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False Piety and the Medicare Debate

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Posted on Aug 19, 2012
Photo by Austen Hufford (CC-BY)

By E.J. Dionne, Jr.

Deficit hawks are worried that the Medicare debate in the presidential campaign will make it impossible to reach a post-election deal to balance the budget. At the same time, much of the punditry focuses on how mean and nasty this campaign is.

Those who are anxious about the deficit should relax. This campaign could actually pave the way for a sensible budget deal. And those who bemoan the rock-’em-sock-’em campaign should stop wringing their hands and get about the business of calling out falsehoods and identifying misleading assertions.

On the budget, the fear is that because President Obama is attacking Paul Ryan’s fiscal road map and because Mitt Romney is responding by assailing the Medicare savings in Obama’s Affordable Care Act, Congress will be scared away from reducing the government’s health care costs. In this view, the campaign will poison the well for future budget talks.

Nothing could be further from the truth. The fact is we cannot have honest budget negotiations until we resolve one big question: Will new revenue—yes, higher taxes—be part of a budget deal or not? The election will settle where the country stands on this proposition.

Despite the fantasies of the trickle-down supply-siders, there is no path to a balanced budget without tax increases. Obama openly supports a tax increase. Romney and Ryan not only oppose higher taxes but also claim they can cut taxes and balance the budget—eventually. If they win, we can look forward to more tax cuts compounding the red ink. Isn’t this what should really concern the deficit hawks?

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If Obama’s critics want to argue that the tax increases the president is endorsing (his centerpiece is letting the Clinton-era income tax rates return for those earning more than $250,000 a year) will not be enough in the long run, they make a valid point. But at least Obama is willing to acknowledge the need for some revenue. The other side would just keep on cutting taxes. Those who care about a “balanced” budget deal should acknowledge where balance lies in this debate.

As for Medicare, the Ryan-Romney—pardon me, Romney-Ryan—claims are simply absurd. They want credit as the ticket willing to face up to the imperative of entitlement cuts, particularly in Medicare and Medicaid. They support a radical change in the structure of Medicare, to a premium-support, aka voucher, system. And then they have the nerve to criticize Obama, who wants to keep the Medicare system intact, for $716 billion in savings. As The Washington Post’s Wonkblog showed, two-thirds of the Obama reductions come from either curtailing the costly Medicare Advantage program, which has subsidized private insurers, or cuts in hospital reimbursements.

And, yes, Ryan has included the Obama savings in his own budget. 

Those who want a searching discussion of the need—and it is a need—to cut the cost of health care do their cause no good by evoking a false equivalence.  There is a difference between Obama saying that Romney and Ryan want to alter Medicare fundamentally, which is true, and the GOP saying that Obama wants to undercut Medicare, which is not.

How misleading is the Romney argument? The liberal blogger Steve Benen summarized the GOP’s strange logic perfectly: “that Barack Obama is a left-wing socialist who wants government-run socialized medicine and that Barack Obama is a far-right brute who wants to undermine government-run socialized medicine,” i.e., Medicare. It doesn’t add up, does it?

In a serious argument, Romney and Ryan would unapologetically make the case for the benefits of premium-support. Obama would insist there are better approaches to containing health care costs. Such a debate might help us make progress.

But Romney and Ryan largely run away from the substance by laying heavy stress on how their plan wouldn’t affect anyone who is 55 and over. They are saying that elderly members of the Republican base don’t have to worry about a thing. But if their idea is so good, why don’t they propose it for today’s seniors and not just for younger Americans somewhere down the road?

This goes to the larger point about campaign commentary. Lurking behind all the charges and counter-charges is a real debate over what Americans want our government to do. Pious sermons about tone and etiquette are a way of avoiding the hard and controversial work of establishing what’s fair, what’s not, and what lies beneath the campaign assaults.


E.J. Dionne’s e-mail address is ejdionne(at)washpost.com.
   
© 2012, Washington Post Writers Group


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