Freedom Line Blog

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.

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.

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.

To wit:

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.

How about it, Renee?

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.

Medicare Part D is a good model for the Ryan Medicare plan.

To be clear up front: Congress was wrong to pass Medicare Part D, the prescription drug program, without more broadly reforming Medicare. As a new entitlement, it is extremely costly, and has exacerbated the government’s debt problem.

That said, the free-market aspects of the plan — the private-sector competition part of it, without a government option — have worked beyond almost the wildest dreams of free marketers.  The liberals were so sure that costs to seniors and the government would rise astronomically without government there to “negotiate” premium” prices that they originally proposed to have government “set” the premium price at $35 with a built-in hike each year for inflation. Lo and behold, in the third year of the program it turned out that the average premium price was still down below $25, ten dollars less than what the libs had wanted to set as the base price. In other words, competition worked to keep prices about 30% lower than government planners had predicted.  What the libs wanted as a limit would instead have been a huge burden.  When the libs in 2007 tried desperately to append a government “negotiation” provision to the program, the attempt was filibustered to death in large part based on those amazing early results.  Thank goodness. Competition, as usual, had worked wonders, and it was not to be messed with — which is why the Dems made no serious attempts thereafter to force the government negotiation option back onto the table. Even four years later, the average premium still is $30, or five dollars below what the libs assumed could be achieved only by government intervention.

It is true that some people have cherry-picked statistics to claim that premiums are skyrocketing, but that’s only because they pick the sorts of plans whose costs have risen, not the average of all plans. James Capretta explains it well today at NRO.

Meanwhile, as Capretta explains, the cost to government — meaning to you and I, Joe Taxpayers — is a whopping 31% less than had been projected. Now, granted, that’s still a ton of money that should not have been spent unless it was part of a larger Medicare overhaul that used competition to save money on the rest of the program as well, but even so, the overall lower costs are a tribute to the virtues of competition.

Moreover, as Rick Santorum explained in the GOP presidential debate last week, the Medicare reforms in Rep. Paul Ryan’s budget proposal are based largely on the competitive aspects of Medicare Part D. They basically apply Part D’s system to all of Medicare — which means they could serve to produce a huge majority of seniors who are satisfied with the program, at a remarkably lower cost.

That’s why and how the Ryan plan can be politically sellable — because seniors happy with Part D can be expected to react at least somewhat favorably to a plan modeled on Part D, as long as the connection is made clear.

Deroy Murdock has a great column up this week. He credits my wise friend Jim Guirard, veteran of many a battle on Capitol Hill, for proposing better marketing language for Paul Ryan’s Medicare proposal (or variations thereof).

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.” The Democrats’ policy — snatching $520 billion from Medicare to fund Obamacare and pretending that the program is the platonic form of fiscal health — invites financial catastrophe. By Sept. 30, 2020, the Congressional Budget Office forecasts, Medicare’s Trust Fund will be “exhausted.” Republicans should reiterate that Democrats — not the greedy, granny-killing GOP — perpetrated a half-trillion-dollar heist against Medicare’s coffers to underwrite Obamacare. Democrats pitifully refuse to do anything to prevent this calamity. What will their negligence yield in just over nine years? The CBO predicts: MediCrash.

Note, in the Murdock column, his photo at the bottom of a potential MediChoice notice that every senior citizen would receive.  Talk about bringing home to them the essential idea that THEY and nobody else controls their choice of a health-care plan!  Great idea.

In the debate last night, Rick Santorum made the excellent point that what Ryan proposes is what ALREADY is working, in popular fashion, in the otherwise problematic Medicare Part D.  If seniors can make such an individual-option plan work for prescription drugs, why not for their whole health-care coverage?

I noted the same analogy here, back on May 5. As I also explained:

[B]ecause of very similar, consumer-based, market-oriented provisions, has cost the government far less money than projected while costing consumers remarkably less in premiums than even the most optimistic number-crunchers expected. In short, the experience of Medicare Part D suggests that Ryan is hardly being outlandish to say that giving control back to consumers in a market-based system can save money without harming benefits – and thus preserve Medicare for future generations.

Now, back to Murdock. As he noted, Ryan’s plan is hardly radical:

Republicans should remind mewling Democrats that economists in liberal thinks tanks came up with the idea in the first place. The Brookings Institution’s Henry J. Aaron and the Urban Institute’s Robert Reischauer fathered “premium support” in 1995.

Former senator John Breaux (D., La.) promoted this reform as co-chairman of President Clinton’s bipartisan Medicare-overhaul commission…. Former senator Bob Kerrey (D., Neb.) echoed Breaux. As he told Reuters in May 1999: “You’re much better off letting 50 million people make decisions on their own than having [Washington] decide things from the top down.”

Santorum was right to take up the gantlet on this issue last night (and earlier), and Newt Gingrich is incredibly wrongheaded to run away from it.  Meanwhile, with some smart use of language, as per Jim Guirard, MediChoice might be a real political winner.

Wow.  With the news that Newt Gingrich’s entire senior campaign staff resigned en masse this morning, some are speculating that the fallout – and newly freed staff – will benefit the rumored Rick Perry for President campaign.

Prognostications about the future aside, Gingrich’s present is spectacularly unclear.  Where does he go from here?  So far, the most memorable moments from Newt’s 2012 odyssey are calling a sensible Medicare reform “right wing social engineering,” an epic press release, a half-a-million-dollar credit line at Tiffany’s, and now this.  Amazing.

One thing’s for sure: Newt needs to find some way to bounce back, if only for his personal future as a pundit, speaker, and idea factory.  If this mass resignation is the final entry of his presidential campaign, it will be awhile before anyone wants to pony up big bucks to get advice from a guy who couldn’t manage a single week of sustained success.

Monday’s news cycle has been very good to two men who don’t receive a lot of sunshine in their lives these days.

The first is former International Monetary Fund head Dominique Strauss-Kahn, who was in a New York City courtroom this morning to plead not guilty to the charge that he sexually assaulted a Big Apple hotel maid. While his circumstances are still unenviable, the media spotlight abandoned the French financier in favor of the equally prurient Anthony Weiner, the Democratic New York congressman who admitted at a press conference earlier today to committing every gross act you already suspected he committed. The irony must be galling to Weiner, who, had he followed Strauss-Kahn’s lead and pursued a career in French politics, would doubtless be up for a cabinet position after his recent revelations.

The second is Michael Steele, the former RNC chairman whose two-year tenure was marked by a parade of rhetorical gaffes and accusations of gross mismanagement. Steele, however, looks like a man with the message discipline of a Soviet apparatchik in comparison to the new DNC chairwoman, Florida Congresswoman Debbie Wasserman Schultz.

As our own Quin Hillyer has repeatedly (and persuasively) argued, Wasserman Schultz is a public official who elevates inanity to an art form. Prior to today, her most egregious exercise in vapidity had been her characterization of Paul Ryan’s plan to reform Medicare:

[Republicans] would take the people who are younger than 55 years old today and tell them, ‘You know what? You’re on your own. Go and find private health insurance in the health care insurance market. We’re going to throw you to the wolves, and allow insurance companies to deny you coverage and drop you for pre-existing conditions.  ‘We’re going to give you X amount of dollars and you figure it out.’

Asinine and, as is now well-documented, totally wrong. But if Wasserman Schultz seemed to have found a floor for exhibitionist stupidity with that remark, she has now gone subterranean. Asked this weekend about the possibility of stricter state voting laws, this was the controlled implosion that ensued:

“Now you have the Republicans, who want to literally drag us all the way back to Jim Crow laws and literally — and very transparently — block access to the polls to voters who are more likely to vote for Democratic candidates than Republican candidates,” she told host Roland Martin on “Washington Watch” this weekend [emphasis hers]. “And it’s nothing short of that blatant.”

Some remarks speak for themselves. But just a few notes for the gentlewoman (I suppose) from Florida:

1. The word “literally” only has one meaning. This isn’t it. No matter what Joe Biden has told you.
2. If Republicans actually were enthusiastic about Jim Crow laws, they’d have to take tutorial sessions from Democrats — who actually authored them.
3. On behalf of all conservatives everywhere … please do more media availability.

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.

Now The Weekly Standard’s John McCormack has gotten into the fray on the DNC Chair’s false claims that the Ryan Medicare plan could deny seniors coverage of pre-existing conditions. He goes even further in tracking down the supposed source of the claims, and in definitively refuting them. Good stuff.

Yesterday, Ezra Klein of the Washington Post listed five hardball questions he’d like to hear answered by President Barack Obama:

1. You have repeatedly lauded the economy of the Clinton years, yet in a time of high and mounting deficits, you want to make most of the Bush tax cuts permanent. Economically speaking, what makes you believe the Clinton-era tax rates are too high?

2. During the 2008 campaign, you pledged never to raise taxes on any families making less than $250,000 a year. The excise tax on high-value health insurance plans, which you supported as part of health-care reform, did raise taxes on families making less than $250,000 a year. If you’re going to raise almost a trillion dollars by cutting and capping expenditures, as your budget proposes, that will also affect families making less than $250,000. When will you admit that fiscal responsibility requires tax increases on families who aren’t rich?

3. Your budget empowers the Independent Payment Advisory Board to push Medicare toward value-based purchasing designs. But it doesn’t empower the board to experiment with benefit design more broadly, or any form of cost sharing. The committee’s powers remain mostly restricted to payment reforms. Why?

4. The main differences between your budget and the Simpson-Bowles report is that your budget raises less in taxes and cuts less in defense spending. Why were those decisions made?

5. You’ve talked frequently about the need to “win the future” through new investments and initiatives. But unlike the budgets proposed by the House Progressives or Andy Stern or EPI, Demos and the Century Foundation, there’s nothing in your budget that specifically commits to any such investments, nor any particular funding source dedicated to them. If these investments are so important, why not build them into your budget? Why accept the framework that this discussion should be entirely about cuts?

The day before, Klein listed eight thoughtful questions to House Budget Committee Chairman Paul Ryan about the latter’s health care reform.

Responses to each set of queries would be greatly beneficial to Americans trying to sort out whether each man’s plan passes the logic and laugh tests.  After hosting several town hall meetings about his budget reforms, Ryan seems eager to go point-by-point.  The president and his entourage; not so much.

In a newly released video, House Budget Committee Chairman Paul Ryan discusses why Congress must reform Medicare in order to save it and the dangers of doing nothing.

In a statement that accompanied the video, Rep. Ryan said:

We can no longer let politicians in Washington deny the danger to Medicare – the danger is all too real, and the health of our nation’s seniors is far too important. We have to save Medicare to avoid disruptions in benefits for current seniors, and to strengthen the program for future generations. House Republicans have put forward a plan to do just that. Democratic leaders in Congress have failed to produce a plan – it has been 755 days since Senate Democrats even passed a budget. Meanwhile, the President’s plan would empower a panel of 15 unelected bureaucrats to cut Medicare for current seniors, while failing to save the program for future retirees.

“This video lays out the clear choice our nation faces on Medicare: Will Medicare become a program in which a board of bureaucrats manages its bankruptcy by denying care to seniors? Or will leaders work together to save and strengthen Medicare by empowering seniors to choose health care plans that work best for them, with less support for the wealthy and more help for the poor and the sick?  House Republicans have advanced solutions to save Medicare. Instead of working with us, the leaders of the Democratic Party have opted to play politics with the health security of America’s seniors.”

Who decides? That is the most important question when it comes to Medicare savings. First, some background:

Conservatives suddenly are abuzz again with talk of an Obamacare “death panel,” and in substance they have a point: If the Independent Payment Advisory Board (IPAB) works anything like its model in Oregon… and if government health-care programs effectively crowd out private options so that the bureaucratic decision-makers in the government program are, for all intents and purposes, the ultimate arbiters of who receives which treatments… then people have serious reason to worry that their lives could be foreshortened by government fiat. Employing the phrase “death panel” has its advantages and disadvantages (the biggest of the latter is that it keeps the establishment media from giving the complaint any credence, even though the problems with IPAB are both real and acute), but the board’s potential for harm is evident in the fact that 72 Democratic House members last year joined Republicans in asking for the panel to be removed from the bill.

Meanwhile, the anti-Obamacare lawsuit which takes on IPAB directly (among other things), led by the Goldwater Institue, seems to me absolutely on target in challenging how the board is set up to be a power unto itself with no congressional oversight of any relevance or weight. That suit merits far more attention, via full columns rather than quick blog mentions, and conservatives are foolish not to rally in support of it.

With all the anti-IPAB talk bubbling up right now, though, the talk has been strangely disconnected from the budget debate that has been front and center of the American political universe for weeks. Yet with President “Don’t Interrupt Me” Obama jetting all over the country to spread demagogic scare tactics against the Medicare portion of Rep. Paul Ryan’s budget proposal, those on the right really haven’t done much to parry the specifics of his attacks on the “voucherization” or “privatization” of Medicare. Yet the fact is that the president aims to save almost as much money from Medicare as Ryan does — except that he wants to use IPAB to do it.

That’s why conservatives should take up his challenge. We should answer that it is he, not we, who is (/are) for “cutting” Medicare. He does it by giving vast powers to unelected bureaucrats almost entirely unanswerable to Congress. We achieve savings, which may not involve actual cuts in care at all, by giving power to the patients themselves. Conservatives should do a very specific poll on Medicare Part D. If, as I suspect, it is still a highly successful program, then conservatives should say that all Ryan wants to do is to make all of Medicare work the same way that Part D does — except without the doughnut hole. The idea is to allow seniors themselves to achieve savings while finding the best care they can.

We save; Obama cuts. More importantly, we give the power to the patients; he gives it to bureaucrats with a mandate to chop costs by unaccountable orders.

So the question is, Who decides: The individual patient, or the government commissars?

When phrased like that, conservatives don’t even need to say the phrase “death panel.” For most listeners, the scary implications of Obama’s approach will be clear.

Faced with the decline and eventual insolvency of America’s welfare state, congressional Republicans led by Paul Ryan laid out a 73- page plan to reform entitlements for a new generation and right America’s economic course. Democrats, on the other hand, cut this ad, a new low in demagoguery:

I don’t ever want to hear another Democrat refer to the GOP as “The Party of No”.