Tuesday, November 15, 2016

Paul Ryan's plan to gut Medicare



From The Week

One of the things that separated Donald Trump from his primary competitors — and the rest of the Republican Party in general — was his left-leaning stance on social insurance. Tossing aside a whole generation of conservative agitprop about the "unsustainability" of these programs, he said he would preserve Social Security, Medicare, and Medicaid during the campaign.

But Speaker of the House Paul Ryan is a hardcore true believer in movement conservatism, which has been champing at the bit to slash these programs basically since the moment they were implemented. This is an unprecedented opportunity to do so, and it looks like Ryan is going to seize it — and Trump might even go along with it. The people who voted for Trump because he seemed to be a route towards material security for the lower and middle classes got conned.

On Friday last week — a mere three days after the election — Ryan was asked in an interview with Fox News' Bret Baier about "entitlement reform." This is Washington code for cuts, and when coming from a hard-right ideologue like Ryan, it means very sharp cuts, if not outright repeal of programs. He said that ObamaCare is "failing" and would be repealed, and that since Medicare and Medicaid were significantly changed as part of ObamaCare, they would need changes as well.

Then followed a duplicitous word salad about costs:

What people don't realize is that Medicare is going broke, that Medicare is going to have price controls. Because of ObamaCare, Medicaid is in fiscal straits. So you have to deal with those issues if you're going to repeal and replace ObamaCare. Medicare has got some serious problems because of ObamaCare. Those things are part of our plan to replace Obamacare.

These are lies. Medicare already has price controls, and in fact ObamaCare probably improved the fiscal position of Medicare and Medicaid. Health care price inflation has been unprecedentedly low since its passage, likely because it contained many cost control measures which appear to be working pretty well. Therefore, repealing it would massively increase the fiscal problems with government health insurance, and bring back the predictions of long-term explosions in deficits.

But unlike Trump's constant and omnidirectional lying, Ryan's lies usually have some specific motivation behind them. In this case, it's obvious enough. He wants to create the perception of a funding crisis to justify cuts. The "Better Way" paper on health care the GOP released in June gives a vision of what they might do — from repealing the ObamaCare cost controls, to expanding the quasi-private Medicare Advantage plans, to destroying Medicare as a public program and replacing it with "premium supports." With a once-in-a-generation chance at tearing up the Great Society, Ryan is likely going to try to shoot for the moon and go for premium supports. (Ironically, this would have to be similar to the basic structure of ObamaCare to have even a prayer of preserving a functioning insurance market for the elderly.)

Now, when Social Security came up during the interview, Ryan punted, saying he wasn't going to address it. However, Zaid Jilani at The Intercept discovered that Trump's transition team is going to have a couple notorious Social Security privatizers on the part of the team overseeing the Social Security Administration. Such people have wanted to turn Social Security into a 401(k)-style program, not least because it would be a stupendous windfall for Wall Street swindlers.

That's not a guarantee that Trump will try to privatize the program, but it suggests either that he was lying when he said he would preserve the program, or his attention span is so flighty that he's not even noticing the movement conservatives who are sneaking in through the general party mechanisms. (If I had to guess, I'd put my money on the latter.) If Trump were really committed to protecting the program, there's no reason on Earth to put such people in charge.

By the end of 2017 there will be a lot of buyers remorse amongst the Trump supporters.  Donald Trump will surely sign any Medicare revisions into law.  Good going depolorables.

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