There’s a fair amount not to like about Washington Post editorial writer Ruth Marcus’ imagined dialogue between Barack Obama and Paul Ryan and certainly the imaginary reasonableness she attributes to Rep Ryan grates. But to me the worst thing about the column is a sentence she puts into Barack Obama’s mouth: “The current system can’t go on. I wouldn’t say this publicly, but my party’s wrong to pretend it can.”
When oh when will Democrats acknowledge the need for some changes to the Medicare status quo?
This is a great question to ask of the tiny minority of House Democrats who voted no on the Affordable Care Act back during the 111th congress. But it’s a terrible question to ask the vast majority of House Democrats who voted “yes” and also a terrible question to ask the Senate Democrats who all voted for it. The story about Republicans backing savage cuts while Democrats are in denial about the need for restraint is a comfortable one, but it bears no relationship to reality. Not only did the Affordable Care Act include specific cuts in Medicare subsidies to private insurers, it establishes a wide array of mechanisms that its authors believe will reduce the growth rate of health care spending, including in public sector programs. Hospitals were squealing about this just yesterday on the front page of The New York Times.
Back when the ACA was being debated, these measures were subjected to a lot of doubts and scrutiny from various quarters. Mostly this focused on the question of political sustainability. And that’s a fair concern. But the exact same concern has to be asked about Paul Ryan’s vouchers. You can’t slow the growth in health care spending without slowing the growth in health providers’ incomes. That’s just math and it’s a problem for everyone. But now we seem to have forgotten the sustainability concern when talking about Ryan, and forgotten the entire existence of the most important health reform in decades (except when we’re attributing magic economy-wrecking effects to it) and just pretending that Obama forgot to address the issue.