The GOP Bill To Cut Medicare is Past Due

Paul Krugman does a beautiful job demolishing Republican arguments on health care reform before they hit the floor:

We are, I believe, witnessing something new in American politics. Last year, looking at claims that we can cut taxes, avoid cuts to any popular program and still balance the budget, I observed that Republicans seemed to have lost interest in the war on terror and shifted focus to the war on arithmetic. But now the G.O.P. has moved on to an even bigger project: the war on logic.

So, about that nonsense: this week the House is expected to pass H.R. 2, the Repealing the Job-Killing Health Care Law Act — its actual name. But Republicans have a small problem: they claim to care about budget deficits, yet the Congressional Budget Office says that repealing last year’s health reform would increase the deficit. So what, other than dismissing the nonpartisan budget office’s verdict as “their opinion” — as Mr. Boehner has — can the G.O.P. do?
The answer is contained in an analysis — or maybe that should be “analysis” — released by the speaker’s office, which purports to show that health care reform actually increases the deficit. Why? That’s where the war on logic comes in.
First of all, says the analysis, the true cost of reform includes the cost of the “doc fix.” What’s that?

Well, in 1997 Congress enacted a formula to determine Medicare payments to physicians. The formula was, however, flawed; it would lead to payments so low that doctors would stop accepting Medicare patients. Instead of changing the formula, however, Congress has consistently enacted one-year fixes. And Republicans claim that the estimated cost of future fixes, $208 billion over the next 10 years, should be considered a cost of health care reform.

But the same spending would still be necessary if we were to undo reform.

The doc fix fallacy started with Paul Ryan, near as I can tell, and every conservative and pundit swallowed it whole:

It never made any sense.

This is Ryan from the Healthcare Summit Obama held:

And I think, probably, the most cynical gimmick in this bill is something that we all probably agree on. We don’t think we should cut doctors 21 percent next year. We’ve stopped those cuts from occurring every year for the last seven years. We all call this, here in Washington, the doc fix. Well, the doc fix, according to your numbers, costs $371 billion. It was in the first iteration of all of these bills, but because it was a big price tag and it made the score look bad, made it look like a deficit, that bill was — that provision was taken out, and it’s been going on in stand-alone legislation. But ignoring these costs does not remove them from the backs of taxpayers. Hiding spending does not reduce spending. And so when you take a look at all of this, it just doesn’t add up.

He’s right. Ignoring the doc fix does not “remove them from the backs of taxpayers”. That’s why I expect Ron Paul and Paul Ryan to introduce legislation to freeze reimbursements to physicians, along with repealing the Affordable Care Act.

If they don’t, and they won’t, because Republicans know full well why they took the House in November, and it had nothing to do with their purely mythical prowess at balancing budgets, the doc fix claim goes from theory to practice, from nonsense to dishonest.

Here’s Mr. Fiscal Conservative Paul Ryan again, at the healthcare summit, introducing the GOP political strategy for the midterms:

Now, when you take a look at what this does, is, according to the chief actuary of Medicare, he’s saying as much as 20 percent of Medicare’s providers will either go out of business or will have to stop seeing Medicare beneficiaries. Millions of seniors who are on — who have chosen Medicare Advantage will lose the coverage that they now enjoy.

I’m going to repeat Krugman’s main point, and rephrase it as a question. It’s the first question from this point forward, because, as you know, Republicans took the House:

Would the same spending still be necessary if we undo reform?






23 replies
  1. 1
    Ija says:

    Don’t they get to appoint their own head of CBO since they’ve taken the House? That’s what happened in 2006 when Democrats took the House and Senate, right? They appointed Orszag? Maybe they want to wait for the numbers from their CBO.

    It’s bullshit. The Republican base is old people, they will never do anything to anger the seniors. Health care reform or no health care reform, the doc fix stays.

  2. 2
    Kay says:

    @Ija:

    Here’s the info:

    The Speaker of the House of Representatives and the President pro tempore of the Senate jointly appoint the CBO Director, after considering recommendations from the two budget committees. The term of office is four years, with no limit on the number of terms a Director may serve. Either House of Congress, however, may remove the Director by resolution.

  3. 3
    Ija says:

    @Kay:

    So now it’s an issue because the House and Senate are held by different parties, so they might not agree on a CBO director. Do we really think Speaker Boehner would agree to keep Doug Elmendorf?

  4. 4
    Montysano says:

    And it’s not about the money. As I tried to explain in my last column, the modern G.O.P. has been taken over by an ideology in which the suffering of the unfortunate isn’t a proper concern of government, and alleviating that suffering at taxpayer expense is immoral, never mind how little it costs.

    I’m so thankful that I’m not that. What a horrid way to go through life.

  5. 5
    cmorenc says:

    What are the chances of the MSM pointedly catching the GOP for this bit of obvious fraudulent accounting? Shouldn’t this be a primary question to insistently ask any member of the GOP House leadership who goes on any of the Sunday talkies next week? IMHO the late Timmeh would have, but not so sure about his successor David Gregory, who shows signs of being less consistently a GOP tool lately, but nonetheless is still well short of achieving any bona fide not-a-tool status.

  6. 6
    Uloborus says:

    Ah, thank you! I was too lazy to look up what docfix was and find out exactly how change was wrong this time. After awhile it gets tiring.

  7. 7
    Kay says:

    @Ija:

    Honestly, I don’t think it matters. The single conservative idea to control Medicare costs was Medicare Advantage. The idea behind privatizing 1/5 of Medicare was (supposedly) to save money.

    That failed. Ryan defends Medicare Advantage, on the ridiculous grounds that seniors should have a “choice”. But the POINT of “choice” was competition. The word “choice” doesn’t have magical cost-saving properties.

  8. 8
    Ija says:

    @Kay:

    The word “choice” doesn’t have magical cost-saving properties.

    I think it does to Republicans. See also: school choice. Not only magical cost saving properties, magical teaching properties as well.

    I guess my point regarding the CBO is, they can pretend that CBO is actually NOT non-partisan because Democrats appointed the director. As a result, they can ignore the CBO numbers.

  9. 9
    Chris says:

    The key paragraph from the Krugman blog post was this;

    The key to understanding the G.O.P. analysis of health reform is that the party’s leaders are not, in fact, opposed to reform because they believe it will increase the deficit. Nor are they opposed because they seriously believe that it will be “job-killing” (which it won’t be). They’re against reform because it would cover the uninsured — and that’s something they just don’t want to do.

    Followed by the “it’s immoral to care for the uninsured” paragraph. That’s something we don’t hear nearly enough about in today’s politics.

  10. 10
    burnspbesq says:

    Old dog, still hunts, as St. Molly used to say.

    “Q: How can you tell that a Republican is lying?
    A:His lips are moving.”

  11. 11
    Ija says:

    “it’s immoral to care for the uninsured”

    That’s blood libel! How dare Krugman implies that Republicans don’t care for the uninsured. Is there no end to this pogrom against Republicans?

  12. 12
    gene108 says:

    Krugman is wrong about the GOP not caring about poor people. The basis of the modern GOP is to win elections at any cost. There only ideology is to have power and to maintain power. Period.

    If poor people voted in large numbers and thus effected the outcome of elections, the GOP would start to cater to them.

    As it is, the poor are not a reliable voting block or one that votes in large numbers relative to their size in the population, unlike the wealthy who really give a damn about elections the outcomes those elections will have on their wealth.

    Therefore the GOP caters to the wealthy because the wealthy, especially after the Citizen’s United decision, can throw gobs of money around to influence elections and have a greater impact on elections than just their vote.

  13. 13
    J says:

    @Montysano: Superb as this column by Krugman was, there is one way in which I don’t think it goes far enough. You might go away from the the key paragraph that Montysano & Chris quote thinking that the Republicans hold a principled position, repellent but principled. But if never letting the government do anything to help the disadvantaged (or even the not supremely advantaged) is a fundamental principle of theirs, it co-exists with what is bound to look like a complete lack of principle to the rest of us, i.e., the willingness to tell an lie, spread any slander, practice any deceit to get their way. I have trouble viewing a position as principled unless, whatever other principles it may include, it isn’t committed to a minimal level of honesty.

  14. 14
    b-psycho says:

    He’s right. Ignoring the doc fix does not “remove them from the backs of taxpayers”. That’s why I expect Ron Paul and Paul Ryan to introduce legislation to freeze reimbursements to physicians, along with repealing the Affordable Care Act.

    Actually it’d be kinda cool if they did that, just for the dissonance of Rand Paul filibustering his dad’s bill.

  15. 15
    Agoraphobic Kleptomaniac says:

    It’s amazing that the more I know about republican proposals, the more fantasy they become.

  16. 16
    Elizabelle says:

    Good morning. Testing iPhone commenting

  17. 17
    Tom M says:

    IMHO the late Timmeh would have, but not so sure about his successor David Gregory,

    @cmorenc
    Oh, please. Timmy was a next door neighbor to Jack Welch on Nantucket. That homespun crap was Timmy’s forte, along with the endless drivel about Big Russ. But Tim was a rich, no, very rich purveyor of Village idiocy. His other constant was his persistent obliviousness on Social Security.
    Gregory, OTOH, only got married on Nantucket.

    Russert is part of the Nantucket NBC crowd, one of the cliques that fuels the isle’s social engine. It was Jack Welch, the story goes, the 20-year chairman and CEO of NBC’s parent company, General Electric, who drew network folk to Nantucket.

    Russert and his wife, Vanity Fair writer Maureen Orth, began summering on Nantucket in 1992…..

    Russert’s boss, NBC CEO Bob Wright, is also on the scene. Add to the cocktail chatter the latest tidbits from the Oval Office, care of White House correspondent David Gregory, who was married on Nantucket and returns with his wife, Beth, for vacations.

    They are both Village insiders with the only real difference being one’s dead. Good riddance.

  18. 18

    […] the Republican effort to undo healthcare reform in the name of fiscal responsibility is actually nuts since the whole point of HCR was to LOWER THE DEFICIT… plus, if you repeal it… you […]

  19. 19

    […] the Republican effort to undo healthcare reform in the name of fiscal responsibility is actually nuts since the whole point of HCR was to LOWER THE DEFICIT… plus, if you repeal it… you […]

  20. 20
    Mike Kay says:

    Paul Krugman is the Anti-Christ!

  21. 21
    Mike Kay says:

    @Tom M: Tim Russert was the Anti-Christ!

  22. 22
    Mike Kay says:

    @Ija:

    “it’s immoral to care for the uninsured”

    what does that say about the few high profile bloggers who felt it was more important to “kill the bill” (HCR) then cover the uninsured.

  23. 23
    A Humble Lurker says:

    @Mike Kay:

    @Ija: what does that say about the few high profile bloggers who felt it was more important to “kill the bill” (HCR) then cover the uninsured.

    On a similar note, what does that say about bloggers who felt it was more important to let all the tax cuts fail than for unemployment checks to keep going out?

    Sorry. I hated that too, but I was very disappointed at how many I heard on the left who seemed to be saying ‘screw the unemployed!!’. Both my parents were hard workers, but they both had periods where they had to depend on unemployment between jobs. So that shit kind of bothered me.

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