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Posts Tagged ‘Medicare’
June 6th, 2022 at 12:49 pm
Drug Costs Remain Far Below Inflation, but Beware Efforts to Impose Socialist “Price Controls”
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CFIF has continuously sounded the alarm on dangerous drug price control efforts, which will only do what artificial price controls always do – cause shortages of the very products they attempt to regulate.  The numbers speak for themselves.

Today, The Wall Street Journal editorial board cogently addresses the looming bankruptcy of Medicare and Social Security, and along the way nicely makes that point that we and others have been making, while also pointing out that drug prices have actually remained flat while prices for other products and services have skyrocketed:

Democrats blame Big Pharma for bankrupting Medicare, but annual Part D prescription drug costs have grown on average 1% over the last five years.  That’s far less than inflation, GDP and other Medicare spending. Even expensive drugs that grow spending in the short run can reduce long-term health spending.

Consider Hepatitis C treatments, which public-health scolds lambasted as too pricey when they launched nearly a decade ago.  Prices have since plummeted 75% from about $100,000 per course thanks to market competition.  A Department of Health and Human Services analysis estimates the treatments reduce patient health costs by about $16,000 annually and will save Medicaid $12 billion after this year.

Once the hospital trust fund runs dry, spending will have to be slashed by 10%.  The Democratic solution is to let Medicare “negotiate” drug prices — their euphemism for price controls.  But this will reduce the incentive to develop innovative treatments for hard-to-treat conditions like Alzheimer’s.  The result may be higher Medicare spending over the long term.

Artificial government efforts to impose price controls never work, whatever the product, whatever the time and whatever the flimsy rationalization.  America leads the world in producing lifesaving pharmaceuticals – 2/3 of all new drugs introduced worldwide, in fact – so we mustn’t tolerate Biden Administration or Congressional efforts to try this failed proposal yet again.  The stakes for us all are too high to re-learn that lesson the hard way.

March 19th, 2015 at 6:11 pm
AEI Scholar: House GOP Budget Needs Work

James Pethokoukis of AEI argues that the new House GOP budget puts too much emphasis on cutting the deficit and not enough on increasing economic growth.

“Indeed, the entire thrust of the budget seems to be that the federal debt is America’s biggest problem,” he writes. “But where’s the evidence? Low interest rates are hardly signaling investor alarm. And not only is the federal debt issued in U.S. dollars, our currency is the world’s reserve. The U.S. is not Greece. The big economic danger here isn’t a debt-driven financial crisis. It’s chronic slow growth from having to sharply raise taxes if we don’t restructure entitlements in a way that promotes saving and work.”

Of course, House budget writers do intend to reform entitlement spending drivers like Medicare and Medicaid – and eventually, one hopes, Social Security. So from at least this standpoint Pethokoukis and the House Budget Committee seem to be in agreement that structural fixes are needed to get entitlement spending on a sustainable trajectory.

What seems to divide them, however, is the motivation for doing so. For the budget drafters it may be containing and reducing an exploding deficit. For Pethokoukis and others, it’s kick-starting the economy to generate more wealth up-and-down the income ladder.

One of these two motivations will ultimately decide what conservative entitlement reform looks like. It will be interesting to see which prevails in the run-up to 2016.

January 18th, 2015 at 10:00 pm
Key ObamaCare Implementer Resigning

Marilyn Tavenner, the chief administrator of the Centers for Medicare and Medicaid Services (CMS), announced in an email last Friday to staff that she is stepping down at the end of February.

The move comes as something of a surprise, but the timing is similar to that of Tavenner’s former boss, Health and Human Services Secretary Kathleen Sebelius. Last year, Sebelius said she was leaving her post after ObamaCare’s initial enrollment period ended. Tavenner’s resignation is effective when the controversial health law’s second enrollment period concludes.

Tavenner’s time in office was marred by a glitch-ridden rollout of Healthcare.gov, the federal ObamaCare website that earned the ire of millions of Americans. She also came under fire for overstating ObamaCare’s enrollment figures by inaccurately including 400,000 dental plans that have never been counted toward health insurance numbers.

With Republicans in control of the Senate that will confirm Tavenner’s replacement, it will be interesting to see who President Barack Obama taps to fill her shoes.

September 23rd, 2014 at 5:24 pm
New ObamaCare Glitch Could Cost Doctors Millions

Doctors who spent heavily trying to comply with ObamaCare’s electronic health records mandate could still be hit with costly penalties.

ObamaCare gives doctors until October 1, 2014, to switch from paper-based to electronic health records. Failure to comply results in losing 1 percent of federal reimbursements for treating Medicare patients.

Here’s the rub.

“[P]hysicians who went electronic for the first time this year are discovering that [the Centers for Medicare and Medicaid Services, or CMS] won’t be ready to officially register the evidence of their work until mid-October. That means they will miss the Oct. 1 deadline, and CMS will withhold 1 percent of their 2015 Medicare payments,” reports Politico.

That means that a doctors’ group like Morganton Eye Physicians in North Carolina spent $1.3 million to buy and implement new software – and added $250,000 to its annual operating budget – only to be threatened with a $65,000 penalty because the federal government can’t meet its own compliance deadline.

One would think CMS has a moral obligation to waive compliance until the agency is able to do its job, but so far it’s requiring doctors to submit to a cumbersome hardship process. How does a business politely explain that the hardship exists completely because of government ineptitude?

Welcome to ObamaCare’s bureaucratic hell. More episodes to follow.

August 14th, 2014 at 3:25 pm
Like IRS, CMS Emails Go Missing

It looks like Lois Lerner – the former IRS manager at the center of the scandal targeting conservative groups – isn’t the only Obama administration official who lost emails subpoenaed by Congress.

Marilyn Tavenner, the head of the Centers for Medicare and Medicaid Services, is now believed to have deleted emails sought by congressional investigators trying to understand why Healthcare.gov had such a horrendous rollout.

“In order to stay below the agency’s Microsoft Outlook email size limit, Tavenner would regularly delete emails after copying or forwarding them to her staff for retention,” says the MSNBC report that broke the story. “However, Tavenner didn’t follow that procedure every time, meaning some emails never made it to her staff for safekeeping before being deleted.”

That could turn out to be a costly oversight for Tavenner.

As Jillian Kay Melchior points out, “Federal law tasks heads of all federal agencies with ‘mak[ing] and preserv[ing] records containing adequate and proper documentation of the organization, functions, policies, decisions, procedures, and essential transactions of the agency and designed to furnish the information necessary to protect the legal and financial rights of the Government and of persons directly affected by the agency’s activities.’”

Unlike Lerner who claims her IRS computer crashed taking with it unrecoverable emails – a claim disputed by IT experts inside and outside the tax-gathering agency – Tavenner, at best, is pleading that she’s too busy to follow the law. At worst, she’s the latest Obama administration official caught skirting her legal obligations to hide inconvenient truths.

To my knowledge, Tavenner isn’t considered an overt Obama loyalist, so it’s possible that the missing emails are a genuine oversight by a busy administrator. The trouble is, Tavenner works in an administration seemingly filled with people who are unwilling to comply with the kind of document sharing necessary for the people – through Congress – to understand and judge what unelected bureaucrats are doing. One of the tragedies of bad behavior by some is the suspicion it casts on everyone else on the team.

So be it.

Darrell Issa (R-CA), Chairman of the House Oversight Committee, has already pledged to hold hearings on alleged wrongdoing by agency heads when Congress returns from its August recess.

Don’t be surprised to see a hearing scheduled to get the truth about Tavenner’s missing emails.

December 5th, 2013 at 2:23 pm
From Romneycare to Single-Payer in Massachusetts?

The Obama administration’s former chief of Medicare and Medicaid is running for Governor of Massachusetts, and hints that his goal is to turn Romneycare into a single-payer system.

“It is time to seriously explore the possibility of a single payer system in Massachusetts,” declares Donald Berwick’s campaign website. (Emphasis in the original) “I will work with the Legislature [to] assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.”

Along with achieving this goal, Berwick makes a series of other promises that seem breathtaking when one considers the amount of information, oversight and control necessary to fulfill them. Again, all bolded words appear the same way on the site.

·    I will personally lead a statewide initiative to make Massachusetts the healthiest state in the nation, through smoking cessation, obesity prevention and reduction, and specific programs to curb domestic and physical violence.
·    We will stop the obesity epidemic in Massachusetts.
·    We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.
·    Massachusetts will be the national leader in patient safety.

I do not dispute that Americans in general – and apparently Massachusetts in particular – are suffering from very serious problems like obesity, substance abuse and suicide, along with all the ancillary problems that follow in their wake. But how is it sensible to assume, as Berwick’s manifesto does, that politicians can solve these deeply personal problems – abetted by a nihilistic culture – through bureaucratic fiat?

Moreover, who is going to pay for all this? Nowhere does Berwick mention the massive increases in state spending his plan implicitly calls for, since Massachusetts will now need an army of public employees to collect data, push ad campaigns and fine or penalize those who don’t change their behavior.

Joshua Archambault outlines other problems with Berwick’s platform, among them the myriad technical difficulties facing a state trying to operate a stand-alone single-payer system.

Berwick is no shoe-in to win the Democratic nomination for governor, but his ideas about single-payer are gaining ground in Massachusetts politics. As Archambault notes, 20% of the state’s heavily Democratic state senate are on record as supporting a single-payer system. That’s not surprising since the Bay State was the first to impose a health insurance mandate on individuals in 2006. As costs have grown, so have calls for more government control.

It bears remembering that President Barack Obama has said repeatedly that Romneycare was a model for Obamacare. If Berwick’s ideas manage to transform the former into a single-payer system, national health care policy may soon have a new maxim: As goes Massachusetts, so goes the nation.

November 2nd, 2013 at 3:43 pm
Obamacare Launch Much Worse Than Medicare Part D Rollout

A meme circulating through the liberal punditry claims that the jaw-droppingly bad launch of Healthcare.gov, the federal Obamacare insurance website, is nothing to get all hot-and-bothered about. Remember the Bush administration’s poor rollout of Medicare Part D, the prescription drug benefit? Its website was glitch prone at the start, but now the portal and the program are considered successful.

The same fate awaits Obamacare.

Or so supporters claim.

The analogy doesn’t hold though.

For starters, Part D was a far simpler program than Obamacare because it (1) added a new benefit to an existing federal scheme, and (2) could tap into existing relationships between Medicare and the intended beneficiaries. By contrast, Obamacare’s exchange model fundamentally changes how millions of individual Americans must buy health insurance; including those without any previous history of doing so.

Unlike liberal sympathizers who want to blur the distinctions in order to obscure Obamacare’s much more significant problems, thoughtful analysts like health expert Yuval Levin see the analogy pointing in a very different direction.

“The fact that even a much simpler federal undertaking ran into real problems should lead us to think that Obamacare could well encounter far, far worse and more difficult problems, on a scale that may not be readily addressable – as in fact seems now to be happening,” writes Levin. “It doesn’t suggest everything will be fine, it suggests the government hasn’t been good at even much easier tasks than the ones now set before it.”

Time will tell if the Obama administration’s “tech surge” fixes the glitches, but in the meantime it would be better if liberals stopped hiding behind false analogies, and admit that their big gamble to remake health care is dangerously close to an unprecedented failure.

October 15th, 2013 at 12:20 pm
Was Obamacare Website a No-Bid Job?

If anyone is looking for another reason to criticize the Obamacare website rollout, here it is.

“Rather than open the contracting process to a competitive public solicitation with multiple bidders, officials in the Department of Health and Human Services’ Centers for Medicare and Medicaid accepted a sole bidder, CGI Federal, the U.S. subsidiary of a Canadian company with an uneven record of IT pricing and contract performance,” reports the Washington Examiner.

An open, competitive process would have revealed that CGI was fired in 2011 by the Ontario government for failing to deliver on time “a new online medical registry for diabetes patients and treatment providers.”

In other words, CGI – the firm responsible for creating a health insurance portal to service 36 American states – couldn’t deliver a much less complicated system for 1 Canadian province. The service was so bad that the Ontario government still refuses to pay any outstanding fees it owes to CGI.

Remember when liberals screamed bloody murder about the no-bid contracts awarded by the George W. Bush administration to defense contractors?

Well, it’s time to mount their high horses again and demand accountability.

I’m looking at you in particular, Jon Stewart.

September 17th, 2013 at 5:47 pm
ObamaCare in Your Bedroom?

The New York Civil Liberties Union and the Goldwater Institute are both warning of dire threats to privacy if ObamaCare’s financial incentives and penalties on doctors aren’t changed soon.

The health law’s ‘reforms’ “aim to turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary, and to violate their Hippocratic Oath to keep patients’ records confidential,” writes Betsy McCaughey in the New York Post.

Topics include asking whether a patient is sexually active, and if so, with what number of partners. Whether a person has same-sex partners is also an area the feds want to know about.

And don’t forget to add in the required questions about a person’s drug history.

Combine this with all the routine yet highly sensitive health information people share with their doctor, and you’ve got the makings for a single-source document that could ruin someone’s life if made public.

To do this, ObamaCare uses financial pressure to compel doctors to participate. Answers go into federally mandated electronic health records. Highly portable, the records can be accessed and shared among regulators.

Resistance won’t be easy.

“Doctors and hospitals who don’t comply with the federal government’s electronic-health-records-requirements forgo incentive payments now; starting in 2015, they’ll face financial penalties from Medicare and Medicaid,” according to McCaughey. “The Department of Health and Human Services has already paid out over $12.7 billion for these incentives.”

And it’s just going to get worse.

Best advice: Try to convince your doctor to keep two sets of books. One that’s real; the other for the Feds.

ObamaCare: Bringing people together in opposition to their government.

July 30th, 2013 at 3:57 pm
Howard Dean: ‘Repeal IPAB’

IPAB – aka, the Independent Payment Advisory Board – is one of the chief cost-containing elements of ObamaCare. As designed, a presidentially appointed panel of medical experts will convene to decide how much the government will pay for certain kinds of care, and who gets which treatments.

That means that “The IPAB is essentially a health-care rationing body,” writes Howard Dean in the Wall Street Journal. “By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.”

Dean, who is a licensed medical doctor and spent 11 years as the Democratic Governor of Vermont before running for president in 2004, knows from experience that IPAB is doomed to fail.

“There does have to be control of costs in our health-care system. However, rate setting – the essential mechanism of the IPAB – has a 40-year track record of failure,” says Dean. “What ends up happening in these schemes (which many states including my home state of Vermont have implemented with virtually no long-term effect on costs) is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients. Most important, once again, these kinds of schemes do not control costs. The medical system simply becomes more bureaucratic.”

Dean goes on to call for a bipartisan repeal of IPAB, which is great to read and should be acted on. But the logic of including IPAB with ObamaCare’s structure makes perfect sense. Government-controlled health care is centrally-controlled and -planned health care.

If Dr. Dean wants a more patient-centered health care system he should be calling for repeal of ObamaCare in its entirety and greater deregulation of the health care industry. Empowering a new generation of medical entrepreneurs that can leverage advances in technology into boutique health care outlets would drive down costs, increase business opportunities and improve the quality of individualized care.

Dean is right to shudder at the care-killing cost of bureaucracy. Maybe one day he’ll discover the possibilities of a freer health care market too.

March 30th, 2013 at 9:42 pm
Obama Should Call an Audible with Late Budget Proposal

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.

March 28th, 2013 at 12:55 pm
The Liberal Origins of Paul Ryan’s Pro-Market Medicare Reforms

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?

December 7th, 2012 at 8:56 am
Podcast: Post Election, What’s Next for Health Care?
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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.

Listen to the interview here.

September 7th, 2012 at 2:17 pm
Ryan’s Democratic Stand-In on Challenges of Prepping Biden

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.

August 23rd, 2012 at 5:59 pm
Romney-Ryan & a Realist Approach to Entitlement Reform

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.

August 15th, 2012 at 9:19 am
Ramirez Cartoon: The Truth About Medicare
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Below is one of the latest cartoons from two-time Pulitzer Prize-winner Michael Ramirez.

 View more of Michael Ramirez’s cartoons on CFIF’s website here.

August 14th, 2012 at 2:25 pm
Ryan the Bipartisan — Plus, Some Marketing Advice

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.”

Good stuff.

August 14th, 2012 at 11:46 am
More on Obama, Ryan, and Medicare
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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:

August 13th, 2012 at 7:50 pm
With Ryan, ObamaCare Deficits Front and Center

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.

August 13th, 2012 at 12:17 pm
The Ryan Pick
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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.