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The Ryan Plan’s Political Problem

I have been meaning to write about the Ryan Plan for days, but have not gotten around to it (although, in general, I think that both James Fallows and Michael Kinsely are largely on target).  This post is less about the plan itself than about the politics of the plan.

To wit, a question:  how likely is the plan to pass the House? (Heck, will it even come to a floor vote?)  In other words:  all the rhetoric of superlatives aside, are Republicans in the House willing to pass the plan?

I am pondering this issue because I am wondering if a majority of House Republicans are going to be willing to go on record for a plan that will end Medicare as we know it.  Yes, there are many in the Republican base, especially the Tea Party faction, that are currently quite passionate about the plan.  However, with the 2012 elections around the corner, how willing are individual members of the House to go home and campaign for reelection after having voted to utterly transform Medicare?  Worse, since even if the given member believed in the Ryan Plan they know that it will never pass the Senate (let alone survive the veto pen if it did).  As such:  why go home and risk the wrath of constituents over Medicare when the whole thing is a legislative dead end?

Remember:  we know that some attendees of Tea Party rallies have brandished signs demanding that the government keep its hands off Medicare.*  Further, many Republicans ran for office in 2010 by campaigning on the notion that the PPACA was damaging to Medicare (for example:Coates Ad: Obama Forcing Seniors into “Government Run Healthcare” and Blunt Ad Complains of Cutting Medicare…to Support “Government-Run Health Care”).

Remember also (and more importantly):  the public overwhelmingly opposes Medicare cuts:  “76% of respondents oppose cutting Medicare (30% find it “unacceptable” and 46% find it “totally unacceptable”)” (see link for details on the given poll—which replicates a consistent result in poll after poll on this topic).

So again:  will the GOP actually go to the mattresses for this plan?

I have my doubts.

Along these lines, I would recommend the following from Charlie Cook:  Death Wish?

One of the biggest and most frequent mistakes in politics is for a party to misread its mandate. When it happens, independent and swing voters get angry and punish a candidate or a party on Election Day. Because American politics is a zero-sum game, punishing one party means rewarding the other party—even when the latter is not necessarily deserving of support. Frequently, the party that benefits from the spanking mistakenly interprets it to mean that the public is embracing every aspect of its agenda. Republicans shouldn’t forget that their party had dismal favorable/unfavorable poll ratings last fall. They won because they weren’t Democrats.

There is no question that the Republican base, conservatives, and supporters of the tea party want to take a meat ax to government spending. When Republican congressional members return home and meet with their constituents, they are encouraged to vote against continuing resolutions and for deep spending cuts. These supporters have intensity, and they adamantly oppose any compromise with Democrats.

It would be a blunder, however, to think that such views drove the election. Republicans, conservatives, and tea partiers did not throw Republicans out of their House and Senate majorities in 2006, and they did not vote to increase the size of the Democratic majorities and elect Barack Obama president in 2008.

Independent voters were the ones who cast their ballots for Democrats by an 18-point margin in 2006 because they were mad at President Bush and upset about the war in Iraq, not to mention Republican scandals and the general performance of the GOP Congress. Two years later, these same voters were still angry at the president, were afraid of the financial crisis, and didn’t care for GOP presidential nominee John McCain.

In 2010, these independent voters were unimpressed by the economic-stimulus package, didn’t like cap-and-trade environmental regulation, and really didn’t like the Democratic health care package. Those over or approaching 65 years of age also feared that health care reform would erode Medicare benefits. Even those unaffected by the reforms rallied to defend Medicare.

It will be interesting to see how the 2012 campaign, both for Congress and for the Republican nomination, shapes up on this issue.——-

*Those signs always make me think of episodes of the original Star Trek wherein Kirk would make a computer self-destruct by introducing a severe bout of logical contradiction (off the top of my head:  Norman the android, the M-5, and Landru).  Really, going to a rally to argue that the government ought to get its hands off of Medicare ought to result in something like this:  click (especially at the 1:21 moment onward).

Related Posts:

About Steven L. Taylor
Steven L. Taylor is Professor and Chair of Political Science at Troy University. His main areas of expertise include parties, elections, and the institutional design of democracies. He is the author of Voting Amid Violence: Electoral Democracy in Colombia and is currently working on a comparative study of the US to 29 other democracies. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging at PoliBlog since 2003. Follow Steven on Twitter

Comments

  1. steveegg says:

    The shorter explanation – We have passed the tipping point of looters outnumbering the producers.

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  2. [...] The Ryan Plan’s Political Problem [...]

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  3. Jack says:

    Heh, I enjoy the Star Trek reference.

    By the way, cognitive dissidence requires cognition to exist in the first place. Draw your own conclusions using your cognitive powers.

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  4. michael reynolds says:

    Yep, that’s what I take from it, too, Steveggg with the Manly Man of Money avatar. It’s the end! The looters are taking my stuff. I won’t have any stuff left soon. Damn you Morlocks! Damn you, untermenschen! Get off my mighty shoulders or I’ll shrug you off!

    In other news, I snuck onto the NYT list for kid series again. Barely, but I’ll take it. In July we’re moving to Marin county because there’s a great private school for our daughter.

    Now, where were we? Oh, yeah: damned looters!

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  5. jwest says:

    It’s always difficult to bring about change, but if a medical safety net for senior citizens is going to be available to those currently under 55, politicians with courage need to tell the truth to people.

    Naturally, the issue will be demagogued by those whose only motivation is to be elected, but it may prove harder than some think to face the questions in a debate over what the answer is. Conservatives have been getting better at framing their message.

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  6. ponce says:

    “In a PPP poll released Tuesday, 43% of voters said Republicans are doing a worse job running the House than Democrats did before being ousted in last year’s midterms. Meanwhile, 36% said Republicans were doing a better job than their counterparts, and an additional 19% said things are about the same.

    The poll also found that a plurality of voters (48%) now say the Republican party is “extremist,” while 40% say the party is mainstream. ”

    http://tinyurl.com/3fw5be2

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  7. wr says:

    I saw conservative Marsha Blackburn “framing the message” on Hardball yesterday — she claimed that killing Medicare and giving seniors a voucher and a pat on the head while telling them to find health coverage from the private market was “giving seniors a choice. And seniors love choice!”

    It was all Chris Matthews could do to keep from bursting into giggles at the stupidity. And he kept giving her chance after chance to reframe this inanity in a way anyone over the age of three — or who wasn’t a TPer — would believe. She kept bragging about the great menu of choices the Republicans were putting forward.

    Yeah, the framing is great.

    Also great: Ryan’s response to Obama’s speech. “He was mean to me! Waaah!”

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  8. hey norm says:

    I promised myself I would not bother again but I cannot resist:
    JW…
    How does putting a retiree into the private insurance market with a voucher that is specifically designed NOT to keep pace with the rate of health care inflation “…a medical safety net for senior citizens is going to be available to those currently under 55…”.
    Before you answer keep in mind that Ryan’s Tea Bag Manifesto also repeals, but does not replace, the ACA which as we all know prohibits denying insurance based on pre-existing conditions or dropping people that develop serious illness.
    So under your vision of a medical safety net Seniors will have to purchase private insurance from companies who are free to deny them coverage or drop them at their whim, and purchase that insurance with money that will continue to shrink as they get older and predictably have greater needs and fewer resources.
    Just exactly does that work?
    Go.

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  9. hey norm says:

    wr:
    Ryan is just not used to anyone calling him on his BS. He has been coddled by the so-called republican establishment, the pundits, and the media. The spoiled midwestern frat boy couldn’t figure it out what was going on…he was lost…in uncharted territory. So he did what spoiled midwestern frat boys do…he whined.

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  10. hey norm says:

    Also JW – while you are at it…
    Why, if Ryan’s Tea Bag Manifestio is so great, are we going to wait ten years to enact it. Why not just do it now?
    I await your answers.

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  11. michael reynolds says:

    People who complain about Obama’s counterpunching style should take a moment to appreciate how neatly this was done.

    Getting Ryan to basically call for ending Medicare and throwing granny onto the tender mercies of an unregulated health insurance industry so that millionaires can get tax breaks? Priceless.

    Now the smug little twit is on the canvas blinking up at the bright lights and wondering what hit him.

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  12. hey norm says:

    not to hog the blog as it were…but I would love to see the CBO analysis of Ryan’s Manestio.
    http://macroadvisers.blogspot.com/2011/04/economic-effects-of-ryan-plan-assuming.html

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  13. mantis says:

    It’s always difficult to bring about change, but if a medical safety net for senior citizens is going to be available to those currently under 55, politicians with courage need to tell the truth to people. it will be despite the Republicans efforts to make sure it disappears.

    Fixed that for you.

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  14. mantis says:

    We have passed the tipping point of looters outnumbering the producers.

    So when I pay into Medicare every two weeks through my paycheck, I’m looting?

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  15. anjin-san says:

    Martis… your photo should be on the wall at the post office

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  16. Max Lybbert says:

    I am pondering this issue because I am wondering if a majority of House Republicans are going to be willing to go on record for a plan that will end Medicare as we know it.

    The truth is that Medicare as we know it is going to end. There is simply no way around that ( http://www.coyoteblog.com/coyote_blog/2011/04/if-social-security-were-medicare.html ). President Obama’s proposal is to have IPAB reduce reimbursement rates. Reductions in reimbursement rates today mean that many doctors are turning away Medicare patients. More reductions will only accelerate that trend.

    Before the budget fight started, Republicans said that they would give President Obama political cover if he took on entitlement spending. He chose not to at the time. His own budget commission proposed taking on entitlement spending because it’s the largest piece of the budget pie by far. He chose not to. Yesterday he proposed a new budget commission.

    What I find interesting is that although I expected entitlement reform to be a lightning rod, by bringing up the problem and by pointing out the dithering at the White House, Republicans appear to have stolen a march on the President. I expect that voting for the Ryan Plan will be a huge asset next year, compared to voting for ObamaCare’s overhaul of Medicare was a huge liability last year. We’ll have to see how it plays out.

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  17. packeryman says:

    This is a ridiculous plan presented by Ryan bringing about the destruction of Medicare. Issuing vouchers to the elderly would put those with pre-existing conditions(nearly all, most don’t develop serious health care problems until up in age)not being able to purchase insurance. Most don’t have the extra money needed for such a plan. This would leave the elderly at the mercy of the parasitic insurance industry. What congress needs to do is put SS and Medicare back in a lock box so politicians can’t steal it for foreign wars, occupations and foreign aid, Then lift the caps on salaries on SS/Medicare and tax on all income.Increase by 1% the levy on SS/Medicare on employee and employer and there would never be another problem. The fight would be over, ended.

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  18. Gerry W. says:

    It is always a one trick pony with the republicans. Cut everything out and have tax cuts for the rich. The middle class lost jobs, now it is SS and Medicare, unions, the safety net, food and water inspections, and the infrastructure. While cuts need to be made, you have to pander to the middle class in which they threw under the bus. Democrats may be dumb, but why would I vote for a bunch of right wing nuts! Years of tax cuts, lost jobs, failed ideology, religion, guns, and God and country. Hilarious.

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  19. jwest says:

    Liberals seem to have a problem conceiving of a time when there are not enough “rich” people to carry the load for everyone else.

    The Medicare system is heading quickly into bankruptcy. Something must be done to alter the system to make it sustainable. Is Ryan’s plan the one I would pick? No. However, it is the only plan that is politically viable at this moment.

    As I have said before, the ideal system for everyone from birth to death is a combination of Health Savings Accounts (HSAs) to provide direct payment from the individual to the provider for all normally anticipated health care needs coupled with a government-run, single payer system for catastrophic care. The reason I believe in the government run single payer system is that the government is the only entity that can impose the decisions of the Death Panel concerning cutoff points for treatment.

    If everyone is in agreement with me, we can scrap the Ryan plan tomorrow.

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  20. wr says:

    jwest — Believe or not, rich people don’t seem to be an endangered species in this country. In fact, they’ve been doing better and better over the last decade. So if your appeal to reason depends on our fear that the top 1%, who currently own something like 40% of this country, are going to dwindle into nothingness, you’re going to have a hard time convincing anyone with a brain.

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  21. hey norm says:

    JW…poor poor JW…an effective tax rate in the mid teens is not the rich carrying everyone else by any stretch of the imagination. Wherever do you get these ideas from?
    You think Ryan’s plan is politically viable? Really? (I think that’s the point of this post.) I bet it doesn’t ever get out of committee. How many so-called republicans do you think are going to vote to abolish Medicare? Once the CBO scores it and we see how ridiculous it really is it’s only going to get worse.
    Medicare is not the problem. Health care costs are the problem. Ryan’s Manifestio does absolutely nothing to contain costs. (Except of course passing the cost onto seniors.) Obama’s plan builds on good ideas for cost containment already in the ACA – which Ryan wants to abolish. Note: many of these good ideas are conservative in nature, given that the ACA is a conservative piece of legislation.
    HSA’s actually are a very inefficient delivery method. So no – I’m not in agreement.

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  22. Max Lybbert says:

    Once the CBO scores [Paul Ryan's proposal] and we see how ridiculous it really is it’s only going to get worse.

    If nothing is done, Medicare will abolish itself (that is the definition of “unsustainable”). By letting the Republicans go first, President Obama has allowed Medicare’s unsustainability to be the headline. When the CBO scores Ryan’s proposal, the President Obama’s proposal, and the status quo, and any other proposal made, Medicare’s unsustainability will become even more obvious. When the Medicare Trustees say that Medicare is unsustainable, that will show up on the front page of every major newspaper. Right next to the articles about our record-breaking debt.

    How will this help President Obama or hurt the Republicans?

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  23. Hey Norm says:

    “If nothing is done, Medicare will abolish itself ”
    Ok so we’ll just abolish it instead of fixing it. Makes sense.

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  24. Fog says:

    Max:
    One of the unspoken assumptions in your argument (Medicare is unsustainable) is that health care in the US is as efficient as it can be, so reform won’t be able to save money and is therefore pointless. In fact, our system is not so efficient compared to other countries. The ACA is at least a first step at trying to remedy that.
    Also, Some (non-libertarian) Americans think we ought to take care of our own. Period.

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  25. packeryman says:

    Medicare is not the problem, it is the cost pushed by the insurance industry and big pharma. Until this system craters as it will due to the fact more and more employers will stop offering medical care and more will go on the free system ,we reach a point of no return. The sooner the better. The only system that will work is a single payer one with the parasitic insurance industry that offers the system nothing out of it. The parasites suck out over 500 billion for nothing. We would no longer need workmens compt, Medicade, Medicare. It would all be under one system. Those who oppose say the government would become the death panel, Who do they think does it now? The insurance industry. Wake up America the far right nuts in the Republican party(religious freaks and teabaggers)are selling us along with the insurance industry and big pharma that the insurance controlled healthcare industry is best for us. Take a look at the rest of the western world. All are covered and they like their health care systems no matter what kind of proproganda the insurance industry, big pharma and the far right in the Republican party put out.

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  26. Tlaloc says:

    I think the problem with Ryan’s plan can best be summed up with a scene from BlackAdder 4:

    Private Baldrick: No, the thing is: The way I see it, these days there’s a war on, right? and, ages ago, there wasn’t a war on, right? So, there must have been a moment when there not being a war on went away, right? and there being a war on came along. So, what I want to know is: How did we get from the one case of affairs to the other case of affairs?
    Captain Blackadder: Do you mean “How did the war start?”
    Lieutenant George: The war started because of the vile Hun and his villainous empire- building.
    Captain Blackadder: George, the British Empire at present covers a quarter of the globe, while the German Empire consists of a small sausage factory in Tanganiki. I hardly think that we can be entirely absolved of blame on the imperialistic front.
    Lieutenant George: Oh, no, sir, absolutely not.
    [aside, to Baldrick]
    Lieutenant George: Mad as a bicycle!
    Private Baldrick: I heard that it started when a bloke called Archie Duke shot an ostrich ’cause he was hungry.
    Captain Blackadder: I think you mean it started when the Archduke of Austro-Hungary got shot.
    Private Baldrick: Nah, there was definitely an ostrich involved, sir.
    Captain Blackadder: Well, possibly. But the real reason for the whole thing was that it was too much effort not to have a war.
    Lieutenant George: By Gum, this is interesting. I always loved history. The Battle of Hastings, Henry VIII and his six knives, all that.
    Captain Blackadder: You see, Baldrick, in order to prevent war in Europe, two superblocs developed: us, the French and the Russians on one side, and the Germans and Austro-Hungary on the other. The idea was to have two vast opposing armies, each acting as the other’s deterrent. That way there could never be a war.
    Private Baldrick: But, this is a sort of a war, isn’t it, sir?
    Captain Blackadder: Yes, that’s right. You see, there was a tiny flaw in the plan.
    Private Baldrick: What was that, sir?
    Captain Blackadder: It was bollocks.

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  27. An Interested Party says:

    However, it is the only plan that is politically viable at this moment.

    Hahahahaha…outside of those that live in Ayn Rand Land, who else considers the Ryan Plan “politically viable”?

    How will this help President Obama or hurt the Republicans?

    Because those same people who oppose cutting Medicare will want it to be modified to be saved rather than to be abolished…

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  28. john personna says:

    jwest, people under 55 have a Medicare pan in place. You are doing a future-Baldrick when you assume there is a point in the future where it will be taken away, cease to be.

    But .. if the current Medicare needs help, why not means testing?

    Are people who can afford to pay (perhaps some) of their Medicare ready to go to the nuclear option, and take away from those who have no way in hell of paying?

    BTW, this chart of top marginal tax rates is new.

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  29. michael reynolds says:

    How will this help President Obama or hurt the Republicans?

    Because people will say, “How can we save Medicare?

    And someone will say, “By letting the top tax bracket return to where it was when Bill Clinton was in office and we had record prosperity.”

    And then people will say, “Oh. Okay.”

    It’s only hard to understand if you’re a Republican.

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  30. Dazedandconfused says:

    I saw that Ryan was shocked, absolutely shocked, at the people that say that his plan is not politically viable. He flat out said that his plan is a “political winner”.

    The man is a true believer, I have no longer any doubts that he sincerely believes that, and in his plan. Been reading too much Ayn Rand, is my guess.

    I actually doubt he would understand the joke here:

    http://www.youtube.com/watch?v=rYqF_BtIwAU&feature=player_embedded

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  31. Tlaloc says:

    He flat out said that his plan is a “political winner”.

    Funny thing about third rails- the people with the most experience with them aren’t around to pass on that experience.

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  32. [...] The Ryan Plan’s Political Problem.  outsidethebeltway.com [...]

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  33. packeryman says:

    Ask anyone who uses Medicare and they will tell you it works perfectly. Their supplemental insurance doesn’t pay on time, they have to call about it all the time. Walk into any cardiologist office and you will find 99% are the elderly on Medicare. These doctors are making hundreds of thousands a year. They are not hurting. Ryans plan is a disaster for the elderly. I hope they rise up and throw out all tea baggers in 2012.

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  34. sam says:

    @Max:

    “I expect that voting for the Ryan Plan will be a huge asset next year, compared to voting for ObamaCare’s overhaul of Medicare was a huge liability last year”

    As you say, we shall see. But all the Dems have to do is point out the math: For every dollar cut in Medicare under Ryan, one dollar in tax breaks is given to those at the top. Now, if you think that’s a winning combo, well, OK then. But I trust you will forgive those of us who think it’s politically nuts.

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  35. Pug says:

    The shorter explanation – We have passed the tipping point of looters outnumbering the producers.

    Manly man steveegg thinks his mother and father and the Marine corporal in Afghanistan are “looters”.

    He, on the other hand, is a heroic Randian “producer”.

    Is there anyone more self-centered and childish than a libertarian?

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  36. jukeboxgrad says:

    taylor:

    we know that some attendees of Tea Party rallies have brandished signs demanding that the government keep its hands off Medicare

    Yes, and don’t forget what Laffer said:

    If you like the Post Office and the Department of Motor Vehicles and you think they’re run well, just wait till you see Medicare, Medicaid, and health care done by the government.

    http://krugman.blogs.nytimes.com/2009/08/07/what-did-laffer-mean/

    packeryman:

    Ask anyone who uses Medicare and they will tell you it works perfectly.

    This is a key point. Notice what Krugman said:

    Right now, right-wingers do not, repeat, do not want people to understand that Medicare is the prime example of that dreaded condition, “government-run health care”; because if people understood that, they might think that government-run care is actually pretty good.

    Ryan’s plan now creates a great opportunity for the Dems to point out this: what the GOP really wants is Medicare for no one, and what the Dems really want is Medicare for everyone.
    =============
    The people who think Ryan should be taken seriously as a fiscal hawk need to explain why he voted for Bush’s Medicare Prescription Drug, Improvement, and Modernization Act, which “added $15.5 trillion (in present value terms) to our nation’s indebtedness.” Which is a helpful reminder that the GOP is in favor of small government except when the GOP is in charge of government.

    If the press was not lazy and stupid, they would ask him how he feels about that vote.

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  37. Barry says:

    steveegg: “We have passed the tipping point of looters outnumbering the producers.”

    mantis: “So when I pay into Medicare every two weeks through my paycheck, I’m looting?”

    Only if you expect something back. Meanwhile, elites destroy the economy and profit from it, but Rand loves them, so it’s OK.

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  38. thc says:

    Ryan’s plan provides a much-needed starting point for negociation, leadership that the Senate and the White House have failed to demonstrate. Will it pass in its present form? Of course not, but conservatives cannot afford the accusations of not offering any solutions.

    Re: Medicare. It surprises me you even mention the polls. Of course most Americans don’t want to see cuts. I don’t want to see cuts. Fact is, it is unsustainable in its present form–it’s simple demographics. The sooner it is overhauled, the better.

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  39. john personna says:

    @the, the problem with Ryan’s Medicare “solution” is that it punts. It doesn’t try to help those who need it. It just reduces benefits for everyone under 55.

    Should I ask how old you are? ;-)

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  40. Steve Verdon says:

    Because people will say, “How can we save Medicare?

    And someone will say, “By letting the top tax bracket return to where it was when Bill Clinton was in office and we had record prosperity.”

    And then people will say, “Oh. Okay.”

    It’s only hard to understand if you’re a Republican.

    This wont save Medicare/Medicaid. Not by a long shot. It might extend the life of program a few months/years depending on the economy but that is it. Economic growth wont save it either unless you believe in magic (i.e. sustained 6-7% economic growth).

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  41. thc says:

    JP–I’m not defending the Ryan plan per se but I am saying that something has to be done with Medicare–it is totally unsustainable in present form.

    I’m a mostly-retired Certified Financial Planner and I have extensive real-world experience with seniors and Medicare. I “retired” two years ago at 51 and, not being eliegible for Medicare for another 12 years, I pay our health insurance premiums completely out of pocket. I hope that provides you enough pertinent background on me.

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  42. john personna says:

    @the, I’m in a similar boat, and I’d say what we should get in 12 years should depend on how well our finances hold up over that time. I don’t find Ryan’s starting point useful at all, because as I say, it reduces across the board.

    BTW, I think Matt Yglesias does well by taking Ryan’s plan one step further. If you are going to fixed price (and not defined coverage) vouchers, just hand out cash.

    But again, does it make sense to give the rich and the poor equal cash?

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  43. michael reynolds says:

    Steve V:

    No, I don’t believe in magic. But neither do I believe that a trend line necessarily continues in the same direction at the same velocity.

    When I was 15 I was taken in by the zero population growth people. Since then I’ve remained skeptical of prophecies of doom that rest on the assumption that things will continue as they have, without evolution or revolution or even simple adaptation.

    Let me add that taken far enough into the future nothing is sustainable. You could have drawn up a graph in 1860 that would show the entire United States covered by railroads by this time.

    As a political matter if you tell people that letting the tax cuts expire will kick the problem down the road for 5 or 10 years? That’s a political winner.

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  44. mantis says:

    But again, does it make sense to give the rich and the poor equal cash?

    Obviously not. The rich should get more. Lots more. Come to think of it, the poor should get nothing. They should just die.

    – Model Republican

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  45. Steve Verdon says:

    Michael,

    Yeah, I know what you are saying. However, in looking at the underlying drivers behind the trend I think they point to high growth…growth above the growth rate of the overall economy. The combination of things like increasing life expectancies, number of elderly, lower population growth, and desire for the latest treatments all add up to unpleasant numbers. Are they written in stone? No. Could everything work out just fine if left alone? Sure, but I’d argue it is an unlikely scenario.

    So, from a policy perspective do we hope for the best and plan for the best…or do we plan for the worst and hope for the best and realize that if things aren’t as bad we can change our policies down the road to better everyone? I prefer the latter. I also think it is the hardest of all the policies to adopt. So much so, that we wont do it and then in 15 – 20 years when things are going off the rails (most likely and I hope not) I wont be disappointed (and I’ll make sure to have plenty of scotch stock piled to make it at least a wee bit less painful for myself).

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  46. Steve Verdon says:

    As a political matter if you tell people that letting the tax cuts expire will kick the problem down the road for 5 or 10 years? That’s a political winner.

    I think that is very optimistic. Still even if it is 1 year, yeah we should do it at this point.

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  47. Steve Verdon says:

    BTW, I think Matt Yglesias does well by taking Ryan’s plan one step further. If you are going to fixed price (and not defined coverage) vouchers, just hand out cash.

    1. I don’t believe the Ryan plan has a fixed price. It is adjusted for inflation at the very least.
    2. Handing out cash means people might opt for no health care coverage.

    So number 2 runs afoul of the desire for everyone to have health care. To achieve that goal some level of coercion is necessary.

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  48. thc says:

    JP: Means testing is fine for Medicaid and welfare but not for Medicare or Social Security because it creates a disincentive for indiviuals to plan for their own futures.

    Mantis: In the future I hope you find something constructive to add.

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  49. hey norm says:

    The Ryan Manifestio is adjusted for inflation. As everyone knows health care inflation is greater than regular old inflation. So the Ryan’s vouchers will become worth less and less as seniors need them more and more.
    TPM has some interesting reporting that Insurance companies want no part of Ryan’s Tea Party Manifesto. Blitely untethered from reality? The Tea Party? Noooo!!!!

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  50. john personna says:

    @Steve, the funny thing is, Yglesias took a page from economic theory. If you are going to aid this segment, then trust them to maximize their utility. This might include healthier food, or as Tyler Cowen points out, medical tourism. (I’m not 100% convinced, but I admire the audacity.)

    @the, obviously incentives can be structured. If you are a financial planner I’m sure you could come up with something yourself. You make “savings + medicare/social-security” better than “savings” or “medicare/social-security” alone. That doesn’t require equal benefits.

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  51. john personna says:

    BTW, when I say “cash” I’m not making the “inflation” argument. I’m saying it makes no guarantee that you can afford any particular procedure at any particular point in time.

    The plan makes no guarantee that the 50-year old cohort will be able to insure for kidney dialysis 20 years from now.

    If I did vouchers, they would be for reimbursement of life-saving procedures, and some prevention.

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  52. thc says:

    As I understand the Ryan plan, it provides for health insurance premium subsidies for seniors. The insured purchases whatever type of policy he/she believes is best suited for their situation. Whether it covers dialysis 20 years down the road depends entirely on the policy the insured selects.

    Many economists believe that one of the primary forces causing health insurance inflation to be greater than overall inflation is the uncompetitive nature of Medicare. Introduce greater competition into healthcare and you reduce the corresponding inflation.

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  53. john personna says:

    Well, it also depends on whether such plans are offered and at what co-pay.

    Don’t assume premium vouchers will cover.

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  54. john personna says:

    An alternate story line is that vouchers are a rent.

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  55. @thc:

    The insured purchases whatever type of policy he/she believes is best suited for their situation. Whether it covers dialysis 20 years down the road depends entirely on the policy the insured selects.

    But this gets to the fundamental problem: how can we know what coverage we are best suited for? What if I purchase one that will not cover dialysis and then, a few years later, discover that, in fact, I need dialysis. What then?

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  56. Davebo says:

    What if I purchase one that will not cover dialysis and then, a few years later, discover that, in fact, I need dialysis. What then?

    You either:

    A: Bankrupt yourselves and your family or

    B: Die

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  57. Taiko Drum says:

    What if I purchase one that will not cover dialysis and then, a few years later, discover that, in fact, I need dialysis. What then?

    You either:

    A: Bankrupt yourselves and your family or

    B: Die

    I don’t think either. IMHO, we will create some new program which will subsidize these kind of situations with taxpayer money.

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  58. [...] Goddard notes a Democracy Corps poll that is reflection of what I was discussing yesterday concerning the Ryan [...]

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  59. Moosebreath says:

    “IMHO, we will create some new program which will subsidize these kind of situations with taxpayer money.”

    And your reason for thinking that the current crop of Randians who control the Republican party would do this, rather than reducing taxes on the rich even further is…?

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  60. john personna says:

    What I think I heard from the economist guest on Morning Joe was that our share of this new Medicare is predicted to be 65% “in out years.” That’s another reason to keep driving the Prius I guess … but it begs the question of what happens to those who don’t have the 65%.

    Steven, you’ve skipped out to a corner case (people who choose bad or wrong insurance) and missed what may be the general case … that the insurance you can buy for straight-voucher will likely be very meager, and millions of people won’t have more to kick in.

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  61. @JP:

    Steven, you’ve skipped out to a corner case (people who choose bad or wrong insurance) and missed what may be the general case … that the insurance you can buy for straight-voucher will likely be very meager, and millions of people won’t have more to kick in.

    That was a specific response to thc’s comment. I concur with your general assessment.

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  62. yetanotherjohn says:

    Answer is Yes, 235 – 193. Now what happens if the house sticks to it’s guns and the senate and Obama have the choice of the Ryan bill or nothing (no appropriations, no CR, etc).

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  63. Taiko Drum says:

    “And your reason for thinking that the current crop of Randians who control the Republican party would do this, rather than reducing taxes on the rich even further is…?”

    Good point, but who says that the current political make-up will remain static in the future when this problem will start raising it’s ugly head? I’m under the impression that the voucher recipient gets to pocket whatever portion of the voucher they don’t spend on health insurance. Please correct me if I’m wrong. If that’s true, then human nature being what it is, at least a significant percentage will “underinsure” themselves by underestimating their possible future medical needs, honestly not knowing future medical needs despite best intentions or just plain greed. These people will vote and I don’t think our society has devolved to the point where we are willing to see significant numbers of seniors die due to lack of medical insurance/ability to pay (although sometimes I wonder). Therefore, enter new program. If the current crop of Republicans are still in office then, I don’t see why they won’t just default to tax breaks for the rich and a new entitlement program. I mean, the tax cuts will spur enough growth to cover the new program right? :)

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  64. thc says:

    JP:

    Well, it also depends on whether such plans are offered and at what co-pay.

    Don’t assume premium vouchers will cover.

    That’s exactly the point! Premium subsidies shouldn’t cover the entire premium. Higher coverage and lower copays are more expensive. The insured HAS to have some skin in the game. That’s the whole problem with the current system. The Medicare patient has no incentive to seek value!

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  65. john personna says:

    @the, there has to be some middle ground. The Ryan plan as it now stands puts more than skin in the game. It puts in heart, lungs, kidneys. And if you can’t cover your 65% share, you are out of luck.

    Sure, an open ended plan has open ended costs, but do we really need to ration care so aggressively and with such a heavy hand?

    How is this plan defensible, in a moral sense? Does it give to those most in need?

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  66. john personna says:

    Again, to thumb-nail it, the terrible thing about this plan is that it takes from the rich and takes from the poor equally, and assumes they both can equally afford it.

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  67. jukeboxgrad says:

    “The law, in its majestic equality, forbids rich and poor alike to sleep under bridges, to beg in the streets, and to steal their bread.”

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  68. thc says:

    Steven L. Taylor:

    But this gets to the fundamental problem: how can we know what coverage we are best suited for? What if I purchase one that will not cover dialysis and then, a few years later, discover that, in fact, I need dialysis. What then?

    Buying health insurance with a government premium subsidy at 65 isn’t any different that choosing a policy at any other age. You have to make an informed choice. Haven’t you ever made insurance decisions? The whole idea of insurance is to cover unexpected health problems. If you make a bad decision there are consequences. We have to get past the notion that the federal government is going to bail us out every time we make a stupid choice!

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  69. john personna says:

    @the, it seems that the thing you aren’t addressing is the size of the voucher.

    I’m sure you understand that it is a cash equivalent. So, do we have any idea of what it will buy? Do we have any idea of what it will buy in 10, or 20 years?

    Of course we can expect people to try to extend the vouchers to the most coverage possible. So what, if the voucher is undersized or medical costs are oversized, it won’t stretch.

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  70. john personna says:

    (I think the Ryan plan is designed to undersize the vouchers.)

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  71. thc says:

    My conclusion, the Ryan plan isn’t law and it won’t be without significant modifications so it’s moot to have such an elaborate discussion over what it does and doesn’t provide.

    As for Medicare, it IS NOT and SHOULD NOT be government’s responsibility to cover 100% of everyone’s health insurance needs until death. Medicaid exists for those who are unsuccessful in life, make poor decisions or are the victims of unforseen circumstances. The rest of us need to take some personal responsibilty and plan for our own futures. America needs to get over this rediculous sense of entitlement.

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  72. john personna says:

    Don’t you think we’ve missed some that should have been discussed more before passage? How do you feel about that Medicare Drug Plan?

    As for Medicare, it IS NOT and SHOULD NOT be government’s responsibility to cover 100% of everyone’s health insurance needs until death. Medicaid exists for those who are unsuccessful in life, make poor decisions or are the victims of unforseen circumstances. The rest of us need to take some personal responsibilty and plan for our own futures. America needs to get over this rediculous sense of entitlement.

    It sounds in the end that you are talking about something means-based, as I mentioned way up above.

    A plan that creates a sharp division between 55 and 56 year olds (and treats all 55 year-olds alike) is not means-based. It’s a rude age-based solution.

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  73. john personna says:

    oops, should have closed my quote before “it sounds”

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  74. Steve Verdon says:

    The Ryan Manifestio is adjusted for inflation. As everyone knows health care inflation is greater than regular old inflation. So the Ryan’s vouchers will become worth less and less as seniors need them more and more.

    Yes, its a rather dubious attempt to try and limit the growth in Medicare costs. It will work but only by making it so recipients have to pay more and more out of pocket to maintain a given level of health care. Still it is not a fixed price in any event.

    Yglesias took a page from economic theory. If you are going to aid this segment, then trust them to maximize their utility. This might include healthier food, or as Tyler Cowen points out, medical tourism. (I’m not 100% convinced, but I admire the audacity.)

    Yglesias doesn’t know shit about economics, the guy is a complete fool. Utility decreases with income. Right now Medicare is a type of imputed income. As such, the Ryan plan will undoubtedly make seniors worse off.

    Personally I think that will happen with or without the Ryan plan, just that the Ryan plan will ease into it. Since Medicare is unsustainable in its current form eventually benefits and/or payments for benefits will be reduced.

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  75. john personna says:

    Utility decreases with income.

    Surely you mean utility has declining returns with income. Or marginal utility declines … and since Medicare as imputed income is still an addition to income it would still result in increased utility.

    Personally I think that will happen with or without the Ryan plan, just that the Ryan plan will ease into it. Since Medicare is unsustainable in its current form eventually benefits and/or payments for benefits will be reduced.

    Sure, IMO the question at this juncture is whether cutbacks should be means-based or across-the-board.

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  76. john personna says:

    Actually another important question is how much means-based savings are possible. If means-based cuts aren’t enough to balance the books, then we look at the real horror of rationing needed care.

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  77. packeryman says:

    The Ryan plan will destroy seniors.Future seniors will see less benefits under the Ryan plan as income goes down with the disappearing middle class. The way to save the existing system is to lock box both SS and Medicare and lift the cap on income for both SS/Medicare. the levy could be increased by1% on both employer and employee for both programs, both would be viable for many years as long as politicians couldn’t steal the money for foreign aid, foreign wars, occupations, etc. The only real solution is all put under a Medicare program. You would then cover all ages which would reduce overall cost per individual. No more need for Work mens compensation, Medicade, or Medicare. We would rid ourselves of the third party useless parasitic insurance industry sucking over 500 billion out of the healthcare system. All would be covered. We don’t have this because the healthcare industry spent over a 100 million in propaganda before the last election to stifle Obama care, which is a long way from a real healthy single payer system. But we are a long way from a viable system due to the far right politicians being owned by the insurance industry and big pharma.

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  78. thc says:

    Cradle to the grave! Right, comrade?

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  79. john personna says:

    @the, you can’t have it both ways. You can’t be fore a safety net and against “cradle to grave, comrade.”

    Comments like this make me really think that modern conservatives aren’t really for the safety net. It’s the key to Ryan’s Medicare reduction (to 35% of a senior’s medical costs?)

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  80. thc says:

    John: I think that your problem understanding concepts that I (and others) have put forward is not that you’re addled, but you just don’t read carefully. My initials are THC, not THE and yesterday, when I was discussing means testing, I was talking about Medicaid not Medicare. Big difference.

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  81. john personna says:

    I guess that’s the limit of my visual acuity. Eye charts shouldn’t have “e’s” and “c’s” on them.

    But still, how is “cradle to grave” hyperbole consistent with support for … anything?

    Come on.

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  82. Steve Verdon says:

    Surely you mean utility has declining returns with income. Or marginal utility declines … and since Medicare as imputed income is still an addition to income it would still result in increased utility.

    No, what I meant was that utility declines as income declines. As such, the idea that greater choice will result in higher levels of utility with lower levels of income is hard to believe, and I’d bet that when it is true it is only for support programs like WIC and only for small variations in income. The variation under the Ryan plan is one that is growing over time unless health care cost growth drops to the rate of inflation, which I don’t see happening.

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