President Obama’s speech really brought home how confused and disoriented liberalism is today, and how very difficult it will be for the Left to accept that the social-democratic welfare state is collapsing and something else must take its place. Yet the very fact that he felt compelled to make such a speech does offer some hope.
As recently as February, in his budget, Obama essentially denied that we had a fiscal crisis. Today, he admitted it and described it, or at least parts of it. It is certainly unorthodox for a president to renounce his own budget two months after proposing it, but that is just what the president did—implicitly dismissing even the goals set out by his budget in its own terms (let alone its potential to achieve them, as measured by the Congressional Budget Office) as totally inadequate. In that sense, the only immediate practical implication of the speech is that it throws the 2012 budget process into disarray. Are the cabinet agencies supposed to be defending the president’s now-repudiated formal budget request before congressional committees in the coming months, or does the administration now expect Congress to ignore its budget? If so, will the administration be offering some particular alternative requests, with details that (unlike this speech) can be scored by CBO?
The other implications are less direct, because the president mostly laid out ends without means. He accepted much of Paul Ryan’s definition of the problem we face, but insisted that it could be solved by trimming our welfare state at the edges, rather than reforming and restructuring it. He held up past examples of such trimming as his model—arguing, preposterously, that the budget agreements of the 1990s, which offered slight adjustments without reforming the institutions of our welfare state, were successful and that we only face a crisis today because George W. Bush cut taxes. In fact, those budget agreements bought a little time while ignoring the basic problem—especially the entitlement problem. That’s why we are where we are, and Obama now proposes to just put the blindfolds back on and make the same mistake again.
Obama offered a kind of “Robert Bork’s America” description of the Ryan budget, filled with ludicrous distortions, and then argued that he could achieve the same fiscal goals by different means. What means? Apparently there are four: First, discretionary spending cuts that amount to an extension of the cuts in this year’s budget. Second, defense cuts that will be decided after yet another review. Third, health-care cost reductions that will be achieved by giving even more power to the panel of experts created by Obamacare to make one-size-fits-all rationing decisions and by assigning that panel even more ambitious goals than the ones that the actuary of Medicare and Medicaid says the panel is already very unlikely to meet. And fourth, greatly increasing taxes.
A fact sheet put out by the White House offers a few more details, though no clearer sense of how the president expects these steps to add up to the kind of savings he says they will achieve. It includes some fairly silly gimmicks. For instance, the president defines his near-term goals using a 12-year budget window, to give the illusion that he would achieve savings on the level of the fiscal commission and the Ryan budget (both of which use the usual 10-year window required by the budget process). He guarantees long-term budget reductions (and therefore on paper guarantees the achievement of his goals without specifying particular means) through a “trigger” that would go into effect at the end of Obama’s second term, forcing arbitrary budget cuts upon his wretched successor when the Obama “framework” has failed to reduce spending. The fact sheet speaks in glittering generalities about such things as “a target of $360 billion in savings from other mandatory programs by 2023,” and commitments to “enact anti-fraud measures.” It implicitly acknowledges that Obamacare would fail to control health-care costs and yet proposes to control those costs by just doing more of what Obamacare would do—tighter rationing within the current program, rather than a fundamentally different approach to helping seniors pay for health insurance.
And yet, for all of its profound inadequacy—its dearth of self-awareness and excess of self-righteousness, its distortions of facts, its contortions of language (“spending reductions in the tax code”? really?), its lack of specificity, its unseriousness—this speech is on the whole a good sign. I fully expected the Democrats to respond to the Ryan budget by simple undiluted demagoguery—that is, with the “Paul Ryan’s America” part of this speech alone. And some Democrats in Congress have certainly done that, with all the usual preposterous dishonesty of the Democrats’ Medicare playbook. But this speech did not limit itself to that. Its demagoguery was diluted some. It accepted Paul Ryan’s definition of the fiscal problem, and it accepted more or less his broad outline of what a solution would look like in fiscal terms—in terms of deficit and debt reduction. And so it defined the debate going forward as a debate about how best to achieve the Republicans’ fiscal goals.
President Obama’s answer to that question is that we can achieve those goals by slight technical modifications of the welfare state we have had since the mid-1960s. Paul Ryan’s answer is that we can achieve those goals by reimagining the welfare state for the 21st century—for an age when the legitimacy of capitalism, the efficacy of markets, the capacity of consumers to make sensible decisions, and the value of choice and variety are hardly questioned; for an aging society that for too long has spent its economic and human capital without giving thought to how they might be replenished and now wants to correct its mistakes. That debate will be the essence of our domestic politics in the coming years. It is a debate about how to fix the terrible mess created by the Great Society—a debate we have put off for too long, and that most on the left would still like to avoid at all costs. It is a debate for which (thanks especially to Ryan) Republicans are suddenly unusually well prepared, and for which (as Obama’s speech demonstrated) Democrats are dismally unready.
It is a good sign that President Obama has judged that he can’t simply avoid this debate, even if he intends to engage in it in such an unserious way. It won’t be a calm, civilized dispute among wonks, and it shouldn’t be. It will be a political struggle, fought out over several elections and no doubt beset on all sides by gimmicks, distortions, and posturing. There is no getting away from that in our democracy. But it is a debate the country could really use and which, in the long run, if we’re lucky, might even allow us to find for ourselves again the path of shared prosperity and constitutional government. And we’re Americans, so we already know we’re lucky.
Cut to the chase, guys.
If the voucher isn't enough to cover enough insurance to keep you in the black, what do you do? Put another way, how do we make sure that the voucher will be enough?
Reply to this commentLinkReport AbuseWhat a wonderful and nuanced take on the whole budget situation. Maybe this is just hype but it certainly seems that in the next few years we as a country are going to decide whether to prosper or go into a European style decline (or perhaps, go further into such a decline). I certainly hope things work out for the best and will try towards that end. I think as Republicans we need to try to maintain some hope, at least a little, sometimes we get so negative and that seems counterproductive. Maybe, I'm just crazy.
Reply to this commentLinkReport AbuseClinging bitterly to failed programs ...
Reply to this commentLinkReport AbuseA fair question, MB, and one I certainly don't have an answer to (I'm not a budget wonk). The reverse question for how Medicare is currently managed is "How do you make sure that defined benefits won't cost too much?" The history of Medicare suggests that there is no answer.
Reply to this commentLinkReport AbuseThe voucher, in Ryan's current proposal, is for $15,000 annually per person. It will be means tested, so that wealthier Medicare recipients will get less. Recipients who have serious health issues or are poor will get more. There may be a geographic adjustment for high cost areas.
Recipients are expected to contribute something to their health care costs, just as they do today through Part B premiums, Medigap insurance and drug deductibles.
What people seem to miss, and this goes to the heart of the issue, is that by removing the vastly market disruptive Medicare fee-for service formulations, medical care prices will adjust. We private insurance people have been subsidizing Medicare indirectly through higher costs for years as providers shift costs from Medicare patients to us.
Reply to this commentLinkReport Abuse"Obama offered a kind of 'Robert Bork’s America' description of the Ryan budget, filled with ludicrous distortions, and then argued that he could achieve the same fiscal goals by different means."
This should come as a surprise to exactly nobody. This is what Obama does. Every single time. He sets up a phony argument that bears the following characteristics:
1) A twisted version of a conservative position that no sane person is making, and;
2) A ludicrous position so far to the left even Michael Moore would reject it.
He then ascribes by implication, the former to his opponents on the right, and rejects both it and the ridiculous leftwing position, thereby casting himself as a moderate.
He ends up saying something like this: "There are those who would deal with our problems by putting health care into the hands of insurance companies and thereby destroying Medicare. And there are those who say we should solve Medicare's funding problems by imposing punitive taxes on every dollar of income earned by the wealthy, regardless of the source, and doubling the corporate share of the Medicare tax. I reject both of those solutions."
And then the drive-by media applaud and proclaim Obama is really a moderate, willing to compromise on the hard decisions.
Makes me want to throw up in my mouth every time I hear it - which is every time he makes a speech.
Reply to this commentLinkReport AbuseWhile you're choking on your vomit, Bernie, cut to the chase.
What happens if the voucher ain't enough?
Reply to this commentLinkReport AbuseStick with me here - it’s third grade all over again. Our class was divided into three reading groups to better facilitate the learning process by grouping students with similar abilities. Of course, the teacher never explicitly stated as much, but to those of us in Group 1, it was pretty obvious. I’m sure that today such a grouping would be found damaging to the self esteem of the Group 2 and 3 readers, but that’s another story…
We had a rather amiable young chap in class that we’ll call Charlie, solidly at the bottom end of the Group 3 readers, who had a penchant for inserting a multitude of 3rd grade writing and other utensils into the accessible orifices of his rather large noggin. Young Charlie had been warned repeatedly not to engage in such activities, but he persisted until the day his pencil eraser became detached and, much to his horror, lodged in his nasal cavity. The Group 3 girls were the first to notice the panicked look in our subject’s eyes, and the teacher, who was astonishingly calm as I remember, promptly escorted him to the school nurse for the eraser extraction procedure. Fifteen post-op minutes later, the glowing, smiling, and slightly slobbering young lad triumphantly returned to class, oddly enough, with a lollipop in his mouth. I remember thinking that that was quite a gig (and an older observer would surely note the irony) but quickly performed the third-grade version of a cost/benefit analysis and decided that there were easier ways to come by a Tootsie Pop.
This was my first year in school with Charlie, and I, like everyone in our class learned very quickly what to expect from him in terms of classroom skills and general demeanor. We all liked Charlie and wished him well, but it was obvious he’d not be in the running for valedictorian. I’m sure the lad had talents outside of the academic setting, but the classroom was not his friend. However, occasionally Charlie would surprise everyone (the Group 3 girls were especially impressionable) and do something completely out of character or would get a seemingly impossible (for him) correct answer on the blackboard. These moments were highlights for Charlie, and they undoubtedly offered glimmers of hope to his teachers and classmates. For the most part, we always had caring teachers, and of course they really played up these rare moments in time with excessive positive reinforcement. But, after the applause and the grinning and the high fives died down, Charlie was still Charlie.
Barack Obama had a Charlie moment when he extended the Bush tax cuts and got some practical things accomplished at the end of 2010. Like one of Charlie’s overly enthusiastic school teachers, the mainstream press beamed and gushed as if this was the return of the prodigal son. A practical, calculated move to the center they said. Much like Charlie sounding out one of his spelling words that the entire class had already learned, Barack finally did something presidential. Undoubtedly, Barack is a fabulous Marxist and one heckuva community organizer, agitator and campaigner, but the White House is not his friend. In reality, Barack’s lapse into competence was really more like Charlie pulling a pencil out of his nostril at the last possible fraction of a second to avoid being sent to the principal’s office.
With an election just around the corner, my biggest fear is that Barack feels the teacher’s stern hand on his shoulder and will pull an eraser, or some other object, out of an orifice in time to correctly pronounce something from page one of Little Toot, and Ali Bama and his 2000 press secretaries (thank you Pat Caddell) will convince enough of the Group 3 crowd that they have just witnessed greatness and that he wins another election. If that happens, much like Charlie with full access to the office supply aisle at Staple’s, Barack will immediately return to his true transformational agenda, and even the slowest among us will eventually understand that Charlie will always be Charlie.
Reply to this commentLinkReport Abuse@MikeB
One approach would be to means test it like any other welfare program. In other words, if given a person's income and the size of the voucher, if they still have inadequate resources to afford insurance then you put them in some sort of welfare program. You should take care to insure that people are truly in a poverty situation before you give them welfare, i.e. if you have cable TV and a cellphone you don't qualify.
This type of means testing is a way to address the problem. Not every Conservative will be enthused with it, certainly not those of a libertarian bend and I'm not sure I like it, but it makes imminently more sense than having the government take control over large sections of the economy.
After all, to address hunger we give out food stamps, we don't have the government take over the production, preparation, and distributions of food in the country.
The problem with this approach is that the left hates it more than the right. They are looking for a very large (in fact universal) government welfare program so that they can ensure future governing majorities by telling the electorate that they will give them more benefits if elected or by holding out the specter that the evil Republicans will diminish their current benefits which they have now become addicted to. That's why it is the left which refuses to discuss sensible things like means testing Social Security benefits. A limited scope welfare program just doesn't win them elections.
Reply to this commentLinkReport Abuse"If the voucher isn't enough to cover enough insurance to keep you in the black, what do you do?"
You don't get the treatment. People are ready to pay millions of other people's money to extend their lives for 2 days but they are not ready to pay $20,000 of their own money to extend it for a month.
Yet, those trade-offs have to be made. Either they will be made by individuals or by 'death panels'. The advantage when they are made by individuals is that this will drive the costs of treatments down. But there will still be many treatments, some of them potentially life-saving, which will need to be forfeited by individuals who can't or don't want to pay for them.
Personally I very much resent Ryan's plan because it protects those over 55 from these trade-offs and saddles the rest of us not only with the reality of being denied treatment, but also with the debt those "poor seniors" amassed while gorging on Medicare. So, though I vehemently opposed Obamacare I prefer death panels to Ryan's plan.
Reply to this commentLinkReport AbuseThe government is not a charity. Was never intended to be. Contrary to liberal belief it is not a bottomless pit of money to be handed out without regard to the public trust. Prior to FDR and LBJ people relied on family and that tried and true virtue called self reliance. It's what built this nation. It's what the greatest generation failed to pass on to this immature generation of whiners and complainers.
Reply to this commentLinkReport AbuseMikeB: "What happens if the voucher ain't enough?"
Use some of your own income to pay for your insurance. Duh.
Or do you think nobody should have to use any of their own money to pay their own expenses? That the magical government money tree will pay all your bills for you?
Welcome to Planet Earth, MikeB.
Reply to this commentLinkReport AbuseMikeB said, "What happens if the voucher ain't enough?"
Mike B. you must have never hear of Medicare Advantage. Medicare already does not cover everything and Medicare Advantage was created. It is a supplemental coverage plan that Seniors can purchase, with their own money, to cover those items not covered, or not covered completely, under Medicare.
So complaining about a voucher program, that would give seniors a chance to shop around for the right coverage for them, because it may not cover the policy of their choosing completly is disingenuous.
Reply to this commentLinkReport AbuseFirst, the President has, once again, committed the error he never seems to learn from, he doubled down on a hugely unpopular idea. Second, he has now proven himself entirely untrustworthy in his obvious renegging on his tax deal from last December. Thirdly NO ONE believes that a tax hike will be used to pay down the deficeit. It is just NOT how Democrats operate.
Reply to this commentLinkReport AbuseJust wanted to hear you guys say it:
"You don't get the treatment."
"Use some of your own income to pay for your insurance."
Fair enough. We should just tell each other the truth.
Reply to this commentLinkReport AbuseI may be mistaken about the meaning of "voucher".
Reply to this commentLinkReport AbuseIsn't the voucher usable to purchase insurance?
Then, the insurance covers the procedure that costs more than $15,000, same as with any insurance.
Except for union members and top executives, $15,000 buys an excellent health insurance policy.
Quote MikeB "Just wanted to hear you guys say it:
"You don't get the treatment."
"Use some of your own income to pay for your insurance."
Fair enough. We should just tell each other the truth."
Not that this is the only solution (see my response below), but exactly how do these responses above differ from almost any other aspect of life? Some people can afford a mansion and some people can afford a trailer. The trailer is neither as comfortable nor as safe as the mansion yet, this is how life works. You can do great damage trying to achieve an unobtainable perfect distribution of wealth, services, healthcare, etc. In fact millions were sacrificed on this altar in the prior century. Life is not fair. It never will be. The quicker you learn that the better life will be for everyone, including those at the bottom. For you see, instead of wrecking a society, an economy, a healthcare system, etc. in pursuit of some unobtainable equitable distribution of wealth it might occur to you to actually help those at the bottom improve their situation.
Reply to this commentLinkReport AbuseF.D. O'Toole: $15,000 buys an excellent health insurance policy.
I would like to see you find an insurance company that would sell any policy, let alone at $15,000 to a senior. A senior is a walking pre-existing condition. Further, seniors are probably not working and thus not eligible for the group rates offered through companies. Getting an individual policy at all when you've had any previous conditions is near impossible. That's why there is Medicare.
Reply to this commentLinkReport AbuseNothing is going to work. We're all doomed.
Seriously, we're doomed. This is an insurmountable obstacle for our country.
No, it's not that the numbers are too big to get under control... if we really wanted to, we could theoretically do it.
But the fact is that we won't. There is simply no political will anywhere but on the very fringes of the right who are willing to come out and say that the only way to save this country is to turn the clock back on our social programs by about fifty years.
Nobody wants to hear that, much less do it. Not on the left and not on the right. Sure, independents are gravely worried about our fiscal situation, as well they should be. But they have no stomach for the cure. Nor do mainstream Republicans. And forget about liberals... they're split between those who refuse to believe there's a problem at all and those who are deliberately trying to tank the economy in order to spawn a new socialist system, by making it so bad that most of the public has no choice but to depend on the government.
The bottom line is that true reform is never gonna happen. We're past the tipping point where enough people are dependent on their handouts (in one form or another) that even if their principles align them more with the right, their livelihoods force them to vote towards the left. Compound that with a media culture that is incapable of properly informing the public, and enough politicians who are willing to speak whatever platitudes the voters want to hear in order to convince them that not only is armageddon NOT just around the corner, but that the free lollipops will never end (and that it's their God-given right to have free lollipops), and you have a recipe for... well, nothing. Nothing at all.
We've completely ignored the constitution for too long. We've strayed too far from the principles that built this country into what it is. We've allowed ourselves --all of us-- to get lazy, both intellectually and physically, and we have nobody to blame but ourselves for it. We've happily and eagerly been sold a bill of goods by one pied piper of socialism after another, who told us that we can have it all, and not have to work terribly hard (or pay) for it, because The Government will take care of everything, somehow. We allow our children to be taught that we've never been exceptional, that our culture is nothing special or particularly worth saving and that everyone hates us because we're viewed as a force of evil in the world.
And now that it's all crashing down around us, our leader closes his eyes, puts his fingers in his ears and says "LALALALALALAA EVERYTHING IS FINE! LALALALALAA"... and more than 50% of the country STILL swallows it whole and puts their hand out for another entitlement.
We can't fix things with a 50% plurality. We can't even fix things with a 60% majority. We're way past half-measures that can be squeaked through in compromise legislation. We need 90%+ support from the population in order to do what really needs to be done, and quite frankly it will simply never happen. At least, not in any future I can foresee at this point.
Quite frankly, we're doomed. The left has played it's hand well, and the right slept through most of it. Now that we've woken up and began to make noise about the impending demise, we're viewed as fringe lunatics by a hostile media and a public fattened and accustomed to the entitlement culture.
We have no arrows left in our quiver other than the ability to shout as loud as we can and pray that it makes a difference somehow. Oh and we'll soon have the luxury of 'I told you so' when the economy collapses entirely and the 'social justice' amendment is written into the constitution. By then it won't matter though. Or at least, less so than it does now, because socialism, as we've come to find out, is all but irreversible.
Reply to this commentLinkReport AbuseI think FD O'Toole is right, the voucher is to purchase insurance -- treatments are to be covered by the insurance. Insurance companies want money, so they will offer some kind of plan at whatever price point the vouchers tend to be for. Discerning individuals will look for differences between the plans to get one that most closely matches the treatment they expect. If one company can offer more coverage of care/treatments than another, its policy will become more popular. Other companies will then look for ways to better compete. Like the auto insurance companies that cater to high-risk drivers, some policies will be designed to cater more to diabetics (for example) or cancer survivors.
And if no company thinks they can offer a policy that covers whatever the consumer is most interested in (e.g. cancer) and still profit, then it won't be offered. Or a company might offer a rider for an additional charge (paid for with the person's own money, not the voucher) to cover the condition in question.
The question is essentially irrelevant. No policy covers everything, not even the ones paid for by employers. Sometimes treatments are expensive for one reason or another and beyond what any company can cover. Some people are unlucky and get the condition that needs expensive treatment to be survived. It has nothing to do with whether the voucher-purchased insurance covers a given treatment.
But the government will not be in a position to deny you treatment based on anything other than your profitability. The insurance company will use profitability over a group as a guideline, but the government might implement class warfare outright and approve more treatment for one class vice another class. The committee that decides such things (not to say death panel) will be unaccountable bureaucrats. If your insurance doesn't cover you the way you expected, you can sue the company, and anyone covered by that company can easily move to another provider. What can you do if the government doesn't cover something?
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