"Whatever you say Tony"-- Paul Ryan edition

Against my better judgement, I recently commented on a friend’s Facebook political discussion (bear with me, it gets fun eventually) :

JX:  ...I don't like the direction Obama is going one bit. As bad as it sounds I'm holding out for Obama to win but the republicans to take both houses. Then we'll see if Obama can become Clinton. Otherwise I'm fine with gridlock.

Tony:  Just wondering if you dislike Obama so much then why hold out for a win by him? Following the reasoning that it's up to Congress to save us (yikes), wouldn't Etch A Sketch Romney be easier to rehabilitate into Clinton?

JX: Hi Tony! I'm not happy with the republican candidates. Of the clowns I like Romney best (but I don't like Romneycare), don't like Santorum or Gingrich at all. I was hoping that Paul Ryan would run this year. Since I really dislike Obama policy I'll take a neutered Obama and gridlock. I'll hold out hope that Ryan runs next time, I like his fiscal conservativeness. (emphasis mine-Tony)

Tony:  Hi JX. Calling Ryan a fiscal conservative is like calling Hugh Hefner celibate. He voted for Medicare Part D, Tarp and auto bailouts. Trillions of dollars. We are all socialists now; Ryan's the most cognitively dissonant (I wouldn't call him a hypocrite because I think he lacks the awareness to be even that)... because his socialism is only for corporations. When he calls for the repeal of EMTALA then maybe he can speak about free markets in health care.

JX: No matter what someone is going to find the flaw arguments for any candidate, nobody is perfect, that's fine. I would say that I'm a free-market capitalist, I want lower corporate taxes, I want lower capital gains rates, I wasn't smaller government, as much as possible I want government out of my life. To me Obama is the antithesis of this. You may like him, that's fine. I know you're someone that I shouldn't get into a political debate with but I still know where my vote is going.

Tony: You cannot have free markets in health care without repeal of EMTALA* , something Paul Ryan is too squeamish to do, thus his entire thesis is invalidated. There are no free markets, there have never been free markets and there never will be free markets. It's a ruse that corporations are pulling and Paul Ryan is carrying their water. Govt will never be "out of my life", so we are better off making a govt that functions.

(EMTALA: Emergency Medical Transfer and Active Labor Act, requires provision of medical care regardless of ability or willingness to pay.)

(this is where it got fun...)

JX: Whatever you say Tony. Obama was voted into office by people who bought into his rally cries of "Yes We Can!" And what did the knucklehead do during his first two years when he had both houses locked and loaded? Um...nothing (sorry, he did win the Nobel peace prize for doing.....nothing, that's not his fault though). In the thirteenth hour, on a technicality, he passed an unconstitutional health care bill that in their haste nobody in his party actually even read (gotta love Nancy Pelosi) and they are passing out exemptions to the disaster faster than Disney World passes out Mickey Mouse ears. He rode a wave of Bush discontent into office on the backs of the lower class, students, Prius owners and Lilith Fair goers that expected him to bring them to utopia of government handouts, free education, and a USA powered solely by wind and solar energy (as I like to say, the world will NEVER run out of oil) and he sat there scratching his head with idiots surrounding him trying to turn the USA into western Europe (oops, that ain't working out so well for western Europe right now now that the wizard behind the curtain was exposed). And what has he done for his supporters? Let's see, he didn't keep unemployment under the level he promised, the numbers of people on food stamps is the highest in history, he killed Keystone, he kept Solyndra afloat long enough for a photo opp, he passes a bill that will probably be overturned by the Supreme Court...hey let's vote this guy back into office, he's awesome!

Tony: Well played.  I’ve come to learn that whenever a missive starts with the world-weary salutation “Whatever you say Tony...” the next few sentences are going to be an emesis of invective devoid of rational craftsmanship.  And this example doesn’t disappoint-- although I am grateful that no regrettable personal insults were lodged my way (at least I have that). In order not to clutter your Mom’s FB page further, I’ll direct you to the Kalamazoo Post website for my “response”, or not...whatever.
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My response:

I’m never sure how the disgorgement of Fox & Friends anti-Obama talking points finds a place in any meaningful discussion, but here we are.  Lilith fair and Prius owners? Really, does Steve Doocy write your stuff? Your frustration about politics might be better directed toward policy.  If we want to invoke the failures of presidential administrations--since it was broached-- why only include the current one? Ten years of tax cuts, increased entitlement obligations (Medicare Part D), corporate welfare (TARP, auto bailouts, farm subsidies), unregulated bubbly housing markets, and funding undeclared wars have certainly played some part in our fiscal woes and an unemployment rate that’s nearly doubled since 2001, no?  And all approved by Rep. Paul Ryan.  Spending? Deficits? Methinks the gentleman doth protest too much.  Not that I’m necessarily enamored with all current policy, but please, the anti-Obama rant will only work on someone who's been asleep for at least a decade.  How soon we forget the world George “This sucker could go down” Bush left us, with a Treasury Secretary on bended knee to Nancy Pelosi.

When the Republicans had control of the presidency and Congress, what did they do? Did they fund Medicare and reform health care to cover the 35 million uninsured? No. Despite inheriting a budget surplus in 2001, we were soon running deficits-- not just deficits, but record deficits-- within a few years, proving once and for all, that trickle down, supply-side tax cuts simply don’t generate enough revenue; with Paul Ryan voting with his party all the way down. And now we have 50 million uninsured.  Enter Paul Ryan for yet another stab at it, only this time we don’t have the luxury of budget surpluses to squander for fun.  

Rep. Paul Ryan has a fiscally conservative budget which supposedly distinguishes him from the Democrats. In addition to lowering taxes further, Ryan’s cost-cutting is predicated largely on revamping Medicare by requiring seniors to purchase health insurance from exchanges, making huge cuts in Medicaid, and pretty much eliminating all other non-defense federal spending, ie, those same programs that he himself has generously voted for over his 14 years in the House.

Since Medicare reform is the linchpin of Ryan’s budget, let’s start there. Ezra Klein from WaPo:

Let’s play a game. I’ll describe a health-care bill to you. Then you tell me if I’m describing President Obama’s Affordable Care Act or the budget released this week by Rep. Paul Ryan (R-Wis.).

The bill works like this: The federal government subsidizes Americans to participate in health insurance markets known as “exchanges.” Inside these exchanges, insurers can’t discriminate based on pre-existing conditions. Individuals can choose to go without insurance, but if they do so, they pay a penalty. To keep premium costs down, the government ties the size of the subsidy to the second-least-expensive plan in the market — a process known as “competitive bidding,” which encourages consumers to choose cheaper plans.

This is, of course, a trick question. That paragraph describes both the Affordable Care Act and Ryan’s proposed Medicare reforms. The insurance markets in both plans are essentially identical.

In other words, Paul Ryan’s Medicare fix is indistinguishable from Obama’s ACA,  yet when the Democrats passed the ACA not one Republican voted for it, nor would they even discuss it, and now they are even challenging the legislation in the Supreme Court. The irony is that if the GOP successfully disallows Obamacare’s provisions, it pretty much scuttles Paul Ryan’s masterful budget which relies on seniors being mandated to buy health insurance with vouchers. Who do you think Ryan will be rooting for this week in the SCOTUS?

As they say on late night TV...but there’s more (Ezra Klein again):

There’s an added complication for Republicans. They have assumed huge savings from applying the exchange-and-subsidies model to Medicare. But they don’t assume — in fact they vehemently deny — that those same savings would result from the identical policy mechanism in the Affordable Care Act. The Democrats haven’t assumed significant savings from the exchange-and-subsidies model in either case.

If the concept works as well as Ryan says it will, then the Affordable Care Act will cost far, far less than is currently projected. There’s no compelling reason to believe competitive bidding will cut costs for seniors but fail among younger, healthier consumers who, if anything, are in a better position to change plans every few years and therefore pressure insurers to cut costs...

[...Republicans are] stuck fighting a war against a plan that they helped to conceive and, on a philosophical level, still believe in. No one has been more confounded by this turn of events than Alice Rivlin, the former White House budget director who supports the Affordable Care Act and helped Ryan design an early version of his Medicare premium-support proposal.

“I could never understand why Ryan didn’t support the exchanges in the Affordable Care Act,” Rivlin says. “In fact, I think he does, and he just doesn’t want to say so.”

Bloomberg Financial says that Paul Ryan’s Medicare fix improves with each new revision.... because it comes closer and closer to looking like Obamacare!

My comment:  The nonpartisan CBO agrees with the Democrats’ conservative estimates of the savings rendered from both the ACA and Ryan’s Medicare plan, which means that Ryan’s estimates without tax increases will not come remotely close to realizing the desired balanced budget.  Personally, I have no confidence at all that market exchanges will work and I think we are merely limping toward the eventual non-employer-based single-payer system that most industrialized nations have implemented. Seniors, especially old and sick ones, will be unable to navigate the insurance markets, thus even more regulation will be needed to ensure workability. Out-of-pocket medical expenses for seniors will increase by Ryan’s own estimate.  If seniors couldn’t afford $30 per month for blood pressure medicine in 2003, which served as the rationale for Ryan voting for the Medicare Part D trillion dollar pharma boondoggle, then how are these same seniors going to pay for cancer surgery?

Very crude, very conservative, back-of-the-envelope calculations for what Obamacare gets us: For $1.3 trillion over 11 years and covering 40 million uninsured: that’s $2900 per person per year. Not bad, and these patients will be placed in the regulated insurance market which Paul Ryan advocates so strongly.  (Granted, this means putting many individuals on Medicaid, but that seems to be the consensus solution from both parties nowadays...unsolicited career advice: forget about medical school as a way to make a living.)  And what did we get for the nearly exact $1 trillion spent over 10 years on the 40 million seniors in Medicare Part D? Answer: certainly not $2500 per patient per year in drug benefits, unless you count 6-figure pharma executives’ bonuses as a benefit.

Bottom line: Obama isn’t as irresponsible as Ryan and the Republicans claim,  Lilith fair-goers notwithstanding, and the Republicans have a storied history of supporting all manner of unfunded mandates (eg, EMTALA) and deficit pork (eg, Medicare Part D), and to think that Ryan will suddenly change seems delusional to me.  Another example: Clearly, Ryan’s cuts to Medicaid are not sustainable and the program will need constant infusions of cash just to keep practitioners in the program.  Paul Ryan says that doctors don’t participate in Medicaid because of its “rules, regulations and mandates” (6:30 mark on this video).  Wrong. Doctors don’t participate in Medicaid because reimbursement is too low. Period.  And Ryan’s Medicaid cuts will need to be remedied by emergency infusions of funds that he has not factored into his budget.  Either he knows this and is lying or he has no real comprehension of the problem; I don’t know which is worse.

Furthermore, Ryan’s budget plan eliminates nearly all non-defense discretionary spending and a large chunk of non-discretionary spending, leaving nothing for roads, airports, infrastructure, national parks, education, research, food, drug and bank regulation, law enforcement, etc.   It might be pleasant to dream of a world without need of such things, but the reality is different.  If we shift all the costs to states, as Ryan proposes, then Mississippi and Alabama will be indistinguishable from Mali and Chad.

Every time someone says they can correct a trillion dollar budget deficit while cutting taxes a puppy dies.

For the record, my gripe with the Democrats is significant: they are cavalier toward protecting the social safety nets on which we all rely from time to time. Going along with Mr Bush and raiding Social Security and borrowing money to pay for ridiculous wars is just one example of Democratic ineptitude, but something Paul Ryan supported as well.  Another: Did you know that Medicare-- MY retirement health insurance plan-- pays the salary, benefits and education expenses of every single doctor-in-training in the USA (nearly $100K per resident per year)?  Why can’t funding come from other sources? Do no other players, ie, business interests and citizen groups, enjoy the benefits of having highly trained physicians?  Why should my Medicare fund it 100%?

Our safety nets have not been nurtured and now they are in jeopardy by political budget hacks. I tend to agree with JX that if Harry Reid and Nancy Pelosi are the best we can do as sentries for our treasured social programs, then maybe we deserve to have them dismantled by Paul Ryan and other water-carriers of the corporatocracy.  But I lay our current budget deficits directly at the feet of Republican policies that spent surpluses and reduced taxes at the behest of lobbyists, and now the only answer Ryan can come up with is to destroy our federal government. Maybe Paul Ryan’s diagnosis and treatment plan are correct, but if so it would be a first for him. His unrealistic tax cuts are boilerplate doggerel written by the wealthy special interests and his budget is not a serious answer to the difficulties we face, needing numerous revisions in order to re-fund all the necessities he's neglected.

One final question: Where is graduate medical education in Paul Ryan’s budget?  You guessed it, it’s not there... he proposes a health care system without doctors!  We can do better.

BTW: now that I'm no longer in Kalamazoo, I've been considering a new name for the blog: "Whatever you Say Tony" is now in the running...

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References:

Ezra Klein, Washington Post, Why Ryancare and Obamacare look so similar.

Bruce Bartlett, Reagan’s Treasury Dept economist, Forbes, Republican Budget Hypocrisy.

Jon Walker, Firedoglake, CBO: Ryan’s budget would massively cut Medicaid and Medicare.

Parija Kavilanz, CNN, Kids caught in Medicaid crossfire.

Editorial, Bloomberg Financial, Paul Ryan’s Medicare voucher plan improves with each pass.

Greg Sargent, Washington Post, Tax Expert: Paul Ryan’s budget is all “smoke and mirrors”.

Chris Wallace, Fox News Sunday, Interview: Rep. Paul Ryan defends GOP budget plan.

Jonathan Cohn, The New Republic, The Bush Deficit.