So I was watching the Fox News 6:00 PM show and the panel was discussing whether Ryan could defend his Medicare cuts or if Ryan’s Medicare cut plan will hurt the Republicans among seniors. This is nuts as a matter of both fact and politics. As between the most recent Ryan budget and the most recent Obama budget, there isn’t any disagreement about whether to cut Medicare. There isn’t even any disagreement about how much to cut Medicare. They both agree to fund Medicare at GDP+.5%. They disagree on how to cut Medicare. Obama wants a central government board (called IPAB) that can cut how much is paid to providers of health care services to Medicare recipients. If IPAB cuts health insurance provider payments too much, the providers will stop seeing Medicare patients and the Medicare recipients won’t get the services. And since Obama-style Medicare cutting only includes one option (what IPAB says or pay out of your own pocket), middle-class and working-class Medicare recipients will simply be out of luck. The Ryan Plan (which is really very close to the Ryan-Wyden Plan) allows future seniors to choose between multiple plans that compete to offer the same services as Medicare at the lowest price. One of the choices will be the current Medicare Fee For Service program that we already know. The Republicans need to make this into an argument between Obama’s IPAB without-appeal vs. choice and competition. One of the problems we face is that, even in among parts of the right-leaning media, the issue isn’t being framed according to the actual policy disputes. This is one of consequences of the right-of-center’s relative lack of interest in positive health care policy prior to about the middle of the last decade. Ryan has done more than any other political figure to move the debate, but his own side isn’t quite ready to hold up its end yet. So what is the Romney campaign to do? Let Ryan go on offense in the paid media. Here is one way to go about it:
1. Buy two minute blocks of commercial time. It costs more than a 30 second spot, but one ad that leaves an impression is worth more than ten that just go over the heads of the audience. Medicare policy is pretty complicated and most viewers don’t know about the proposals in dispute. Also, Ryan is at his best when he has a little time to work with.
2. Let Ryan spend the first minute explaining how Obama’s budget cuts Medicare spending. Have him explain how IPAB works and why those kinds of centralized cuts are both a bad idea in principle and why working-class and middle-class Medicare recipients would be in the most danger if providers stopped seeing Medicare recipients. A lot of the audience will be surprised to learn that Obama has proposed such large Medicare cuts, much less how Obama plans to implement them.
3. Let Ryan spend the second minute explaining how Ryan-Wyden-style premium support works. Have him explain that all bidders would have to offer the standard Medicare benefit and that the current Fee For Service Medicare system will be one of the choices. Have him explain that sicker Medicare recipients will have larger premium support payments. Have him explain why he thinks this will allow the government to buy more health care services for seniors per dollar spent while giving seniors more choice.
4. Take your time. Get the most out of every word and use some graphics. Ryan is pretty good at this. Make the most of his skills.
5. Fund the ad buy. Spend lots of money. If you can win the Mediscare war, you are a long way to winning. Right now, defining this battlefield is the most important thing. There will be plenty of Republican-affiliated Super PAC money to run ads about how Obama has presided over high unemployment, high gas prices, and epic deficits. The Romney team has to carry the weight of neutralizing Obama’s Mediscare campaign, and Ryan is the best person on the Romney team to make this case.
6. Spending the money doesn’t just get you those eyeballs for those two minutes that Ryan explains the Medicare issue. It is an investment. Romney’s allies and well wishers will see the ads and pick up the message. They will learn how to frame the issue. It will also make it easier for the Romney-Ryan ticket to make the Medicare case if tens of millions of Americans have a basic understanding of how Obama has proposed to cut Medicare and how the Ryan-Wyden-style premium support plan works. All of this makes it much harder for Obama and his media allies to successfully demagogue the issue later in the campaign.
7. So let Ryan do his thing. Make the ad. Spend the money. Win this fight.
August 13th, 2012 | 10:34 pm
[...] The Republican Medicare Equation: The Best Defense = A Good Offense Lots …First Things (blog)As between the most recent Ryan budget and the most recent Obama budget, there isn't any disagreement about whether to cut Medicare. There isn't even any disagreement about how much to cut Medicare. They both agree to fund Medicare at GDP .5%.and more » [...]
August 14th, 2012 | 2:00 am
There are huge differences between the President’s proposal and Paul Ryan’s plan.
Republicans can’t seem to decide whether the President’s proposal would cut $500 billion from Medicare, as Romney asserted last week or $700 billion, as RNC chair Priebus asserted on Sunday.
Medicare funding, under his propsal, will continue to grow over the next ten years, but at a smaller rate than it would have without the ACA. That’s because the ACA already targets savings to be realized to Medicare, thus less spending. There is no actual loss of services to seniors (or the poor). Paul Ryan’s plan is not at all similar here.
Spending cuts will also be realized by cutting fraud, which is already being done through the largest fines ever imposed under any administration. The federal government is winning many criminal convictions against fraudulent doctors, patients and health care organizations. (Just google “record Medicare fraud cases.”)
Insurance companies (aka persons) should expect to get their hands spanked when attempting to over-bill Medicare as well. The spending is going to get stingy. It’s not that doctors will get paid less for agreed-upon fees, and thus quit seeing Medicare patients. It’s that they and their Insurance persons are facing and will face tighter rules and stiffer penalties when attempting to fleece the tax payer for unnecessary services and exorbitant billing.
Ryan supporters, including Pete, have asserted that a person opting out of Medicare would possibly be able to find a private plan which would actually cost him less than would care under Medicare. Anything is possible, but the probability here wouldn’t be worth calculating, at least not for similar coverage (apples to apples and all that). On the one hand, we’re supposed to fear doctors declining to care for Medicare patients because of imagined deep cuts in payments made to doctors under the President’s plan. While on the other hand, you want us to believe that some doctors might actually be willing to accept an even lower payment from a patient who finds private insurance that costs the patient less than Medicare. That’s just more GOP fuzzy math. I guess that will be splained to us in one of those two-minute ads by the other white meat. He should make sure to splain how an insurance person will do all this and make the profit he demands and that the government doesn’t. Ain’t gonna happen. Maybe Ryan is assuming that by 2022, 65-year-olds won’t be getting sick, and could buy plans accordingly.
The ACA does indeed find savings through reductions in annual increases in fees-in-service (except to doctors). Ryan’s plan puts more, much more, of costs onto the patient, rather than anything or anyone else. In fact, the CBO estimates that under the Ryan plan in 2022 (the first year vouchers would go into effect) expenditures for a typical 65-year-old would be 40% higher than those expenditures would be under the current Medicare system. That’s not nothin’. That’s throwing the typical 65-year-old out of the doctor’s office, out of the hospital, out of the nursing home. Under the Ryan plan, again, according to CBO estimates, that same patient will pay more than double what he would pay under Medicare.
In 2022 under current Medicare: gov’t pays $8600/ patient pays $6150.
In 2022 under Ryan Plan: gov’t pays $8000/ patient pays $12,500
But, of course, under the Ryan plan, the age of eligibility would be raised from 65 to 67, so even these numbers are skewed to hide further harm to seniors. And notice that overall costs are much higher under the Ryan plan, to the tune of $5750 more. The huge difference here is that Ryan doesn’t go after total health care cost savings. He merely goes after making the patient pay more. The government saves a mere $600, while the patient pays $6400 more. The President’s plan actually finds savings for both the government and the patient, a real life, bona fide win-win.
And perhaps one or two of those two-minute ads could be dedicated to why a Ryan plan would eliminate taxes on capital gains, interest and dividends. That would mean that Romney would have paid .82% in taxes, due to his earnings as an author and in speaking fees in 2010. He would owe no other taxes for that year. Who knows,besides John McCain, what he owe for any other year. (The second two-minute ad I suggested could be spent walking that one back and apologizing to the American people for thinking us so stupid as to support such tax proposals.)
But wait, don’t those kinds of tax loopholes help the rich create jobs? No, they sure don’t. Take Romney, for example. His hundreds of millions are in off-shore accounts, creating zero jobs for Americans, except that maybe there are some expatriated Americans working as bank security guards. Yes, I’m sure that must right.
August 14th, 2012 | 8:23 am
Dan, just a thought, maybe I don’t understand. But doesn’t Ryan
‘s plan A) allow one to keep the current medicare plan B) give you a choice on insurance plans? If you choose an insurance plan that costs you less, does that actually mean that the doctor gets less? If that were true, what doctor would take any but the most expensive plan?
Did the CBO estimate break down the average cost among poor vs. richer seniors? Ryan mentions that poorer seniors would be pay less and the richer ones more… any one know how that actually plays out?
I mean, CBO estimates are notoriously hit or miss in general, so maybe they are missing the costs that are saved by creating incentives to economize? Not to mention that if the debt crashes us, were pretty hosed anyway?
Also, I don’t really trust a single board of 15 guys to have enough information as compared to the information that is spread out among all health providers and patients trying to economize….but maybe I am ignorant here.
August 14th, 2012 | 8:25 am
Also, I doubt that Romney’s money would come back to the U.S. if the taxes on them got higher.
Capital gains etc. serve as incentives that spur even the very selfish to create jobs in the U.S. and keep there money here…I don’t see how raising the taxes is going to make them more virtuous and want to handle their money they way you’d like them to…
August 14th, 2012 | 10:35 am
Jy, good questions.
Having an insurance plan that costs less does not necessarily mean the doctor would receive less in payment. It could also mean that the patient receives less coverage. That was what I meant about comparing apples to apples. Insurance companies already offer plans which appear to cost less than other plans. However, the patient/customer often finds out much too late, like at the time to pay his bill, that his plan doesn’t cover his needs.
Worse still, most, if not all, insurance companies already violate policies’ terms by denying payments for coverages which are clearly spelled out in their plans. This is done for the simple fact that insurance companies know, from experience, that there is quite a high percentage of customers who will tire of the appeal process, won’t sue the company, and will just go ahead and either pay a bill or refuse treatment. Now there’e another win-win for the insurance companies. They get paid for coverage they refuse to provide. It’s a lose-lose for the patient. They pay for coverage they don’t receive.
The CBO, at least in the information that I read, uses the phrase “typical 65 year-old.” I would take that as an average person, with an average income. The CBO, like any other entity, can only estimate about the future and what a change in policy might bring. But they have great advantages over others, in that they have the resources needed, including the particulars of both the Ryan plan and the President’s plan, and the particulars of the ACA. They also make these kinds of estimates for a living, and as much as any of us might like to deny it, they are as non-partisan as we’ll find.
Medicare already has a board that sets pricing on fees-in-service. Doctors are the key members on that board. I trust doctors much more than I do insurance companies where it comes to anything. But this board is all about helping Medicare recipients receive quality care, and that includes making sure that care providers are getting paid enough to continue providing services, not the other way around.
As for Romney’s money coming home, raising his taxes on his money before it leaves the U.S. should be the aim. He and many others have more incentive to send their money off-shore where it helps create no jobs than they do to keep it here and create jobs. Incidently, there is not an ounce of proof to support the idea that the trickle-down theory creates more jobs. However, what has proven to create by far the most jobs is an economy in which more money is being spent by more people. That only occurs when more people have more money in their pockets. And that only occurs when more people are paid more in salary and wages.
We’re not going to reduce our debt without growing the middle class. We are not going to reduce our debt by allowing the very rich to pay .82% in taxes, which is part of the Ryan plan. We are not going to reduce our debt or grow our economy by raising taxes on eveyone else. That’s exactly what the Ryan plan does. And it further requires more money from the average person’s pocket to pay for things like Medicare. It’s a plan that would crush the middle class, not save it. It’s a plan that would devastate our economy. It’s asinine to float such a plan out there and expect the public to elect the author of it.
August 14th, 2012 | 12:25 pm
Daniel, let’s take it a few things at a time,
“Republicans can’t seem to decide whether the President’s proposal would cut $500 billion from Medicare, as Romney asserted last week or $700 billion, as RNC chair Priebus asserted on Sunday.”
The most recent CBO estimate of Obamcare’s Medicare cuts is $716 billion.
http://www.forbes.com/sites/aroy/2012/08/13/yes-obamacare-cuts-medicare-more-than-president-romney-would/
“Spending cuts will also be realized by cutting fraud” Actually, on planet Earth, Obamacare cuts payments to hospitals. https://www.sdaho.org/index.php?option=com_content&task=view&id=449&Itemid=650
I thought the funniest thing I’d heard in years was when Gingrich said he was going to solve the Medicare problem (more or less) by cutting fraud. But now hearing it from partisans of the Solyndra administration makes it even funnier! Good times.
“Ryan supporters, including Pete, have asserted that a person opting out of Medicare would possibly be able to find a private plan which would actually cost him less than would care under Medicare. Anything is possible, but the probability here wouldn’t be worth calculating, at least not for similar coverage (apples to apples and all that).”
I take it you mean “the probability here wouldn’t be worth calculating” to actually mean “very likely.” Sort of like how “bad” meant “good” in the later 1980s.
http://www.nationalreview.com/agenda/313243/new-estimate-potential-impact-competitive-bidding-medicare-expenditures-reihan-salam
In any case, under a Romney-Wyden-style plan, if FFS Medicare is the lowest bidder for services at the same price to recipients, the premium support would cover…FFS Medicare. And it would fund it at the exact same level as Obama’s latest budget. Though as James Capretta has pointed out elsewhere, US health care is regionalized and there will likely be places (especially rural areas) where FFS is the low bid. The Ryan-Wyden approach adjusts the premium support for region and health status.
“On the one hand, we’re supposed to fear doctors declining to care for Medicare patients because of imagined deep cuts in payments made to doctors under the President’s plan. While on the other hand, you want us to believe that some doctors might actually be willing to accept an even lower payment from a patient who finds private insurance that costs the patient less than Medicare.”
This assumes that health care delivery is so close to optimal, that the only way to improve efficiency is for a single third party payer to impose across-the-board reimbursement cuts to all providers while leaving no price signals that would steer consumers to higher productivity networks. There is reason to doubt this proposition:
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande?currentPage=all?currentPage=all
http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/
“In fact, the CBO estimates that under the Ryan plan in 2022 (the first year vouchers would go into effect) expenditures for a typical 65-year-old would be 40% higher than those expenditures would be under the current Medicare system.”
Those numbers do not take into account either the Medicare cuts that Obama proposed this year or this year’s Ryan budget with higher Medicare spending. It is 2012, your numbers are out of date, President Obama is now for SSM and the Giants won the Super Bowl. So let us spell this out one more time: The Ryan plan, at the very worst case scenario, spends as much on Medicare FFS as does the Obama budget.
http://www.forbes.com/sites/aroy/2012/03/20/paul-ryans-new-and-improved-plan-for-medicare-and-medicaid-reform/
I can see why you want to rely on stale talking points.
http://www.businessinsider.com/paul-ryan-romney-medicare-plans-budget-2012-8
If I were a partisan of the incumbent, I would focus my criticisms on the recent Ryan budget’s cuts to domestic discretionary spending in the out years. That is problematic – though not as problematic as Obama’s budget plan to raise taxes, centrally cut Medicare, and still go bankrupt by the middle years of the next decade (or more likely come back for even more tax increases after the election.
August 14th, 2012 | 1:31 pm
Dan
So I am still left wondering how the average money actually breaks down, but with the modifications from the new plan, it may be a moot point. And I still wonder how a board of 15 in DC knows more than many doctors and patients spread throughout the country…
I also believe that even if more costs would in theory be passed down to the average person, the very fact that more of the cost is known to the person would cause less wasteful spending in healthcare, which would benefit everyone.
You also still failed to answer how higher taxes are an incentive for Romney to keep his money here. Also, I am mystified as to how Ryan’s plan increases taxes for everyone…not even the CBO says that…
It is clear to me at this point that Ryan offers a multitude of plans because he is constantly refining them based on knowledge…the point being that he allows his study to dynamically inform his policy proposals…way more than I can say for many politicians, let alone Obama. He is perhaps the most studious member of congress, and probably knows more about these issues than any one in the United States….esp Obama.
August 14th, 2012 | 6:10 pm
[...] about how (and how much) Obama plans to cut Medicare and how Ryan-Wyden-style reform works. They almost can’t overinvest in such a strategy and will very likely under invest. Comments [...]
August 18th, 2012 | 9:13 pm
[...] would be well served to put Ryan on some one or two minute (preferably two minute) ads where he can explain what Romney-Ryan premium support means in 2012. Somebody is going to define the Republican Medicare plan. The best person to do it is Ryan, and [...]
August 19th, 2012 | 3:02 pm
[...] Medicare, they will pick up Ryan’s talking points and learn to speak more effectively. There is a lot to be gained from putting Ryan in two minute ads to explain his current premium suppo… Comments [...]
August 20th, 2012 | 10:29 am
[...] Pete Spiliakos wrote shortly after the selection of Ryan was announced: As between the most recent Ryan budget and the [...]
August 21st, 2012 | 12:52 am
[...] The Republican Medicare Equation: The Best Defense = A Good Offense + Lots of Paul Ryan – Pete Spiliakos (Postmodern Conservative believes the best thing the GOP can do to counter Democrat criticism is to let Ryan be Ryan. [...]
August 22nd, 2012 | 8:01 pm
[...] a vehicle for upper-class interest group and white identity politics. That is why I favor, as just one small measure, somewhat longer ads that explain policies in more detail and plain language. It would, for many [...]
September 23rd, 2012 | 7:13 pm
[...] Romney actually has a much stronger case to make against Obama on Obama’s Medicare record and current Medicare proposal, and even on abortion. Romney was actually doing pretty good when the debate was focused on Medicare [...]
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