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Bizarro Health Care World, Brought By Bachmann and Ezra Klein

Bizarro Bachmann:

BACHMANN: A couple of months ago I was in the White House with President Obama. We asked him three times, ‘what’s your plan to make Medicare solvent.’ He mumbled around and didn’t give answer…he said, ‘Obamacare.’ And so what senior citizens don’t realize is that President Obama’s plan for Medicare is they will all go into Obamacare. There won’t be a Medicare going forward under President Obama.

[cue sarcasm] Yes. This would be why the Affordable Care Act ripped Medicare out of the clutches of insurers by ending the Medicare Advantage subsidies. So he could turn it into the Paul Ryan plan for privatized Medicare handled by insurance companies who are about 300% less efficient than Medicare is. Sure. [end sarcasm]

So I wrote a post about Michele Bachmann’s bizarro world and posted it on Crooks and Liars with a passing reference to Bachmann’s inanity. In fact, this was my comment on that particular insane moment:

Check out the clip at the top from BillO’s show last night for an example of how she operates. Note how, after ducking questions about how she would handle “entitlement reform,” she leans into Bill and insists on sharing a bit of gossip that cannot be confirmed or denied. She says, confidentially, of course, that she and some others met at the White House with President Obama and when they asked about Medicare, he said “Obamacare.” She sort of expanded on that to suggest that Medicare would devolve into subsidized, means-tested private health insurance. Yes, that’s what Michele Bachmann says the President said.

But wait. That’s Paul Ryan’s plan. No worries, Fox viewers, Michele Bachmann creates whatever reality she wants to live in, especially if it stokes anxiety and fear about the scary black man in the Oval Office.

And honestly, I gave it no more weight than that. Until I happened to catch digby’s post, where she quotes Ezra Klein’s post about an earlier and similar Bachmann moment:

Ironically, bringing ObamaCare to Medicare is an obvious long-term compromise on health care. If Republicans can make their peace with the Affordable Care Act and help figure out how to make the Affordable Care Act’s exchanges work to control costs and improve quality, it’d be natural to eventually migrate Medicaid and Medicare into the system. Liberals would like that because it’d mean better care for Medicaid beneficiaries and less fragmentation in the health-care system. Conservatives would like it because it’d break the two largest single-payer health-care systems in America and turn their beneficiaries into consumers. But the implementation and success of the Affordable Care Act is a necessary precondition to any compromise of this sort. You can’t transform Medicaid and Medicare until you’ve proven that what you’re transforming them into is better. Only the Affordable Care Act has the potential to do that.

So Bachmann is perhaps right to say that the president is moving us towards a day when ObamaCare — or, to put it more neutrally, “premium support” — might come to Medicare. He’s seeing whether it works in the private health-care market first and, if it does, there’s little doubt that the political pressure to extend it to other groups will be intense.

To which I respond to Ezra (albeit about eight weeks too late) with this question: Ezra Klein, have you lost your mind?

Digby writes:

I reacted rather badly to that when I first wrote about it. I certainly don’t recall anyone saying that the health care reform would eventually lead to Medicare being abolished. Indeed, those of us who favored Medicare for all were told repeatedly that the Rube Goldberg ACA was necessary as a first step to its expansion.

Bachman’s been saying this for a while and it’s a clever line. I wouldn’t be surprised to see the GOP adopt it more widely. Her understanding of how and why that happens is silly and confused, but according the Ezra she isn’t wrong. Indeed, it’s apparently the dream of all the policy wonks who designed the ACA. You can’t blame the Republicans for using it — it has the ring of truth.

Note to digby: I’m one of the ones who believes the Affordable Care Act is the next step to Medicare for All. And I’ll defend that belief by noting that it enables states to establish single-payer plans which dovetails with President Obama’s statements in support of state-sponsored single payer health plans.  If I’m wrong, I’ll eat my words and my hat.

Yes, now I am fully submerged in bizarro world. So my next stop is the President’s April speech where he shreds the Ryan plan up one side and right down the other. Because really, Paul Ryan’s plan is nothing more than an extension of the Affordable Care Act to people over age 65; a Medicare Advantage on steroids, if you will.  Why on EARTH would Ezra think that subsuming traditional Medicare with the Affordable Care Act “premium assistance” would be cost-effective or in any way a policy goal of this administration? From the President’s April speech:

It’s a vision that says America can’t afford to keep the promise we’ve made to care for our seniors.  It says that 10 years from now, if you’re a 65-year-old who’s eligible for Medicare, you should have to pay nearly $6,400 more than you would today.  It says instead of guaranteed health care, you will get a voucher.  And if that voucher isn’t worth enough to buy the insurance that’s available in the open marketplace, well, tough luck -– you’re on your own.  Put simply, it ends Medicare as we know it. 

Does that sound like he’s got some secret plan to shift everyone from Medicare to the subsidized premium model? Sure doesn’t sound like it to me. And later in that speech, he affirms that:

The third step in our approach is to further reduce health care spending in our budget.  Now, here, the difference with the House Republican plan could not be clearer.  Their plan essentially lowers the government’s health care bills by asking seniors and poor families to pay them instead.  Our approach lowers the government’s health care bills by reducing the cost of health care itself. 

Right. Not by shifting to privatized Medicare and providing “premium assistance”, but by getting costs down, which is a huge, major, important goal.

Already, the reforms we passed in the health care law will reduce our deficit by $1 trillion.  My approach would build on these reforms.  We will reduce wasteful subsidies and erroneous payments.  We will cut spending on prescription drugs by using Medicare’s purchasing power to drive greater efficiency and speed generic brands of medicine onto the market.  We will work with governors of both parties to demand more efficiency and accountability from Medicaid.

We will change the way we pay for health care -– not by the procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results.  And we will slow the growth of Medicare costs by strengthening an independent commission of doctors, nurses, medical experts and consumers who will look at all the evidence and recommend the best ways to reduce unnecessary spending while protecting access to the services that seniors need.

Now, we believe the reforms we’ve proposed to strengthen Medicare and Medicaid will enable us to keep these commitments to our citizens while saving us $500 billion by 2023, and an additional $1 trillion in the decade after that.  But if we’re wrong, and Medicare costs rise faster than we expect, then this approach will give the independent commission the authority to make additional savings by further improving Medicare.  

So far, so good. He rejects outright the idea of turning health care over to the states, but instead using Medicare as a model to reduce health care costs across the board for all. So now we turn to his conclusion:

But let me be absolutely clear:  I will preserve these health care programs as a promise we make to each other in this society.  I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs.  I will not tell families with children who have disabilities that they have to fend for themselves.  We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations.

I don’t really think it gets clearer than that.

Now I’m sure I’ll hear a lot of grumbling about how he “put Medicare on the table” for the “grand bargain.” Well, yes he did. And one of the proposals that was floated was raising the Medicare eligibility age to 67 beginning in 2017 and ending in 2030, which means the Affordable Care Act will have been in effect for 16 years at the first raise point. Sixteen years is about the right time horizon to be seeing some very serious changes in health care costs under the framework outlined above. It doesn’t end Medicare, nor does it leave older people dangling out in the wind with no health insurance or safety net because the Affordable Care Act’s subsidies are still there. Nor does it replace one with the other. It simply blends the transition.

It seems to me that any thoughts that the plan is to turn Medicare into Obamacare are the product of Michele Bachmann’s fevered brain and have been augmented by fear that any effort to touch Medicare will kill it. I obviously think Bachmann is out to lunch, and for that matter, so is Ezra Klein on his speculative post.

Let’s leave bizarro world and talk about facts for a minute. Medicare has a problem, and liberals have a choice. We can either work on fixing the problem while we have someone in office who doesn’t want to kill it, or we can be obstinate and unyielding and leave it for President Bachmann/Romney/Huntsman/OtherUnnamedRepublicanPresident, who, as a matter of ideological purity, loathes Medicare and Social Security and the whole idea of a social safety net.

If we, as Democrats/progressives/etc, created it, we ought to own the responsibility to fix it. And there aren’t that many ways to do that. Here they are:

  • Control health care costs. (ACA – Check)
  • Encourage healthy lifestyles (ACA – Check)
  • Negotiate drug prices – Maybe, but doubtful with this Congress
  • Maintain benefit levels but defer eligibility to slow entry during the baby boomer eligibility phase – Maybe it will happen
  • Raise taxes to pay for Medicare costs – Good luck with that in this Congress.
  • Open Medicare up to everyone and set a rate for buy-in that covers current and some portion of future costs – Get a FDR Congress that’s about 70 Senators and 300 in the House first.

There may be more, but these are the highest-profile policy solutions at this time. It’s great to talk about how Medicare for all would solve many problems. I happen to agree with that. But we don’t live in a reality where that’s going to happen right now. The best possible outcome we can (maybe) hope for would be negotiated drug prices, slower entry, and some slight increase to the Medicare payroll tax rate.

That’s it. And, by the way, that’s more or less (with exception of the tax rate), what the President put on the table for the Grand Bargain. Liberals everywhere howled, but the fact is that if we’re going to be good stewards of the New Deal, we’d damn well better own the problems and fix them while we have the chance, because I guarantee you that any weaknesses in these programs which exist at the time a Republican takes the White House will be exploited to end them forever.

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