The USCCB has issued a very clear and reasonable response to yesterday’s decision by the Supreme Court to uphold the Affordable Care Act as a tax. The Bishops reminded us that, while they have for many years been advocates of health care reform, they opposed the ACA’s final passage because of its “fundamental flaws.” Specifically:
First, ACA allows use of federal funds to pay for elective abortions and for plans that cover such abortions, contradicting longstanding federal policy. [ . . . ]
Second, the Act fails to include necessary language to provide essential conscience protection, both within and beyond the abortion context. [ . . . ]
Third, ACA fails to treat immigrant workers and their families fairly.
The Conference went on to say that, since the ACA’s enactment, it “has not joined in the efforts to repeal the law in its entirety.” Rather, they concentrate their efforts on urging Congress and the Administration to fix the flaws and make the ACA truly life-affirming.
June 29th, 2012 | 12:12 pm
Either the NRLC or USCCB is completely out of touch with reality. Here are some excerpts from a NRLC fund raising email I just received:
Why isn’t any of this mentioned in the USCCB’s list of the fundamental flaws of the ACA? Surely, if the NRLC’s assessment of the ACA is correct, then the Bishops are seriously negligent in not mentioning any of this. If the USCCB’s assessment is realistic, then the NRLC is engaging in an inexcusable use of scare tactics.
Do our left-leaning Bishops have a serious blind spot when it comes to the ACA? Or is the NRLC engaging in some of the lowest and dirtiest political tactics? Which is it?
Any First Things readers willing to shed some light on this?
June 29th, 2012 | 2:14 pm
“Or is the NRLC engaging in some of the lowest and dirtiest political tactics?”
Bingo!
June 29th, 2012 | 3:40 pm
Joe Your bingo is invalid, maybe you covered the number in error
June 29th, 2012 | 4:23 pm
harry,
It is “the NRLC engaging in some of the lowest and dirtiest political tactics.” Here is a link to an explanation of the Independent Payment Advisory Board (IPAB) by the Henry J. Kaiser Family Foundation. Your fundraising letter says:
I can find nothing whatsoever to justify this statement. The IPAB is primarily charged with making cost-control recommendations for Medicare coverage. These could not possibly affect what hospitals and doctors would do for patients who have private insurance or can pay for treatment out of pocket. IPAB and other mechanisms in ACA can also make recommendations on what are cost-effective treatments and what are not. However, the impact would be primarily on Medicare and secondarily on private insurance.
What is completely ironic is that there are two completely incompatible conservative arguments against ACA. First, it will be too expensive to pay for everything. Second, it will put limits on what is paid for. Medicare can’t possibly pay all the health care costs it will be required to cover, but how dare anyone put limits on coverage!
The fact of the matter is that health care is “rationed” right now. If you can’t afford it, you can’t get it. And if you are insured and your insurance company won’t pay for something, you either pay for it out of pocket, or you don’t get it.
June 29th, 2012 | 5:32 pm
Actually, neither the USCCB or the NRLC is facing up to the reality of the situation. The quite common reality of involuntary euthanasia is finally being brought to the public’s attention and being openly discussed in Great Britain:
Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year
This has yet to happen on this side of the pond. Involuntary euthanasia similar to that discussed in the article at the link above is rampant in the USA, too. It should surprise no one that the ACA will provide a facade of legality to this practice, as though killing innocent people could actually be made legal. Only then will the secular, anti-life MSM consider bringing it to the public’s attention in the USA.
June 29th, 2012 | 6:02 pm
Harry – “the NRLC engaging in some of the lowest and dirtiest political tactics” – you are right on the spot!
Just some simple facts: In term of health care, America is spending the highest amount per capita compared to all other industrialized countries. And yet, the result is one of the bottoms in term of:
- life expectancy
- Number of insured people ~ 50 millions
- Number of under insured people ~ 100 millions
- Number of bankruptcies due to medical costs
- etc.
June 30th, 2012 | 10:09 am
I don’t think the USCCB response to the law or to the Supreme Court decision is reasonable at all.
The bishops are overlooking a whole host of anti-life and anti-health care efficacy issues which accompany Obamacare–or any other socialized-medicine scheme. In my opinion the biggest next issue, which they ignore, is the fact of radical rationing via politically-driven mechanisms. It simply must come to that to make any socialized medicine system the least bit viable–and therefore it will be undertaken.
If Obamacare or some socialized-medicine substitute for it prevails, the bishops will have a life issue on their hands that will make the current culture of death look like a cakewalk. Why this is not clear to them, I don’t know. Blind guides!
June 30th, 2012 | 11:40 am
The bishops are overlooking a whole host of anti-life and anti-health care efficacy issues which accompany Obamacare–or any other socialized-medicine scheme.
Joe DeVet,
“Obamacare” is not, by any stretch of the imagination, socialized medicine.
I am bewildered by people who claim that the country cannot afford “Obamacare,” or Medicare, who then turn around with scare stories about “rationing.”
June 30th, 2012 | 12:43 pm
NRLC concluded long ago – back during the Clinton proposals for reform – that anything other than a free market fee for service approach would lead to rationing. USCCB has never embraced this perspective. Both are being consistent with their histories.
The bishops have always been more prudent and cautious in their determinations. If the law does not clearly present problems they are unlikely to see it as a definite problem.
June 30th, 2012 | 4:45 pm
Involuntary euthanasia similar to that discussed in the article at the link above is rampant in the USA, too.
harry,
Evidence? Documentation?
It should surprise no one that the ACA will provide a facade of legality to this practice, as though killing innocent people could actually be made legal.
You are not trying to imply, are you, that one of the purposes of the ACA, in addition to attempting to extend insurance to 30 million Americans, was actually to provide cover for massive euthanasia?
I can understand people who believe that ACA was an overreach by the government, that it will be too expensive, and so on. But I can’t understand people who think it is an instrument of “the culture of death”! It is one thing to believe that liberals are misguidedly trying to be everyone’s nanny. It’s another thing entirely to claim that liberals are setting things up to exterminate the disabled and the elderly! This is not what nannies do!
July 2nd, 2012 | 9:04 am
Contact Peter Breen, who serves as Executive Director & Legal Counsel of the Thomas More Society, a national public interest law firm focused on restoring the respect for life in law.
Contact Bobby Schindler or Suzanne Vitadamo of Terri Schiavo Life & Hope Network.
I am saying what the NRLC fund raising email said, but am saying in addition to that, that involuntary euthanasia is already common in the USA, and, yes, one of the purposes of the ACA is to legitimize this practice.
July 2nd, 2012 | 9:52 am
Obamacare may not be technically socialized medicine in its official description–it does pretend to accept private-company insurance as well as hospitals, doctors, etc–but in its implimentation it will be, or certainly become, socialized medicine. When every medical decision is effectively controlled by the government, I say socialized medicine.
July 2nd, 2012 | 10:05 am
To all in this discussion,
You may be interested to read NRLC’s analysis of how the law’s IPAB will limit the rights of senior citizens to spend their own money to save their own lives:
http://www.nrlc.org/HealthCareRationing/Life%20at%20Risk%20Routes%20to%20Rationing%206272012%20%281%29.pdf
July 2nd, 2012 | 10:28 am
In 2009, Candy Hill, Senior V.P. for Social Policy and Governmental Affairs at Catholic Charities USA, in testimony before the U.S. House Committee on Ways and Means defined the unprecedented demand on front-line charities in this county. Ms. Hill suggested that “innovative partnerships between governments and community partners should be strengthened. While Catholic Charities is committed to continuing our work as an effective and ACCOUNTABLE partner with government…we know that ONLY through the LEADERSHIP and support of the federal government will we be able to address the growing problems that face our nation.”
Ms. Snow then suggests “It is also a time for us to embrace 21st enntury solutions to the 21st century poverty in our communities. Let us collectively commit ourselves to this LOFTIER goal, one which will ultimately eliminate the need for our [Catholic] services.”
I respectfully disagree with Ms. Snow, Catholic Charities and many of the Bishops who look to government to care for the poor. The real solution is found in our Trust in Him. We, as Catholics, have lost our Way. We need to trust in 1st century solutions for 21st century poverty. That is Love or, if you will, Charity. The other is redistribution. There is no grace in forced redistribution.
I am blessed to be poor. Please, do not invoke my name to take that which I value most from me.
July 2nd, 2012 | 10:35 am
You may be interested to read NRLC’s analysis . . .
No, actually not. Linking to blatant propaganda on either side of these issues is not helpful. The NRLC is no place to turn to understand ACA. If you already oppose Obamacare, you can turn to NRLC to hear exactly what you want to hear. They don’t provide information. They provide pre-packaged ammunition, and there is absolutely no guarantee that it isn’t totally distorted.
July 2nd, 2012 | 10:46 am
At least 60% of the funding for Catholic Charities comes from government sources.
July 2nd, 2012 | 12:04 pm
There were 2 major rulings last week (Arizona’s Immigration Law, and the ObamaCare IM law) that might have some reprecussions for illegal aliens (esp those who work here ). Since Justice Roberts took it upon himself to re-write a portion of ObamaCare to make the IM an actual tax, illegal aliens who do work here will be setting themselves up for tax evasion. Whether the IRS actually prosecutes them is something else entirely. But, it does create a very thorny issue. If a worker turns down insurance coverage he will be liable to the new tax (which will most certainly go up, as ObamaCare is currently pegged to be $1.76 trillion short over the next 10 years). From an equal protection as well as financial stand poiint (there are estimated as many as 13 million illegal workers here), the federal government will not be able to ignore this issue. And if the IRS does begin to enforce this portion of ObamaCare, advocates for foreign workers will have a collective fit.
July 2nd, 2012 | 12:08 pm
“I can find nothing whatsoever to justify this statement. The IPAB is primarily charged with making cost-control recommendations for Medicare coverage. These could not possibly affect what hospitals and doctors would do for patients who have private insurance or can pay for treatment out of pocket. ”
Most of the elderly are losing their Medicare supplemental insurance (previously provided by the states). Medicare will be all they’ve got. And just last March, the CBO revised upwards the cost of ObamaCare (from $900 billion to $1.76 trillion over 10 ten years. A doubling in just 2 years). Where do you think the extra money will come from? Take a wild guess. Bending the cost curve is what ObamaCare is all about.
July 2nd, 2012 | 1:26 pm
Since Justice Roberts took it upon himself to re-write a portion of ObamaCare to make the IM an actual tax, illegal aliens who do work here will be setting themselves up for tax evasion.
JP,
Justice Roberts did not “rewrite” anything having to do with the individual mandate. Roberts simply interpreted the penalty charged for not buying insurance as a tax.
Illegal aliens are not covered by ACA. They will not be penalized for not buying insurance and they will also not get government subsidies to buy insurance or even be allowed to buy insurance on the state insurance exchanges. The Catholic Bishops are objecting to this as unfair, and I agree with them. The more people who have insurance the better, and that includes illegal aliens.
July 2nd, 2012 | 1:44 pm
Most of the elderly are losing their Medicare supplemental insurance (previously provided by the states).
JP,
Medicare supplemental insurance (aka Medigap policies) are not provided by the states. It is sold by private insurance companies, although there is some regulation by the government. About a sixth of Medicare recipients purchase Medigap policies. ACA is not causing any of the elderly to lose supplemental insurance. What is happening is that Medigap policies, under ACA, may have higher deductibles. The theory is that if people have insurance that simply covers everything “free,” they will get treatments they don’t need, adding to overall health care costs. If they have to pay something out of pocket, they will think twice before going to the doctor or undergoing some optional treatment. This, by the way, is a very Republican idea—making the health care consumer responsible for his or her choices will make them thriftier, because they will be spending some of their own money instead of just spending money from the insurance company.
July 2nd, 2012 | 3:13 pm
Hello Megan,
Thanks for that link. It was helpful.
July 2nd, 2012 | 3:39 pm
“What is completely ironic is that there are two completely incompatible conservative arguments against ACA. First, it will be too expensive to pay for everything. Second, it will put limits on what is paid for. Medicare can’t possibly pay all the health care costs it will be required to cover, but how dare anyone put limits on coverage!”
I think this encapsulation of the ‘conservative’ viewpoint on Medicare is a bit overly simplified and off-target…
Nonetheless, no, the two viewpoints you’ve expressed are not incompatible: it will be too expensive to pay for everything allowed, and some things will not be paid for in an effort to bring down the government’s share of that expense.
“The fact of the matter is that health care is “rationed” right now. If you can’t afford it, you can’t get it. And if you are insured and your insurance company won’t pay for something, you either pay for it out of pocket, or you don’t get it.”
Surely you see that that rationing isn’t purely economic, but consists of other types of pressure as well. The direction this is going in – the fact of the matter – is that there will be procedures for you which you will be able to raise all the money you want, but because of determinations of your own health and the relative drain on government funds and resources – doctor and operating room time which is deemed to be better spent on a healthier individual for example – you will be denied the option to pay for it out of pocket or otherwise. The rationing that takes place right now is certainly economic, with no small amount of societal and political pressure applied in order to minimize that expense. Expect that pressure to increase as the economic side hits critical limits.
July 2nd, 2012 | 4:03 pm
(You may be interested to read NRLC’s analysis . . .)
“No, actually not. … If you already oppose Obamacare, you can turn to NRLC to hear exactly what you want to hear. …there is absolutely no guarantee that it isn’t totally distorted.”
Oh brother. And if you already support Obamacare, you needn’t devote any time to considering the NRLC response – they won’t be telling you what you want to hear.
July 2nd, 2012 | 4:10 pm
doctor and operating room time which is deemed to be better spent on a healthier individual for example – you will be denied the option to pay for it out of pocket or otherwise.
JDD,
Nowhere can I find a source that documents this assertion—that is, that that there will be limits on medical care that people can afford to pay for themselves. Can you (or anyone else) please point me to a source that explains exactly how this will happen rather than a source that simply states it will?
July 2nd, 2012 | 4:44 pm
Oh brother. And if you already support Obamacare, you needn’t devote any time to considering the NRLC response – they won’t be telling you what you want to hear.
JDD,
Please note that I said, “Linking to blatant propaganda on either side of these issues is not helpful.” If I try to counter what NRLC says by giving links to NARAL or Planned Parenthood, do you think that would be helpful in getting at the truth here? If you quote from Fox News and I quote from MSNBC, or if you quote from The National Review and I quote from The Nation, will that get us anywhere?
I did actually read what was linked to at NRLC, and I think it is biased and in some cases factually wrong.
July 2nd, 2012 | 5:06 pm
Cal Thomas on Why Obamacare may beget euthanasia
See also:
Quiet Euthanasia
Catholic nurse recounts hospice horror, says doctor euthanized priest
Are Euthanasia Advocates Taking Over America’s Hospice Industry?
And take a look at this web page on the Physicians for Life web site:
http://www.physiciansforlife.org/content/view/1958/75/
It is a 2010 article mentioning the Liverpool Care Pathway protocol discussed in the article I posted a link to above, “Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year.”
Here is an excerpt from the Physicians for Life article:
And visit:
http://www.hospicepatients.org/
July 3rd, 2012 | 2:00 pm
David Nickol,
“Please note that I said, “Linking to blatant propaganda on either side of these issues is not helpful.” If I try to counter what NRLC says by giving links to NARAL or Planned Parenthood, do you think that would be helpful in getting at the truth here?”
Yes, I would. Perhaps this is a difference between the way you and I go about things, or maybe you’ll find yourself agreeing with some of how I word this: I hope you agree that the definition of ‘propoganda’ is inherently difficult to lock down. What one once sees as ‘propoganda’, one later might begin to be convinced by – perhaps on ‘either side’ of the arguments.
I believe everything is ‘biased’ to some extent, by virtue of coming from human beings. We discard information which we deem to be irrelevant, inconsequential… while someone on the other side of the argument believes that what we’ve discarded is actually a critical marker, an indication of a trend, etc.
We could have a whole conversation on that, I’m sure.
Part of the absolute pursuit of truth is daring to let yourself be exposed to all the arguments without qualification. It’s a difficult enough undertaking for one who might be an Atheist or at least a Relativist, for example. I confess it is even more challenging for a person who believes in a real spiritual realm, and who believes in a real spiritual Adversary who wishes to separate me from truth – which is to say to ultimately separate me from God.
I long ago was impressed by the story told of Karol Wojtyla, how he read the works of Communist authors while in Seminary, and how this scandalized certain friends. To which he proclaimed, “I want to know what the other side thinks.” Yes, okay, he was being diligent and offering an example of intellectual diligence, etc., But there was also a risk there, if one believes that, a) not all arguments are made in good faith, b) not all philosophies and viewpoints are ‘equally good’ for the human person, and c) I am not intellectually invulnerable to being persuaded – no matter how sharp I think I am.
I’ve tried to take all of this to heart, as I’ve listened to Planned Parenthood’s (for example) arguments for certain causes – not the least of which is the healthcare law. I wondered indeed if I might find some good reasoning there, and expected there should be. I have instead been utterly unimpressed by PP’s methods of reasoning, and utterly unconvinced by their arguments. – and THAT is why I don’t hold them myself.
By the way, you can tell a lot about a law by the way different sides react to it. The reaction to the healthcare law decision of various national groups across the board who support various ‘rights’, should tell you a lot about what ‘freedoms’ the law expands upon and what entities are likely to benefit.
“I did actually read what was linked to at NRLC, and I think it is biased and in some cases factually wrong.”
Fine – then please show me where. My Rock is not the NRLC – and everyone has a rock. You might be surprised to know that I don’t take the NRLC as absolute Gospel, and in fact don’t check in with it particularly often. But it was you who first wrote, “No actually not.” and threw out the ‘propoganda’ label, seemingly out of the blue since the weblink was offered to everyone, not you in particular. I think had the roles been reversed, you would have slapped your responder silly. :)
In any case, I hope you have a great – and safe – Independence Day.
JDD
July 3rd, 2012 | 3:57 pm
JDD,
I don’t disagree with most of what you say. I read almost everything people link to, no matter unhelpful I expect the source to be.
[DN] I did actually read what was linked to at NRLC, and I think it is biased and in some cases factually wrong.”
[JDD]Fine – then please show me where.
Here’s the problem with that. We’re having a discussion here in which I take the time to express my position, often doing a fair amount of research and providing links to back up what I say. Then someone comes along and, providing only a link, says, “Oh, but read this . . . ” Now, I don’t mind spending a long time responding to other posters’ comments, but it is beyond the scope of what I am prepared to do to read, research, and try to debunk a document from an advocacy organization that was no doubt put together by a team of people. That is the job of other advocacy organizations.
If someone wants to make a case here and link to NRLC to help document that case, I will probably read what they have to say, what NRLC has to say, and comment. But if someone relies solely on posting links, what they are doing is basically saying, “Let’s you and NRLC fight, and I’ll sit back and watch.” There’s no way to be sure they have even read the NRLC document themselves, or understood it, or are capable of defending it.
There are various ways of hopelessly tying up people in a blog discussion, and one of them is to expect people (like me) to read long documents and spend hours researching them and trying to refute them.
Happy Fourth to you, too!
July 3rd, 2012 | 6:04 pm
And another tactic is to claim the other guy’s documentation is “blatant propaganda” and “pre-packaged ammunition,” that you can’t be sure isn’t “totally distorted,” and then hint that the one offering it probably hasn’t even read it and just likes “tying up people in a blog discussion.” This tactic is most often used when one doesn’t have a substantive answer to the argument being made, and cannot refute the facts provided by the documentation.
July 4th, 2012 | 4:43 pm
The fact of the matter is that health care is “rationed” right now. If you can’t afford it, you can’t get it.
That is the entire justification for socialized health care, and the situation that is supposed to be fixed.
Everyone is supposed to get health care needs met.
Now that we all agree that socialized health care is incapable of fulfilling the one thing that justifies its existence, what is the advantage again?
The truth is there is no way for society to pay for everyone to have everything they need, let alone everything they want. And it’s already clear that the government plans on pandering to what people want – the fact that it will not make people responsible for their own birth control pills means either that (a) we are entering into a model where we are abandoning the idea that people can or should be responsible for anything at all and/or (b) the government is using medical benefits to bribe voters.
(A) indicates that the government will increasingly be forced to cover all preventive measures, while (b) means corruption.
Whether it’s (a) or (b) (or both), neither is an improvement over free market economics. At least under free market economics the government can provide protection (in the form of a safety net and/or in the form of a court to appeal to), but who provides protection when the government is the one refusing your claim?
July 5th, 2012 | 1:52 am
“Everyone is supposed to get health care needs met.”
Yes, within reason, of course.
“Now that we all agree that socialized health care is incapable of fulfilling the one thing that justifies its existence”
But who agrees that socialized health care (universal health care of some kind) is incapable of delivering?
Let’s compare the US to other developed countries such as Australia, France, Norway, Sweden, etc. All these countries successfully provide variants of “socialized health care,” and their citizenry live longer and have fewer childbirth death than the US. Not perfect, but certainly better (and cheaper) than in the US. So it can work quite well.
One thing is to oppose universal health care out of ideological reasons. It is quite another to claim that it cannot work. The latter is simply false.
July 5th, 2012 | 4:15 am
Blake
I do not see why government-sponsored health care cannot fulfil its primary purpose of reducing the number of working days lost through sickness without being ruinously expensive. One simply has to use the sort of triage system that the military has been employing since Napoléon’s time.
That would include both prophylactic and therapeutic measures.
July 5th, 2012 | 10:26 am
David Nickol,
“Then someone comes along and, providing only a link, says, “Oh, but read this . . . ” Now, I don’t mind spending a long time responding to other posters’ comments, but it is beyond the scope of what I am prepared to do to read, research, and try to debunk a document from an advocacy organization that was no doubt put together by a team of people. That is the job of other advocacy organizations.”
David, this has NEVER stopped you before !
“If someone wants to make a case here and link to NRLC to help document that case, I will probably read what they have to say, what NRLC has to say, and comment. But if someone relies solely on posting links, what they are doing is basically saying, “Let’s you and NRLC fight, and I’ll sit back and watch.” … There are various ways of hopelessly tying up people in a blog discussion, and one of them is to expect people (like me) to read long documents and spend hours researching them and trying to refute them.”
Yes, I get that. The problem is, that’s not what happened here. No one singled you out. No one asked you personally to dig in and defend. You chose to respond personally with an admonition to dismiss the link out of hand, and when pushed a little, in your response said this: “I did actually read what was linked to at NRLC, and I think it is biased and in some cases factually wrong.”
So you’re not being asked to do any more reading or research than you already have. Tell me what you *already* found that supports *your* statement. Anything else at this point looks like a knee-jerk reaction based on the organization not supporting your point of view.
Regards,
JDD
July 6th, 2012 | 3:54 pm
David, this has NEVER stopped you before !
JDD,
True! And I guess it is not stopping me now. Let me say at the outset that the very first claim in the NRLC document is a complete and total misrepresentation of what the law actually says. They have misinterpreted the task of the IPAB to be to hold Medicare spending to within certain targeted limits. This is not the case at all. They have also implied that IPAB is responsible for holding private (nonfederal) spending to within certain limits, which is untrue, and in fact IPAB has no authority at all over nonfederal spending.
From the NRLC document:
The text that I have put in italics is just dead wrong. Go to the link and look at the chart on page 3.
NRLC is claiming, for example, that for 2015, IPAB must limit healthcare spending growth to the lesser or (A)”halfway between medical and general inflation” and (B) 0.5%. That is a completely mistaken interpretation. What is actually the case for 2015 is that IPAB does nothing unless projected Medicare spending is going to exceed “halfway between medical and general inflation,” something which for 2015 is unlikely to happen (see below). If it does indeed happen, IPAB will be required to make proposals to cut costs by no more than 0.5%.
From 2018 onward, the trigger is the rate of growth of GDP per capita plus 1%. As long as Medicare spending projections do not increase faster than GDP plus 1%, the IPAB does nothing. If projected Medicare spending does exceed GDP plus 1%, IPAB makes recommendations to cut Medicare costs by no more than 1.5%.
Here is an explanation of what is actually the case, and which NRLC misrepresents:
According to ACA: “The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria.” It is a strange “rationing commission” that is forbidden by law to make recommendations to ration health care.
The Medicare recommendations work as follows:
According to Ezra Klein in the Washington Post, Medicare costs are rising at less than the rate that triggers IPAB recommendations. If that continues, the IPAB makes no Medicare recommendations at all.
As for recommendations on nonfederal medical spending:
So NRLC has it entirely wrong. IPAB is required to make recommendations to cut Medicare spending by at most 1.5% a year no matter how fast Medicate grows. IPAB is not tasked with keeping Medicare spending below any certain level, as NRLC suggests. And as for nonfederal spending, it makes only recommendations. It has no power to implement them.
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