In a sharp switch from their historic reproach of government-backed health care, Republicans on Capitol Hill this year are embracing Medicare in their bid to kill the Democrats’ health reform plans.
Last year, when the Bush administration rolled out its annual budget proposing more than $500 billion in Medicare cuts, many Republican leaders cheered the legislation as a necessary move in the direction of fiscal responsibility.
Rep. Roy Blunt (R-Mo.), then-minority whip, called the cuts “the needed first-step” to lend Medicare “a solid economic footing.” House Minority Leader John Boehner (R-Ohio) said the proposal marked “an important starting point” for reining in Medicare spending. And Rep. Paul Ryan (Wis.), senior Republican on the House Budget Committee, cheered the plan for taking “a significant, critical step toward addressing the greatest threat to our nation’s future strength and prosperity — the unsustainable growth of our largest entitlement programs.”
What a difference a year can make.
As the Democrats aim to overhaul the nation’s health care system this year — a plan that would cut hundreds of billions of dollars in projected Medicare spending — the message coming from conservative leaders has been hardly congratulatory. Instead, most are warning of the disastrous effects that those cuts will have on seniors. Senate Minority Leader Mitch McConnell (R-Ky.) charged the Democrats with using “Medicare as a piggy bank” to fund their health reform plans. Sen. John Cornyn (R-Texas), who chairs the National Republican Senatorial Committee, has accused those across the aisle of trying “to cannibalize” Medicare. And Boehner has said the proposal would create “fewer choices and lower health care quality for our nation’s seniors.”
“I don’t think that’s right,” the minority leader said late last month.
The sentimental flip-flop, many experts argue, is hardly accidental. Faced with sweeping Democratic proposals that include the creation of a public insurance plan and the broad expansion of Medicaid to subsidize millions of uninsured Americans, Republicans are fighting tooth and nail to kill the legislation. Their tactics have ranged from the wholly absurd — like claims that the Obama administration hopes to promote abortion and euthanasia — to the simply uncharacteristic, like the sudden embrace of the same Medicare system they’ve long tried to privatize. The scare tactics have resonated with seniors, who oppose the reforms more than any other group. But the opposition strategy also puts Republicans in the odd position of blasting away at the public plan at the same time that they’re adamantly defending the virtues of Medicare, the working definition of government-backed health care. In the eyes of many experts, the strategy is sign that GOP leaders will say anything to defeat the legislation.
Alluding to the trillions of dollars of deficit spending run up by Republican leaders this decade, Henry Aaron, health policy expert at the Brookings Institution, seemed to find the change of heart amusing. “They do not want to do anything ** that would raise the deficit and they do not want to cut spending because that would deny someone something (even though there is considerable waste),” Aaron said in an email. “But they claim to be all in favor of health reform. Go figure!”
“As far as economic probity is concerned,” Aaron added, “no one has ever accused the Republican leadership of consistency.”
Julian Zelizer, political scientist at Princeton University, pointed to a similar explanation. “It’s just politics — politics and hypocrisy,” he said. “It can scare seniors against Obama’s plan.”
Yale political scientist Jacob Hacker echoed that message, pointing out that conservatives have proposed cuts to Medicare long before last year’s Bush administration budget, including a fierce push in the mid-1990s originated by then-House Speaker Newt Gingrich (R-Ga.), who promoted the idea of allowing Medicare to “wither on the vine.” The current opposition from Republicans the the Democrats’ proposals, Hacker said, is “nakedly hypocritical.”
“There’s an underlying, consistent point that the Republicans don’t like Obama’s plan,” he said. “They’re using every argument they can throw out there.”
The comments arrive as Democrats are taking to town halls across the country in hopes of selling the party’s reform plans to a skeptical public — and Republicans are fanning the flames of opposition with claims that the proposals will lead to rationing and fewer benefits for seniors.
Under the House health reform bill — which has already passed through the three committees with jurisdiction over health care legislation — Democrats are proposing cuts to projected Medicare spending that would top $500 billion. While the number is comparable to last year’s Bush administration proposal, there are vast differences between the two plans in terms of where the money would be spent.
Unlike the Bush Medicare cuts which went largely to fund an extension of the Bush-era tax cuts — most of which are scheduled to expire at the end of 2010 — the bulk of the money trimmed from Medicare under the Democrats’ plan would be pumped back into the health system. For example, House Democrats have proposed to subsidize health coverage for those earning too much to qualify for Medicaid, but not enough to purchase their own insurance easily. The House bill would provide such subsidies to those earning up to 400 percent of poverty, or $88,000 for a family of four. The House bill would also spend $245 billion to fix the faulty formula designed to update Medicare payments to doctors — a fix that Congress currently tackles on an annual, temporary basis, usually with deficit spending. The 2009 Bush budget ignored the so-called doc-fix issue.
But, despite an endorsement from the AARP, the proposed cuts have put Medicare beneficiaries on edge. Seniors have emerged as the demographic most doubtful of the Democrats’ plans, with only 20 percent in support, according to a recent Gallup poll.
Speaking at a town hall gathering in New Hampshire on Tuesday, President Obama sought to allay those fears, arguing that the proposed Medicare cuts represent overpayments, waste and corporate profits, not direct spending on health care. “This is not money going to you to pay for your benefits,” Obama said. “This is money that is subsidizing folks who don’t need it.”
For example, the House bill cuts more than $156 billion from the Medicare Advantage program, a controversial, Republican-created initiative under which the government buys private health insurance for seniors. Billed as a program capable of trimming Medicare spending, Medicare Advantage instead costs 14 percent more per patient than traditional Medicare — a discrepancy the Democrats have long-attempted to eliminate. The fight over the program has always been as much about ideology as it’s been about policy.
“This is not just an issue of cutting Medicare,” said Hacker, author of Health at Risk: America’s Ailing Health System — and How to Heal It. “It’s an issue of where the funds are going.”
The debate arrives as the nation’s health care costs continue to grow at a pace head and shoulders above the rest of the economy, threatening to swamp federal spending in a few short decades. This year health care spending is projected to hit $2.6 trillion, representing 18 percent of the gross domestic product, according to the Congressional Budget Office. By 2017, the figure is projected to jump to 20 percent.
Frustrating the Democrats efforts, there appears to be a failure among at least some Medicare beneficiaries to recognize that the program providing their health care is a public plan. It’s a dynamic that hasn’t been lost on Obama.
“I got a letter the other day from a woman,” he said last month at a health care forum sponsored by AARP. “She said, ‘I don’t want government-run health care, I don’t want socialized medicine, and don’t touch my Medicare.’ And I wanted to say, well, I mean, that’s what Medicare is, is it’s a government-run health care plan that people are very happy with.
“But I think,” he added, “that we’ve been so accustomed to hearing those phrases that sometimes we can’t sort out the myth from the reality.”