Jared Bernstein has a good and clear explanation as to why Rep. Paul Ryan’s (R-WI) argument about seniors using “premium support” vouchers to “deny business to inefficient providers” is so horribly wrong:

Suppose you send me to the grocery store to buy you a gallon of milk. Milk costs $3.50 a gallon but you give me $2. I spend the whole day “denying business to inefficient providers”—i.e., grocers who all charge more than that—and at the end of the day, bring you back a pint.

Now, instead of milk, where I’ve got the information I need to be a smart shopper, suppose you give me the same under-priced voucher but ask me to bring you back a plan for treating that strange pain you’ve been experiencing on your left side on humid days.

There’s no “denying business to inefficient providers” in the Ryan plan because there’s no market discipline that average folks with incomplete information armed with an inadequate voucher can enforce on a private health insurance market that’s…well, different.

Part of the problem is that individuals don’t have the market clout of a large employer or a program like traditional Medicare, which are able to secure better prices from providers than future retirees purchasing coverage on their own (under Ryan’s plan) or many other private payers.

Look at this data from S&P tracking the growth of health care costs. As Maggie Mahar points out, over the year ending March 2011, Medicare spending rose at an annual rate of 2.78% — the lowest rate posted for the Medicare Index in its six-year history — while “health care costs covered by commercial insurers rose by 7.57%.” This creates a problem for those who argue that private businesses are magically able to control costs better than government programs:

Why is Medicare cost growth slowing? It appears that “costs for Medicare patients are being better contained than those covered under commercial insurance plans,” observes David M. Blitzer, chairman of the S&P Index Committee. And the provisions in the Affordable Care Act that will put Medicare on the road to financial solvency haven’t even begun to kick in. Meanwhile, conservatives argue that we must privatize Medicare, because taxpayers cannot affords “runaway” government entitlement programs. I wonder how they explain the S&P report.

Robert Pear reports that the Obama administration is raising concerns about Indiana’s new law to cut off all state and federal dollars to Planned Parenthood, arguing that the measure may impose “impermissible restrictions on the freedom of Medicaid recipients to choose health care providers.” The Indiana measure “prohibits state agencies from entering contracts with or making grants to ‘any entity that performs abortions or maintains or operates a facility where abortions are performed’ and “terminates existing state contracts with such entities”:

Asked for comment on the Indiana law, the federal Centers for Medicare and Medicaid Services provided this statement, cleared by the White House: “Federal law prohibits federal Medicaid dollars from being spent on abortion services. Medicaid does not allow states to stop beneficiaries from getting care they need — like cancer screenings and preventive care — because their provider offers certain other services. We are reviewing this particular situation and situations in other states.” [...]

States can obtain federal permission to waive certain requirements of the federal Medicaid law. But the federal law says that “no waiver” may restrict the choice of Medicaid beneficiaries in receiving family planning services.

In other words: House Republicans who voted to ban federal funding to Planned Parenthood in Congress and the five states — Kansas, North Carolina, Oklahoma, Texas and Wisconsin — considering similar legislation are actively trying to do what they accuse the federal government of doing: ration health care to millions of lower-income Americans. The Obama administration — the alleged rationer-in-chief — is working to preserve “choice” and fair access to providers.

The other irony is that the GOP’s efforts to restrict funding to contraception will great increase spending, further undermining the GOP’s claims of fiscal responsibility. According to a new study from the Guttmacher Institute, unintended pregnancies cost taxpayers approximately $11 billion per year. Not surprisingly, “rates of unintended pregnancy are far higher among poor and near-poor women (those with incomes under twice the federal poverty level) than those with higher incomes” — the very women who would be denied contraception under the GOP’s reforms. As NPR’s Julie Rovner reports, “As a result, nearly two-thirds (64 percent) of the 1.6 million births resulting from unintended pregnancies in 2006 were paid for by public health insurance programs.”

By Igor Volsky and Pat Garofalo

This morning, former Minnesota Governor Tim Pawlenty (R) formally announced his candidacy for the 2012 GOP presidential nomination in Des Moines, Iowa, promising Americans “a different approach” to his campaign and potential presidency. “I am going to tell you the truth. The truth is, Washington’s broken,” Pawlenty declared. “It’s time for new leadership. It’s time for a new approach. And, it’s time for America’s president – and anyone who wants to be president – to look you in the eye and tell you the truth.”

From there, Pawlenty preceded to list various “truths” about the state of the nation, many of which appear — on closer examination — to be either completely untrue or grossly exaggerated:

T-PAW TRUTH: Health care reform has added to the national debt. Social Security is in peril. “Our national debt, combined with Obamacare, have placed Social Security, Medicare, and Medicaid in real peril. I’ll tell young people the truth that over time and for them only, we’re going to gradually raise their Social Security retirement age.”

ACTUAL TRUTH: Health care reform reduced health care spending. According to the Congressional Budget Office, enacting the Affordable Care Act “will produce a net reduction in federal deficits of $143 billion over the 2010-2019 period.” Similarly, the Center for Medicare and Medicaid Services (CMS) concluded that Medicare spending will decline $86.4 billion and that by 2019, it is projected to grow 7.7 percent—0.9 percentage point more slowly” than if the law had not passed.

ACTUAL TRUTH: Social Security is not in real peril. It can pay full benefits through 2036 and close to full benefits for decades after that, according to the latest trustee’s report. Moderate tweaks to the system, including raising the cap on the payroll tax can more than make up for the program’s long-term shortfall. Raising the retirement age is not only unnecessary, but is a hugely regressive change. Furthermore, the Affordable Care Act and the national debt have nothing to do with the financial health of Social Security.

T-PAW TRUTH: Block granting Medicaid will “solve problems.” “And, we need to block grant Medicaid to the states. There, innovative reformers closest to the patients can solve problems and save money.”

ACTUAL TRUTH: Millions of lower-income Americans will lose health coverage. As a recent Kaiser Family Foundation report pointed out, converting the existing matching rate formula into a block grant would give states less money that they would have otherwise received and force local governments to cut eligibility to the program. Kaiser examined different scenarios for state responses to reduced federal Medicaid spending and estimated 31 to 44 million Americans could lose their health insurance coverage.

T-PAW TRUTH: Reformed health system in Minnesota. “I know how to do health care reform right. I’ve done it at the state level. No mandates, no takeovers. and it’s the opposite of Obamacare.”

ACTUAL TRUTH: Number of uninsured increased under his governorship. Pawlenty did experiment with different methods of bundling payments to providers — creating baskets for certain conditions — and implemented pay-for performance initiatives, but as Minnesota Public Radio has reported, it’s unclear if his small efforts have actually saved the state any money. But most importantly, as David Frum has pointed out, the number of Minnesotans without health care actually increased during his time as governor from 395,000 citizens without health insurance in 2003, to 446,000 in 2008, the last year before the recession struck.

T-PAW TRUTH: The United States is broke. “Our country is going broke.”

ACTUAL TRUTH: The United States isn’t broke. As the Center for American Progress’ Michael Linden and Michael Ettlinger note, “The notion that the United States is ‘broke’ is a popular talking point for conservative lawmakers…But we’re not broke. Not at all. If we were, it would mean that we were out of money, unable to pay our bills, or meet our financial obligations. We are none of those things.” Bloomberg’s David Lynch has more.

T-PAW TRUTH: Against bailouts and “too-big-to-fail”. “I’m going to New York City, to tell Wall Street that if I’m elected, the era of bailouts, handouts, and carve outs will be over. No more subsidies, no more special treatment. No more Fannie and Freddie, no more TARP, and no more “too big to fail.”

ACTUAL TRUTH: Pawlenty would preserve too-big-to-fail and has flip-flopped on bailouts. The Dodd-Frank financial reform law signed by President Obama last year includes important powers for the government to dismantle large, failed financial firms without resorting to ad-hoc bailouts; Pawlenty opposes those powers. Pawlenty was also for TARP before he was against it, saying in 2008 that TARP “is an imperfect solution, but, like has been said, [the banks] are too big, the consequences are too severe for innocent bystanders to allow them to fail.”

T-PAW TRUTH: The NLRB can dictate to companies where to move. “It especially means the National Labor Relations Board will never again tell an American company where it can and can’t do business.”

ACTUAL TRUTH: The NLRB has not told an American company where it can and can’t do business. Pawlenty has been criticizing a decision by the NLRB that would prevent mega-manufacturer Boeing from shifting a production line from Washington state to South Carolina as retribution against workers who engaged in strikes. Under labor law, it is illegal to retaliate against striking workers by shifting production, but the NLRB has made it abundantly clear that Boeing is free to open new facilities wherever it pleases, provided it complies with the law.

T-PAW TRUTH: Against energy subsidies. “As part of a larger reform, we need to phase out subsidies across all sources of energy and all industries, including ethanol. We simply can’t afford them anymore.”

ACTUAL TRUTH: For oil and gas subsidies. Just a few weeks ago, Pawlenty said that cutting subsidies to oil and gas companies is “ludicrous.” “I mean the worst thing we could do is raise the cost burden on costs on energy and oil…It’s preposterous,” he said.

Republicans have long opposed Dr. Don Berwick, the current head of the Center for Medicare and Medicaid Services, pointing to the Harvard professor’s respect for the British health care system and other European models as evidence that he supports “socialized medicine” and would support government-centered rationing of health care in the United States. “I believe the President of the United States now has what he wants, his health care rationing czar,” Sen. John Barrasso (R-WY) said on the floor of the Senate. “We have a president — a president-appointed czar, essentially a czar to ration health care.” Sen. Pat Roberts (R-KS) expressed similar outrage after Berwick was nominated for the position, saying, “Dr. Berwick is the perfect nominee for a president whose aim has always been to save money by rationing health care.”

But not all prominent Republicans oppose Berwick. In fact, it turns out that 2012 presidential hopeful and former Speaker of the House Newt Gingrich was once a strong promoter of the CMS administrator, praising Berwick for what Republicans are now characterizing as “rationing” — his work to improve the quality of the nation’s health care system. In early part of the last decade, Gingrich “gave credibility and visibility to a set of ideas being talked about in the health policy world about using information technology to improve medical care.” He advocated “reforms such as ‘data-driven reimbursement’ informed by best practices, a national electronic health network and a focus on prevention and wellness. All those items — and others Gingrich supported — are contained in the HITECH Act, part of the budget stimulus package and the Affordable Care Act,” Michael Millenson notes.

An Amazon search of Gingrich’s “Saving Lives & Saving Money” reveals three separate references to Berwick — who was and still is a national leader in improving health care quality — in which Gingrich praises the current CMS head for his passionate belief that quality-care focused systems improve health outcomes and reduce health care spending. Gingrich even included a plug for Berwick’s nonprofit, the Institute for Health Improvement, reprinting the organization’s website on page 122 of his book. In an August 2000 Washington Post op-ed calling on President Bill Clinton to “stop defending inefficiency and to drag health care into the 21st century by insisting on modern management and information systems,” Gingrich singled out Berwick for spreading the word about “quality control”:

The Veterans Administration’s Palo Alto Health Care System is creating a computerized patient medical record system. The new Northwestern Memorial Hospital in Chicago was designed from its conception to be a safer, more accurate and more electronic facility. Don Berwick at the Institute for Healthcare Improvement has worked for years to spread the word that the same systematic approach to quality control that has worked so well in manufacturing could create a dramatically safer, less expensive and more effective system of health and health care.

In July of 2010, however, Gingrich slammed President Obama for recess appointing Berwick to CMS, describing the decision as “a sad mistake” and used Berwick’s appointment as evidence for how “left” Obama is.

“I described it as a secular Socialist machine in a book I wrote recently. And I think what you saw [Obama] do with Dr. Berwick is a good example of machine behavior,” Gingrich said during a July 8, 2010 appearance on The O’Reilly Factor. He added: “Among the elites, there will be great applause for Don Berwick. Among the rest of the country, there will be a very chilly attitude that says is this guy really going to try to impose a British national healthcare system in America? And so, there’s a real split emerging in the country. But among the people in the White House, my hunch is almost all of them uniformly agree with what he’s doing and uniformly believe that somehow they’ll find a way to sell it.”