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.

Earlier this year, Republicans faced a backlash after Rep. Chris Smith (R-NJ) — an anti-abortion leader in the House — tried to narrow the definition rape to “forcible rape,” thereby preventing women who are drugged, verbally threatened, or do not physically fight off the rapist, from receiving an abortion with federal funds. Smith promised to remove the language, but in “a sly legislative maneuver,” the GOP still managed to alter the definition in H.R. 3, the No Taxpayer Funding For Abortion Act, an anti-abortion measure that passed the House earlier this month. As Tanya Somanader explained, “essentially, if the bill is challenged in court, judges will look at the congressional committee report to determine intent. The committee report for H.R. 3 says the bill will ‘not allow the Federal Government to subsidize abortions in cases of statutory rape’ — thus excluding statutory rape-related abortions from Medicaid coverage.”

Yesterday, the GOP continued its assault against rape victims. As the Huffington Post’s Laura Bassett reports, “The House Committee on Rules blocked an amendment from going to vote on Wednesday that would have allowed military rape victims to access abortion care through their government-provided health plans”:

Earlier this week, Rep. Susan Davis (D-Calif.) and five other House Democrats submitted an amendment to the 2012 National Defense Authorization Act that would reverse the current policy of denying abortion coverage to military women who are raped and become pregnant during their service. As the bill currently stands, servicewomen have to pay out of pocket for an expensive abortion procedure unless they can prove that their lives are in danger.

By contrast, other federal bans on abortion coverage, including those for Medicaid recipients, federal employees, and women in federal prisons, all include exceptions for victims of rape and incest. The ban on abortion coverage for military rape victims is actually more extreme than the Hyde Amendment, which has prohibited federally funded abortions for the past 30 years except in the cases of rape, incest and life endangerment.

Republicans in the House also approved an amendment “that would prevent a federal healthcare education fund from being used for abortion or to provide for training for abortion procedures.” These moves come just days after a new study found that the national abortion rate has actually decreased by 8 percent between 2000 and 2008, but rose “nearly 18 percent among the country’s poorest women” — the very women who are most impacted by the GOP’s attack on choice.

Liz Kowalczyk of the Boston Globe reports on troubling new health data out of Massachusetts which finds that insurance companies are paying some hospitals “significantly more than others for providing similar care,” even though the higher paid hospitals are not producing better outcomes:

Cambridge Health Alliance was paid less than $5,000 each for 55 caesarean sections performed in 2009, while Massachusetts General Hospital was paid more than $10,000 each for 483 caesarean deliveries that year, state officials found.

They said it was unclear why insurers paid some hospitals dramatically more, since officials found no obvious differences in quality of care, and their analysis allowed for instances in which hospitals treat sicker patients.

Disparities in payments were first documented by Attorney General Martha Coakley’s staff last year, which concluded after an investigation that the highest paid hospitals had more market clout, some because of their brand names, but that they were not necessarily providing better care. The new report, which the governor’s office planned to release to the public today, mirrors Coakley’s initial findings.

It’s hard to know exactly how to counter this kind of waste, but the Independent Payment Advisory Board (IPAB) in the Affordable Care Act and some of the payment reform demonstration projects could provide a good starting point by changing the way Medicare pays providers and thereby nudging private insurers to adopt similar reforms. The budget the Center for American Progress released yesterday would get even more to the point by empowering the board to modify payment practices across the entire health system:

In our plan, aggressive implementation of the new health reform law, along with some enhancements to its existing cost-control mechanisms, will result in dramatically lower health expenditures, both for the federal government and overall. But predicting the exact effect of the myriad test programs and reforms in the new health law is fraught with uncertainty. Thus we also include a failsafe mechanism that would ensure significant savings.

Our failsafe would be triggered if, starting in 2020, total economywide health care expenditures grow at a rate faster than the economy. Should that happen then we would empower the Independent Payment Advisory Board to extend successful reforms in Medicare and other public programs to insurance plans offered in the health care exchanges and then potentially to all health care plans, such that the target is met. This will ensure that costs are constrained across the health care sector, preventing cost-shifting and maintaining access for all.

In that model you can see how reforms like pay-for-performance (if successful) could begin to ratchet down the overpayments some hospitals are now enjoying.