Thursday, May 26, 2011

Using the special election in NY-26 as a salutary lesson

Republicans can offer all the spin they want, but it is clear that the victory of the Democrat in New York's 26th congressional district was fought on the Medicare issue. The Democrat benefited from demagoguery and deception about the Ryan plan. Michael Barone neatly summarizes what analysts can learn from the special election.

Republicans need to use the defeat as a lesson of what they need to be able to do before next year's elections. They have an argument and they need to make sure that all their candidates can make it. As John Fund says, the election should be a
wake-up call for the GOP." And then they need to get out there in town halls all over the place to make their argument over and over.

Karl Rove is on the case.
Next year, Republicans must describe their Medicare reforms plainly, set the record straight vigorously when Democrats demagogue, and go on the attack. Congressional Republicans—especially in the House—need a political war college that schools incumbents and challengers in the best way to explain, defend and attack on the issue of Medicare reform. They have to become as comfortable talking about Medicare in the coming year as they did in talking about health-care reform last year.

There needs to be preparation and self-education, followed by extensive town halls, outreach meetings, visits to senior citizen centers, and the use of every available communications tool to get the reform message across.

A good starting point is Mr. Ryan's message from his speech at the Economic Club of Chicago that his Medicare reform package "makes no changes for those in or near retirement, and offers future generations a strengthened Medicare program they can count on, with guaranteed coverage options, less help for the wealthy, and more help for the poor and the sick."

The populist note is especially important: When he starts receiving Medicare, Bill Gates should bear a greater share of his health-care costs than the less healthy or less wealthy.

Defense, no matter how robust, well-informed and persistent, is insufficient. Republicans must also go on offense. Democratic nonchalance towards Medicare's bankruptcy in 2024 and the crushing debt it will leave for our children gives the GOP the chance to depict Democrats as tone deaf, irresponsible and reckless. The country can't afford Democratic leaders who simply order the orchestra to play louder as the Titanic tilts and begins to slide under.
Paul Ryan's video that he issued yesterday to explain how Medicare "as we know it" is going broke and won't exist for long. Then he explains the differences between his plan and what will happen under Obamacare. As Ryan said in his statement accompanying his video,
This video lays out the clear choice our nation faces on Medicare: Will Medicare become a program in which a board of bureaucrats manages its bankruptcy by denying care to seniors? Or will leaders work together to save and strengthen Medicare by empowering seniors to choose health care plans that work best for them, with less support for the wealthy and more help for the poor and the sick? House Republicans have advanced solutions to save Medicare. Instead of working with us, the leaders of the Democratic Party have opted to play politics with the health security of America’s seniors.
Rove is right. All Republicans need to be able to make this argument. It's not all that difficult. If they need a boot camp where they can practice until they can speak clearly on the plan that they voted for, answering constituents' questions, while being able to forcefully respond to criticisms then send them off to that boot camp and let them practice. This debate is too important to be left to bumble-brained GOP candidates who haven't mastered a defense of policies that they purport to support.

And fortunately for the Republicans, the facts are on their side. All they need to do is explain to voters what the Democrats have already passed in Obamacare. Conn Carroll has the argument that Republicans need to make.
But there is a much more immediate threat to Medicare recipients that Democrats have allowed to fester: the doc fix. In order to preserve the fantasy that Obamacare was deficit neutral Democrats preserved Clinton-era doctor payment formulas that are scheduled to cut doctor Medicare payments by 29.4% in 2012. If the Democrat plan is to keep Medicare as it is, then Republicans must make them own that 29.4% doctor payment cut. Independents need to be told that Democrats want to pay their doctors 30% less to provide them health care.
The Democrats voted for it; Obama led the fight. They own this attack on our medical system. Republicans need to go on the offensive to make this clear to voters that the Democrats have already attacked Medicare "as we know it."

And while they're at it, they can make clear what Obamacare did to Medicaid. Jeffrey Anderson has the details.
The chief actuary for Medicare and Medicaid, who works in the Obama administration, says that, without Obamacare, there would be 61 million people on Medicaid in 2014, the same number that there are today. With Obamacare, he says there will be 84 million people on Medicaid in 2014 (see Table 2). That’s right: Obamacare would dump 23 million people onto the rolls of Medicaid — one of the two “biggest drivers” of our debt. (You hardly hear Obama talk about it, but this is a large part of how Obamacare would decrease the number of uninsured.)

In the process, the Congressional Budget Office (partly here, partly here) says that Obamacare would increase Medicaid spending by nearly $1 trillion over Obamacare’s real first decade (2014 to 2023). How would we pay for these nearly 13 figures of new spending? The CBO says that Obamacare would include enough new taxes and fines — levied for such transgressions as American citizens refusing to buy government approved health insurance — to raise that colossal sum. Of course, that $1 trillion or so could otherwise be used to reduce our deficits or pay down our national debt. (Links in original)
Then there are the facts about how Obama raided Medicare to pay for Obamacare. As the Medicare actuary reports,
Without major changes in health care delivery systems, the prices paid by Medicare for health services are very likely to fall increasingly short of the costs of providing these services. By the end of the long-range projection period, Medicare prices for hospital, skilled nursing facility, home health, hospice, ambulatory surgical center, diagnostic laboratory, and many other services would be less than half of their level under the prior [pre-Obamacare] law. Medicare prices would be considerably below the current relative level of Medicaid prices, which have already led to access problems for Medicaid enrollees, and far below the levels paid by private health insurance. (emphasis added)
In other words, Obamacare would result in a level of care for Medicare beneficiaries that would become increasingly similar to the level of care currently provided to those on Medicaid. Obamacare would reduce payments to Medicare providers to levels that would cause many providers to quit seeing Medicare patients. The money saved by not paying Medicare providers anything like the going rate for medical care would be used to fund Obamacare, even while the Obama administration disingenuously maintains that each dollar raided from Medicare could be spent on both Medicare and Obamacare.
Then add in the cuts that will be made by Obamacare's unelected board that will make cuts that can't be overruled even by the courts or a majority vote of Congress.

Why can't Republicans make this argument? The details of Obamacare are scary. Educate voters and let the debates begin.