Last week, after months of arguing that health care reform would ration care and pull the plug on grandma, Republicans initiated a focused and organized campaign against seniors. Since “older people vote in bigger numbers than younger people” and are “more likely to call their representatives or attend a town hall meeting,” their support is key. The elderly are weary of health care reform and afraid of losing their existing government-sponsored health care plans; convincing them of the Republican narrative on health care reform, could doom Democratic reform efforts and virtually guarantee large Republican gains in the midterm elections and beyond.
For Republicans, the strategy requires some juggling and plain old intellectual dishonesty: the GOP has to support Medicare, but argue against a Medicare-like public option. Last Monday, GOP Chairman Michael Steele penned a rather awkward op-ed defending and defaming the Medicare program. He rebranded the proposed $500 billion cuts to Medicare and Medicaid waste — which he himself has supported in the past — as a “raid” on Medicare and accused the President of cutting Medicare benefits.
The AMA and AARP endorsed House health care bill rationed care to seniors, Republicans claimed. The President must scrap the House plan, and propose his own legislation. This afternoon, during an appearance on Fox News, Rep. Mike Pence (R-IN) made that very argument, criticizing Democrats in Congress for writing health care legislation and calling on Congress to “scrap the bill that has been moving through the House of Representatives” and “demand the President of the United States to bring forward his own bill.” The House legislation, Pence claimed, increased “the cost of prescription drugs for seniors under Medicare Part D”:
It really is, particularly, when you start to realize that where they are going to find these supposed savings are in cuts to Medicare. They are actually talking, as House Republicans published today, they are talking about increasing the cost of prescription drugs for seniors under Medicare Part D of upwards to 20% in the coming years, to close that so-called ‘donut hole.‘
False hits only work if they build on kernels of truth. In this case, Pence is perverting a recently released Congressional Budget Office letter — which found that premiums would increase but net spending on drugs would decrease — to substantiate the Republican narrative. The reality is quite different. The House bill would improve Medicare payments to physicians, create incentives for doctors to work in underserved rural areas, eliminate co-payments and deductibles for preventive services in Medicare, and fill in the coverage gap – the “donut hole” – in the Medicare prescription drug benefit.
According to the Congressional Budget Office, closing the donut hole alone would cause “spending on prescription drugs apart from those premiums” to “fall, on average, as would their overall prescription drug spending (including both premiums and cost sharing).” The federal government would save “about $30 billion over the 2010–2019 period.”
Beneficiaries’ premiums would increase as a consequence of the donut hole contraction and the behavior of prescription drug companies. Under the legislation, “prescription drug plans would be responsible for covering some costs in the doughnut hole and above the catastrophic level that they are not required to cover under current law.” “Because enrollees pay for about 25 percent of the cost of coverage through their premiums, premiums would also be higher.” Pharmaceutical manufacturers would also add to premiums by “charging higher prices for new drugs,” and lowering “the rebates they pay to prescription drug plans.” Yet on the whole, “in return for those higher premiums, enrollees would receive greater protection against incurring high drug costs” and incur lower out-of-pocket expenses. As a result, “beneficiaries’ total prescription drug spending would fall on average,” the CBO found.
The counter-narrative is more complicated but no less essential; without it, the President will likely lose the debate. Until now, Obama has treated the health care debate as an economic symposium; he has played the professor in the GOP’s far more moving drama about long waiting lines and rationed health care services. To win the health care debate and blunt the GOP’s far more compelling story, the President will have to reassure seniors that health reform will strengthen the Medicare. His story could sound something like this: health care reform “ensures that Medicare beneficiaries will continue to choose their doctors, hospitals and other providers, receive an improved range of benefits, and enjoy the financial and health security Medicare has provided for more than 40 years.” After all, this narrative has the benefit of being true.