for real reform of the largest deficit driver in the federal budget. This should be a motivator for every fiscal conservative to make this election the year Ryan’s reforms become law so America can get its finances in order.
Back in December I wrote a column defending a Medicare reform proposal outlined by Rep. Paul Ryan (R-WI) and Senator Ron Wyden (D-OR). Unlike Ryan’s “Path to Prosperity” budget resolution that passed the House in 2011, Ryan-Wyden retains traditional Medicare. However, like Ryan’s original reform, Ryan-Wyden introduces private sector competition by allowing seniors to use vouchers to select the plan – public or private – that they want, with any savings from a less expensive plan landing in the seniors’ pocket.
At the time, Ryan-Wyden was reported as an idea by two policy wonks with no discernable political support on Capitol Hill. That changed this week when Senators Tom Coburn (R-OK) and Richard Burr (R-NC) introduced a bill that substantially mirrors Ryan-Wyden’s Medicare-plus-competition proposal. Although both pairings are so far quiet on the similarities between their plans, this is a good first step toward getting a common conceptual framework around an idea that increases competition.
Not that you’d know any this from reading Think Progress’ headline announcing the Coburn-Burr plan as “Two Republican Senators Try to Walk Back Paul Ryan’s Medicare Privatization Plan.” Indeed, one has to read halfway into the article to discover that Coburn-Burr “is very similar to the bipartisan framework outlined by Ryan and Sen. Ron Wyden (D-OR) last year and adds little to the Medicare reform debate.”
To Think Progress’ way of thinking there is little news value when two conservative Republican Senators introduce an almost identical reform plan to one announced by a liberal Democratic colleague and the most influential Republican Congressman. Almost everyone else knows better. With support growing for Ryan’s Medicare 2.0 reform, expect to see more movement Ryan’s way as the year rolls on.
While responsible politicians like Rep. Paul Ryan (R-WI) and Senator Ron Wyden (D-OR) are busy proposing a bold reform of Medicare, others in Congress are engaging in less helpful behavior on the public dime.
Rep. Keith Ellison, D-Minn., embarked on a 24-hour hunger strike in solidarity with four Occupy DC protesters who have gone without food since Dec. 8 to advocate for D.C. voting rights.
Ellison, the first Muslim to serve in the House, met with the hunger strikers Thursday and pledged to read their declaration – which calls for full voting rights for District residents as well as legislative and budget autonomy – on the floor of the House of Representatives to enter it into the congressional record.
Not to be outdone in the brazen department, Senator Debbie Stabenow (D-MI) berated former Senate colleague and multi-millionaire Jon Corzine for his MF Global failures. Apparently, though, there is at least one other reason for Stabenow’s outrage:
The Democratic senator who savaged Jon Corzine at a high-profile Capitol Hill hearing this week had another reason to go hard on her former colleague — she recently pressed him for campaign contributions but didn’t get any.
“She would literally call once every two or three weeks,” one Corzine intimate said of Sen. Debbie Stabenow (DMich.).
“She called all the time.”
But to no avail.
Sources in Corzine’s inner circle said they were “stunned” and “amazed” by Stabenow’s attack.
The two had served together in the Senate, but Corzine hasn’t delivered with contributions in some time.
So far this year, Corzine’s name has not appeared on Stabenow’s campaign finance reports.
Records show he last donated to her in 2006, contributing $2,000. Corzine and his then-wife, Joanne, each gave Stabenow $1,000 in 1999.
Thankfully, both Ellison and Stabenow are up for reelection next year. Perhaps their antics will inspire some enterprising campaign lawyer to put together the first Super PAC to defeat loudmouth liberals.
With the end of the year only about a month away, Republicans on Capitol Hill are stuck in a bit of a quandary. Under current law, the dawning of 2012 will bring with it the expiration of the payroll tax cuts passed last year, which dropped employee rates from 6.2 to 4.2 percent.
As I’ve written before, the payroll tax cuts get you less bang for your buck than virtually any alternative. The savings for an average American are about $40 per paycheck — not nothing, but certainly not enough for even the most dyed-in-the-wool Keynesian to think aggregate demand will shift, particularly because the program’s temporary nature means that it is not altering long-term plans. Also, remember that the payroll tax is there to finance Social Security and Medicare, so pulling money out of those accounts only hastens the day of fiscal reckoning for both of those programs. Finally, there’s the fact that there’s only a cut to the employee’s chunk of the payroll tax, not the employer’s. That means it does absolutely nothing to galvanize hiring.
Savvy congressional Republicans have made these points, but voting to end the break would put them in the unusual position of defending an increase in taxes at a time of extreme economic weakness. While the payroll rate will eventually have to return to the status quo, the GOP is thus stuck looking for something to plug the hole in in the interim.
Kudos, then, to the Republican leadership, who, according to Politico, are looking to pay for the continued tax break by extending a salary freeze for federal employees and lawmakers, a move that would save about $100 billion. While the country’s biggest economic need is a wholesale overhaul of tax policy and regulatory policy combined with a dramatic reduction in federal spending, that won’t happen in the current atmosphere of political polarization in Washington. If we have to muddle through in the interim, this is a fairly reasonable way to do it — don’t increase the debt and let the Washington crowd foot the bill for the everyday Americans they’ve so badly misserved.
There are few things more annoying than trying to compete against someone who won’t play the game.
In today’s Wall Street Journal, House Budget Chairman Paul Ryan (R-WI) expresses the frustration of many conservatives who want a real debate about the purposes of government and our ability as a nation to fund them. Ryan rightly chides President Obama for failing to engage in specifics about how to focus policymakers’ attention on the debt, not just its ceiling.
It is mystifying to me that the president continues to shut out Ryan’s “Path to Prosperity” proposal as a middle ground between bankrupting Medicare and Medicaid and eliminating them altogether.
One would think The One could see a Clintonian moment when presented. But rather than see Ryan’s willingness to preserve the social safety net for what it is – a path to a long-term bipartisan solution – the president can’t see past his own partisan nose.
Yet instead of laying out his own vision, President Obama continues to offer speeches instead of specifics. Lots of us want a debate about the ends of government, and how we structure our economy to pay for it. If the leader of the Democratic Party won’t engage in a serious debate about it, maybe the Democrats should get someone who will.
In an interview with CFIF, Sally Pipes, President of Pacific Research Institute, discusses the fate of ObamaCare, Medicare and health care, generally, in the aftermath of the elections.
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