Jonathan Chait and Greg Sargent are predicting that having all but officially lost their battle to privatize Medicare, Republicans will now continue to attack Democrats from the left for cutting the program through the Affordable Care Act. They will argue (as Speaker of the House John Boehner (R-OH) does here) that the GOP budget preserves benefits for everybody over 54 while the Democrats cut benefits to today’s seniors and will continue to ration their care and allow the program to go bankrupt. As Chait points out, there is very little truth to any of that:
Of course, there are different ways to cut benefits. The liberal method is to try to get Medicare to stop paying for ineffective procedures, and to encourage measures of results rather than simply incentivize more spending. Conservatives have decided that any measure seeking to root out waste in Medicare amounts to “rationing” and is unacceptable. They prefer to put beneficiaries into private insurance, and then slowly reduce the subsidy for that insurance, so that customers can shop for cheaper plans.
What the Democrats actually did is cut the rate of growth in Medicare, reduced annual increases in payments to hospitals, skilled nursing facilities, home health agencies and other institutions to spur productivity and cut overpayments to private insurers that are not delivering value for Medicare dollars. They used that money to expand coverage to 32 million Americans — many of whom were receiving uncompensated care at these institutions — extend the life of the Medicare program and invest in new demonstration projects that aim to deliver quality care more efficiently.
Those are just the facts, and the problem for the GOP is that they actually voted for many of these reductions as part of the Ryan budget without investing the savings in coverage expansion or changing the way the government finances health care. Jonathan Cohn gets at the difference in his Kaiser Health News column:
Republicans claim, as Democrats do, that their plan will nudge the whole health care system in the direction of more efficiency — not by changing the behavior of providers, as Democrats prefer, but by changing the behavior of consumers, in ways that will create a more vibrant and competitive market. It’s a highly dubious argument, given that private insurance has higher overhead and less bargaining power than government insurance. (Remember, the Democratic plans would take money back from private insurers serving the Medicare population, for precisely the same reason.) But even if it were true, there’s no credible expert who thinks the savings from competition would be large enough to offset the massive reduction in funding Republicans have in mind.
There is also no credible research showing that forcing individuals to be more cost conscious will significantly lower national health care spending, so the GOP is voting for these cuts without increasing coverage or lowering costs.