The news, these days, seems stuck on two storylines: covering the wave of uinrest across the Middle East and breathlessly reporting every minor step in Washington's painful budget process (chances are, that's followed locally by news in your state about the state level budget crises).
If I'm not writing much these days, and especially not much about politics, it's because I think a lot of this budget maneuvering is meaningless. Republicans in the House couldn't get their most extreme cuts past the Senate or signed by the President, and the President's new budget can't pass the House, and most of the speeches and news interviews are posturing with few real suggestions of a workable compromise. If nothing changes, then there's little likelihood of anything getting done. And for now... I'll wait and see what develops, but I don't expect much.
Everybody's got - well every political junkie like me, anyway, all nine of ya - their pet budget issues, and mine, as I've said is healthcare; or in the current language of budget talks 2 of the big 3 "entitlements" of Medicare and Medicaid. Like many on all sides of the budget discussion, I tend to agree that without some attempt to tackle health care costs through these two programs, it's impossible to significantly redue the deficit (you could cut defense spending, another unpopular topic, but you'd stil be stuck). So my test for any seriousness in these discussions of deficit reduction is: how seriously are they planning to reform Medicare or Medicaid?
By that measure, I'd say we're miles, and years, away from any serious or deep change. President Obama's budget did essentially nothing to tackleeither of these problems, and he admitted, basically, that he's not doing anything until Republicans offer a proposal. Republicans haven't offered much, either. John Boehner says he wants to remove President Obama's Medicare cuts from the Affordable Care Act and replace them with other "market based" reforms, and Paul Ryan now says he wants to turn Medicare into a "defined contribution" program, where the government subsidizes private health insurnce for seniors (yes, off in the distance there, you can see "mandate" in the offing), and then a system of "defined payments" for Medicaid, which means block grants to states.
Both are pretty much useless. Boehner's new version of "repeal and replace" is about as unserious as the "cuts" that Democrats have claimed to have enacted, but haven't and likely won't come to pass. Though Dems have cut funding for Medicare Advantage, which allowed some seniors to obtain HMO coverage rather than use traditional Medicare (which matters especially to seniors in rural areas where services may be scarce), Congress already put off, again, reforms to the reimbursement fees to doctors and has no plans to follow through on other cuts. Boehner's "market based" reforms is basically code for restoring the Medicare Advantage money, and some lip service about "waste fraud and abuse" but they have even less stomach for reducing reimbursements, which would be the crux of reforming the healthcare market. So much for "market based."
Ryan's proposal is interesting, but unlikely to amount to much; like much of his "Roadmap", it's a proposal Republicans support until actual hard choices have to be made (remember how they were cutting $100 million from this year's government spending, only to get to about $68?). Ryan's proposal would theoretically take the government out of the "price setting" role it has in healthcare through Medicare's reimbursement rates... but that's illusory because the "defined contribution" role, by its definition, would do the same thing. Also, there's a reason Medicare was started in the first place, and it's because private insurers don't particularly want to insure the oldest and sickest members of our population who require the most and costliest care. Ryan's Medicaid idea is even more fanciful: states alreeady can barley cover Medicaid costs, and that's under a formula that offers some flexibility to get additional federal money. Take even that small cushion away, and you're just making healthcare for poor people that much worse
The main point, though, is that Ryan's proposals - or Boehner's - don't exist as legislation. Indeed, there's no indication that Ryan can write a bill with either proposal that can pass the House - even the Medicaid plan, which might be attractive to the House majority, will elicit howls from state Governors, mainly Republicans - never mind, again, the Senate or the President's desk. Better still, I don't think Ryan can even muster the relatively painful exercise of following through on soke sort of reimbursement reform in Medicare fees (which, by formula, would also affect Medicaid), and that's just basic - a House majority that can't cut costs by, well, cutting them... can't claim seirousness on deficit reduction.
In some sense all this roiling in Washington - and the implicit threat to voters of "don't keep yelling at us to cut something... or we will" - is pretending to make something not hard look very hard and complicated. It would be eay to cut the budget: just stop spending as much. The problem is, a government that actually spends less would be a government doing less, and that, in turn, would make people's lives harder. The math is not the problem... it's the potential results that are where the real pain lies.
Ryan and others are already trying to calim that "political demagoguery" is the problem, as a way to protect themselves from the negative fallout of proposals to cut Medicare or Social Security (remember, no one speaks for the poor, so Medicaid protests won't be heard). The harsher reality is that historically voters have punished Congresses that have cut those programs, and my bet - as many others do - is that voters wouldn't hesitate, in 2012, to do much the same thing. And for now, fear of being punished is really the beginning and end of why nothing has really happened on the budget. I'll wait... but I think we're going to find, in the coming months, that all of the notions of breathess drama and pitched budget battles will end in a muddle of both sides doing very little to reduce spending, or deficits, especially when it comes to the big, painful decisions needed on healthcare. And that's not necessarily good fiscal policy... but given this crop of politicians, I think failure and stasis may be the best result.
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