Since Rep. Paul Ryan (R-WI) became the GOP nominee for Vice
President, the future of Medicare has gone from being an important
secondary issue to the issue most mainstream pundits (and both
campaigns) are talking about. The Romney campaign has released an
ad hammering Obama over his Medicare cuts, liberals and
conservatives alike have gone after the Obama and Romney campaigns,
and the Obama campaign Twitter feed seems to only stop talking
about Medicare and the Patient Protection & Affordable Care Act
(Affordable Care Act) when it wants to talk about how bad Ryan and
Romney are for women.
A number of the Tweets from the campaign have their
inaccuracies, but one claim in particular on August 15 was
egregiously inaccurate:
“FACT: The President’s health care law extends the life of
Medicare by eight years without cutting benefits to seniors.”
I won’t get into the life extension debate — that’s been dealt
with by others — but his claim that the Affordable Care Act won’t
cut benefits to seniors is the President’s version of trying to
have his cake and eat it too.
How is this happening? Superficially, the President is correct.
He won’t cut benefits to seniors. Instead, the law has components
that may cut
payments to health care providers, per certain programs it has
enacted. Will this impact benefits to seniors? Consider some
recent
congressional history regarding the so-called “Doc Fix,”
including how many doctors began refusing Medicare patients:
As explained in a
2011 Medicare actuarial study, Congress enacted [the law that
created the Doc Fix] “to limit growth in spending on physician
services to a sustainable rate, roughly in line with the rate of
overall economic growth.” This effort lasted for five years, and in
2002, the New York Times
reported: “For the first time, significant numbers of doctors
are refusing to take new Medicare patients, saying the government
now pays them too little to cover the costs of caring for the
elderly.”
This practice of refusing new Medicare patients has continued to
this day, which is why Congress regularly delays implementation of
the Doc Fix. From the link above:
…[F]or every year since 2003, various congresses and presidents
have legislatively overridden this so-called “sustainable growth
rate” to ensure that Medicare patients have access to care.
However, instead of removing this provision entirely, they overrode
it one year at a time. Hence, each year, the distance between
reality and what the law specifies became wider. This explains why
Medicare was due to cut payments for physicians services by a
whopping 27% this year.
Now, liberals may argue that the cuts will happen, especially
with the power given to
the Independent Payment Advisory Board (IPAB) to enact cuts that
may be politically unpopular. Additionally, they cite CBO reports
noting the cuts are set to happen. However, as I
pointed out in the Hot Air Green Room two months ago, many are
the policies that are supposed to happen in CBO’s
estimates that never actually do because of a lack of political
courage. CBO accounts for this, actually, in its secondary budget
estimates:
The CBO baseline budget expectations are those based upon
current law. The alternative scenario is based upon expected
political actions, aka current policy, and shows a fiscal scenario
that is far, far worse than the baseline expectations. [Is] the
baseline budget more feasible than the alternative scenario, given
the delayed implementation of several major policies in recent
years, including ending the Bush tax policies, implementing the
payment reimbursement cuts in the “Doc Fix,” and taxing millions of
Americans under the AMT?
So, in short, with this one Tweet, the President has set himself
up for one of two lies: either his law will harm seniors by
limiting their access to health care providers, or his law won’t
make the cuts it promises, thus not increasing the life of Medicare
as much as he claims.
The country’s financial situation desperately calls for
reforming the entire federal government, especially Medicare,
Medicaid, Social Security, the Pentagon, and the tax code. Cuts are
going to be a part of the solution, whether by design (Congress
actually doing its job) or from external forces (think
international investors and inflation), but for the President to
claim he can have his cake and eat it too is intellectually
dishonest.
