Medicare Miracle?

More Krugman on good health care news...Medicare is, perhaps not a "miracle," but in very good shape compared to the dire predictions of crank "deficit scolds" (who routinely used the worst Medicare predictions moving forward primarily to deflect from the the issue of health care cost inflation to attack any and all government spending - except of course defense):

So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate. 

The story so far: We’ve all seen projections of giant federal deficits over the next few decades, and there’s a whole industry devoted to issuing dire warnings about the budget and demanding cuts in Socialsecuritymedicareandmedicaid. Policy wonks have long known, however, that there’s no such program, and that health care, rather than retirement, was driving those scary projections. Why? Because, historically, health spending has grown much faster than G.D.P., and it was assumed that this trend would continue. 

But a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago. 

This is a really big deal, in at least three ways.

"Washington is still stuck in the wrong conversation"

Ryan Cooper @ WaPo Plumline explains how the Beltway is still stuck on Stupid...or worse:

With the shutdown and debt ceiling crisis over and budget negotiations beginning, it’s worth noting that we’re stuck back in the same old rut we’ve been stuck in since Republicans took the House in 2010. Republicans want cuts to social insurance, or say they do, and Democrats want a bit of new tax revenue in return. On a policy level, this is nuts. We’re trading austerity for…more austerity. Democrats and Republicans ought to consider bringing in other ideas. Almost anything else would be better.

Is a Medicare Cost Slowdown Closing the Budget Gap?

Peter Orzag, former White House budget analyst, points @ Bloomberg to a possible breakthrough in health care costs that could dramatically impact the debate over deficits - at least that part of the debate which is based on honest, informed analysis (which often appears, at least among our elites, to be the terrain amidst this brouhaha that is the smallest and least often heard):

Past Increases in Health Care Costs

New evidence that the slowdown in health care costs over the past five years is happening not only because of a weak economy comes from the Economic Report of the President, released last week by the President’s Council of Economic Advisers. If the slowdown were to continue in the future, the report shows, Medicare spending would basically remain flat as a share of the economy.

Nevertheless, new data suggest Medicare spending growth may be picking up a bit. So it’s important to take more aggressive action to improve value in health care.

"The Sequestering of Barack Obama"

Robert Kuttner @ The American Prospect takes a hard look at the economics and politics of the sequester in the context of President Obama's overall strategic and substantive performance on the economy - a sobering critique:

President Obama has miscalculated both the tactical politics of the sequester and the depressive economic impact of budget cuts on the rest of his presidency. The sequester will cut economic growth in half this year. But it’s now clear, one way or another, that we will get cuts in the $85 billion range that the sequester mandates this fiscal year. All that remains are the details.

Obama’s miscalculation began in his fist term, with his embrace of the premise that substantial deficit cutting was both politically expected and economically necessary, and his appointment of the 2010 Bowles-Simpson Commission as the expression of that mistaken philosophy. Although the Commission’s plan was never carried out, its prestige and Obama’s parentage of it locked the president into a deflationary deficit reduction path.

This past week, we’ve seen how the Republicans took advantage of Obama’s self-inflicted wound. With the March 1 deadline looming, the White House assumed that if the president gave enough publicity to the harm of pending automatic cuts, the Republicans would just cave. But the Republican leadership calculated that the ensuing political and economic damage would be worse for Obama, so they hung tough.

Obama also assumed that military cuts would be enough to move Republicans to  compromise. But with two wars winding down, most Republicans decided that this year they were deficit hawks more than defense hawks.

The president also played the populist card, calling for tax increase on the wealthy to spare the rest of the country program cuts. But that didn’t move the Republicans either.

The Republican leadership also deftly evaded the risk of being blamed for shutting down the government. They offered the Democrats a continuing resolution to allow government to keep operating, but at $85 billion below current spending levels. That shifted the onus to Democrats if they refused to take the deal and Congressional leaders advised the president that they were not prepared to take that risk.

Finally, Republicans took some of the sting—and responsibility—out of the sequester by offering to give Obama new flexibility in how he implemented it, thus making it even more his problem.

Next to come is the long awaited grand bargain of the austerity lobby, in which Republicans agree to close some tax loopholes (which start out grotesquely swollen) and Democrats agree to breach the previously sacrosanct fortresses of Social Security and Medicare.

On all counts, advantage: Republicans.

Long term, colluding in the politics of budget austerity has left Obama with no real capacity to offer the public investment that the economy needs for a robust, broadly-based recovery, and leaves him with the prospect of a weak economy between now and the end of his term--unless he drastically shifts course and repudiates the entire view of the budget and the economy.

Cowards, Liars

 Ezra Klein:

This is pretty much the Republican Party in one tweet:

Today’s Republican Party thinks the key problem America faces is out-of-control entitlement spending. But cutting entitlement spending is unpopular and the GOP’s coalition relies heavily on seniors. And so they don’t want to propose entitlement cuts. If possible, they’d even like to attack President Obama for proposing entitlement cuts. But they also want to see entitlements cut and will refuse to solve the fiscal cliff or raise the debt ceiling unless there are entitlement cuts.

You can see why these negotiations aren’t going well.

Exception to the rule - "A Conservative Case for the Welfare State"

Authentically conservative and eminently sensible policy wonk Bruce Bartlett - a former advisor to Reagan, GHW Bush,  Jack Kemp and Ron Paul - combats The GOP Crazy:

At the root of much of the dispute between Democrats and Republicans over the so-called fiscal cliff is a deep disagreement over the welfare state. Republicans continue to fight a long-running war against Social Security, Medicare, Medicaid and many other social-welfare programs that most Americans support overwhelmingly and oppose cutting.

The bottom line on the central spending issue facing the US

Republicans in Congress opposed the New Deal and the Great Society, but Republican presidents from Dwight D. Eisenhower through George H.W. Bush accepted the legitimacy of the welfare state and sought to manage it properly and fund it adequately. When Republicans regained control of Congress in 1994 they nevertheless sought to repeal the New Deal and Great Society programs they had always opposed.

Energized by their success in abolishing the principal federal welfare program, Aid to Families With Dependent Children, in 1996, Republicans tried to abolish Social Security as well, through partial privatization during the George W. Bush administration, and they more recently have attempted to change Medicaid into a block grant program with funds going to the states and to turn Medicare into a voucher program.

In the 40th anniversary edition of his book, “Capitalism and Freedom,” Milton Friedman advised conservatives to use crises as opportunities to advance their agenda. “Only a crisis – actual or perceived – produces real change,” he contended.

Thus Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.

This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state. Historically, it has been conservatives like the 19th century chancellor of Germany, Otto von Bismarck, who established the welfare state in Europe. They did so because masses of poor people create social instability and become breeding grounds for radical movements.

"Medicare spending isn't out of control"

While there is agreement among economists and health care experts that overall the US has highly inflationary health care expenses over the long term - certainly compared to other relatively wealthy countries with high-quality medical care and much better health outcomes - Uwe E. Reinhardt @ New York Times Economix shows, once again, that the locus of this "out of control" spending isn't Medicare:

It’s the season of holiday cocktail parties, demanding intelligent chit-chat over Chardonnay. In such data-free environments it is always safe to say, “Medicare spending is out of control!” Wise heads will nod, because it is a credo with wide currency.

After all, as I explained in my previous post, traditional Medicare, which still attracts about 75 percent of all Medicare beneficiaries, affords its enrollees free choice of providers and therapy. In the jargon of health-policy wonks, it is “unmanaged.” Thus, it would not be surprising if unmanaged Medicare spending were, indeed, out of control.

But some caution is in order. A really wise guy in the crowd, one familiar with relevant data, might challenge you with: “Oh, really? In what sense is Medicare spending out of control?”

That query might have been prompted by the following data.

 

Kaiser Family Foundation

These data, most of which have been published by the Office of the Actuary, Centers of Medicare and Medicaid Services, of the Department of Health and Human Services (see Table 16), show that in most periods Medicare spending per Medicare beneficiary has risen more slowly than per-capita spending under private health insurance.

The exceptions are the period 1993-97, when private managed-care plans appeared to be able to hold down their outlays on health care better than did Medicare, and 2002-7, because there was a jump in spending as Medicare began, in 2006, to cover prescription drugs under the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

So anyone claiming that “Medicare spending is out of control” can fairly be asked to explain on what data that assertion is based. The responses might be interesting.

Two objections might be raised to my interpretation of the data.

The only way that Social Security and Medicare can go “bankrupt” is if we let them.

James Surowiecki at The New Yorker:

One of the most influential ideas in Washington these days is that Social Security and Medicare are on the verge of going bust. Earlier this month, Senator Lindsey Graham warned of the “imminent bankruptcy” of these insurance programs for the elderly, and Republican leaders are citing the threat of insolvency as a reason that entitlement reform must be part of any fiscal-cliff deal. The argument sounds reasonable enough, but it’s really a bid to turn the great political strength of these programs—the fact that they were designed to be self-supporting—into a weakness.

Unlike most government programs, Social Security and, in part, Medicare are funded by payroll taxes dedicated specifically to them. Some of the tax revenue pays for current benefits; anything that’s left over goes into trust funds for the future. The programs were designed this way for political reasons. When F.D.R. introduced Social Security, he calculated that funding it through a payroll tax rather than out of general tax revenue would make people think of the program not as welfare but as an entitlement—as something that they had paid for and had a right to. Many liberals initially opposed the idea, because payroll tax rates aren’t progressive (everyone pays the same rate) and because they tax only labor income. But the system proved as resilient as F.D.R. had predicted, and when Lyndon Johnson introduced Medicare, in the nineteen-sixties, he adopted it, too. Over the years, Social Security and Medicare taxes have risen sharply, to the point where payroll taxes account for thirty-six per cent of all federal revenue. Today, most American households pay more in payroll taxes than in income tax. Yet there’s little public hostility to these taxes, and the programs they fund remain enormously popular.

But the trust-fund strategy has an Achilles’ heel: funds can run out of money. Projections show that, owing to an aging population and rising health-care costs, the Medicare Trust Fund will become insolvent in 2024 and Social Security in 2033. The image of empty coffers is a powerful one: half of all Americans aged between eighteen and twenty-nine don’t think that Social Security will exist when they retire. That’s a bizarre thing to believe about an important government program. No one ever says, “I don’t think the U.S. Army will be there when I get old” or talks about the Defense Department “going broke.” We assume that there will always be a need for the military, and that we’ll end up paying the taxes that are necessary to fund it. But, because Social Security and Medicare have always been self-supporting, it’s easy to believe that they’ll just vanish if the trust funds dry up. This isn’t the case. Relatively minor tweaks to Social Security will allow it to keep paying full benefits for many decades. And, if we wanted, we could supplement funding for both programs with general government revenue. That’s what most European countries do, and, indeed, parts of Medicare are already paid for out of general revenue. The only way that Social Security and Medicare can go “bankrupt” is if we let them.

"Preserving Medicare Benefits by Controlling Health Care Costs"

From Campaign for America's Future:

The Challenge:

To "fix the debt," we should focus on fixing the economy. Investment in jobs and growth will a) reduce the costs of high unemployment, b) raise more revenue, and b) reduce the debt burden. Instead, a small but well-funded and loud group of "deficit hawks" is demanding to "cut entitlements," including Medicare. Now, as President Obama seems to be on the verge of forcing Republicans to accept tax increases on the wealthy, conservatives are demanding a large payoff in return: cuts to Medicare benefits that would raise costs for seniors now and undermine the program for future retirees.

The trade-off is morally offensive: Why should fairer taxes from the rich be allowed only if accompanied by less health care for the old or vulnerable?

Their cuts are aimed at the wrong target. We don't have an "entitlements" problem; we have a broken health care system. The rising costs of publicly funded health care programs like Medicare will consume a larger portion of the budget in the future if nothing is done. But the real problem is runaway health care costs generally, driven by the entrenched corporate interests – the drug and insurance companies and the private hospital complexes – that have made our health care the most expensive in the world.

Make the Case:

Voters overwhelmingly rejected the right's plan to turn Medicare into a "voucher" in the 2012 elections. Now conservatives have another strategy to weaken Medicare: raise the age of eligibility; that is, eliminate benefits for 65- and 66-year-olds. (Republican leaders in Congress don't want to admit that publicly, so they propose $600 billion in Medicare and Medicaid cuts without any explanation of how they arrived at that number or which specific policies they have in mind to reach that number.)

Denying Medicare to 65- and 66-year-olds will actually cost more money than it saves. The best estimate is that $5.7 billion in projected federal savings in Medicare will end up forcing individuals, states and employers to pay an additional $11.4 billion for health care...

There are also reports that House Republicans want to increase Medicare costs for people with higher incomes. But three out of four people with Medicare have incomes under $40,000, and the very small number of seniors with incomes over $80,000 already pay considerably more for Medicare.

If the overall U.S. health care system controlled costs as well as most European countries, both Medicare and overall health care costs would be fully affordable. To do that, you have to take on the drug companies, insurance companies and hospital complexes that drive up costs. Cutting benefits - or eliminating them for 65- and 66-year-olds - doesn't control costs. It simply shifts the costs from the public budget to individual seniors or their families.  (Economist Dean Baker of the Center for Economic and Policy Research documents this.)

Cliff notes...

Laura D'Andrea Tyson @ New York Times:

...The economy continues to operate far below its capacity. The unemployment rate is at least two percentage points higher than what most economists consider consistent with a full recovery. Other measures, such as the high rate of long-term unemployment and the low labor-force participation rate, reflect an impaired labor market.

According to the Congressional Budget Office, gross domestic product is still about 6 percent, or about $973 billion, below the potential level the economy is capable of producing at full capacity. This is the largest gap between actual and potential output following a recession in modern American history.

The weakness of government spending at the state and local level and more recently at the federal level has been a significant factor behind the slow recovery. The phasing out of earlier federal stimulus measures, the expiration of temporary payroll-tax relief and extended unemployment benefits scheduled at the end of the year, and the tight caps on discretionary federal spending already in force mean more federal fiscal drag on the economy’s growth next year even if the fiscal cliff is averted...

"The pirates behind the campaign to fix the debt"

The wonderfully ascerbic Mr. Charles Pierce @ Esquire:

There are many more important topics out there than The Deficit, the scary, hairy monster that haunts the dreams of David Gregory and only the blood of the poor and elderly can appease its wrath. Climate change comes immediately to mind, as do income inequality, the vast inequities of our tax code, the ongoing upward translation of the nation's wealth, why more bankers aren't in federal prison, and whatever did I do to the baby Jeebus that he allowed Notre Dame to play for a national championship. But the biggest reason why we should shut the national piehole on the topic is not that we have more serious problems, or even that any discussion violates the blog's first rule of economics — Fk The Deficit. People Got No Jobs. People Got No Money.

The real reason we should stop talking about it for a while is that the people who are insisting that it will eat us and our posterity on toast are lying swine who would sell your white-haired granny to the Somali pirates for another three points on the Dow. Until we all acknowledge the fact that organized wealth in this country has become downright sociopathic in the heedless damage it does, any discussion of The Deficit can and will be hijacked by that quarter in order to gain absolution for its grievous sins and the right to go on committing them against the rest of us, over and over again.

Listening to these people talk about the national economy is like listening to a burglar tell you that you should really polish the silver more often.

"The US doesn't have a spending problem..." - It's the distribution, stupid!

 James Kwak at The Atlantic:

In this season of fiscal silliness, many people are saying that we cannot afford our current entitlement programs. They shake their heads solemnly and say that Social Security and Medicare were well-intentioned ideas, but we simply do not have the money to pay for them and there is no escaping the need for "structural changes."

Hogwash.

Zombies "at the table"

Lots of talk about what's "on the table" in "fiscal cliff" negotiations. Krugman, again, clarifies what's at stake and what "zombie ideas" are just stupid. Let's keep the zombies away from "the table":

America’s political landscape is infested with many zombie ideas — beliefs about policy that have been repeatedly refuted with evidence and analysis but refuse to die. The most prominent zombie is the insistence that low taxes on rich people are the key to prosperity. But there are others. 

Undead?

And right now the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare. Even some Democrats — including, according to reports, the president — have seemed susceptible to this argument. But it’s a cruel, foolish idea — cruel in the case of Social Security, foolish in the case of Medicare — and we shouldn’t let it eat our brains. 

First of all, you need to understand that while life expectancy at birth has gone up a lot, that’s not relevant to this issue; what matters is life expectancy for those at or near retirement age. When, to take one example, Alan Simpson — the co-chairman of President Obama’s deficit commission — declared that Social Security was “never intended as a retirement program” because life expectancy when it was founded was only 63, he was displaying his ignorance. Even in 1940, Americans who made it to age 65 generally had many years left. 

Grand Bargain? "Aim High" Mr President

Robert Reich:

I hope the President starts negotiations over a “grand bargain” for deficit reduction by aiming high. After all, he won the election. And if the past four years has proven anything it’s that the White House should not begin with a compromise.

Assuming the goal is $4 trillion of deficit reduction over the next decade (that’s the consensus of the Simpson-Bowles commission, the Congressional Budget Office, and most independent analysts), here’s what the President should propose:

First, raise taxes on the rich – and by more than the highest marginal rate under Bill Clinton or even a 30 percent (so-called Buffett Rule) minimum rate on millionaires. Remember: America’s top earners are now wealthier than they’ve ever been, and they’re taking home a larger share of total income and wealth than top earners have received in over 80 years.

"The Sham of Simpson Bowles"

Illinois Congressional Representative Jan Shakowsky:

Erskine Bowles and former Senator Alan Simpson deserve some kind of medal for creating the widely held perception that their plan for reducing the deficit and debt is anything other than a bad proposal.

It has been nearly two years since the commission they chaired, which I served on, finished its work. The duo’s proposal has attained almost mythical status in Washington as the epitome of what a “grand bargain” should look like.

But everyone look again. They will discover that it is far less than meets the eye.

Have Simpson-Bowles’ champions read it? Given any real scrutiny, this plan falls far short of being a serious, workable or reasonable proposal – from either an economic or political analysis.

In one of its few specific points, for example, Simpson-Bowles mandates a top individual tax rate of 29 percent “or less.” Much like the vague Romney proposals, the Simpson-Bowles plan would make up the shortfall by eliminating tax loopholes, suggesting options such as having employees pay taxes on their health benefits. Not only is this likely to increase costs to middle-income families, it could threaten coverage altogether. The proposal for corporate tax reform would eliminate taxes on profits earned overseas, rewarding companies that move jobs offshore.

Deficits - Don't believe the "Mediscare" hype. The issue is systemic healthcare costs, which are driven by private markets.

Ezra Klein:

From the Congressional Budget Office’s hot new white paper, “Options for Deficit Reduction“:

That’s all of the federal government’s spending in three graphs. The top graph is health care, including Medicare, Medicaid and the Affordable Care Act. The middle graph is Social Security. And then there’s literally everything else: Defense, education, infrastructure, food safety, R&D, farm subsidies, the FBI, etc.

What these three charts tell you is simple: It’s all about health care. Spending on Social Security is expected to rise, but not particularly quickly. Spending on everything else is actually falling. It’s health care that contains most all of our future deficit problems. And the situation is even worse than it looks on this graph: Private health spending is racing upwards even faster than public health spending, so the problem the federal government is showing in its budget projections is mirrored on the budgets of every family and business that purchases health insurance...

Got that?  Private health care costs are inflating faster than government health care spending.  Which means it's not a "Medicare" problem.  The issue we need to attack is getting systemic health care costs under control. When you hear anyone blame Medicare as the root of our budget problems or their target in "getting health care costs under control", they are either selling you their ideology or their ignorance.  The prevalence of this nonsense is a key to understanding why as a nation our health care spending per capita is about twice as much as the high-quality universal systems such as France and Canada, with no better outcomes to show for it.

Remember, when "Morning Joe" et. al. blame Medicare for out-of-control costs, you are listening to people spreading ignorance

CBPP:

Cutting Medicare and Medicaid is a sure path to INCREASING the percentage of GDP the county spends on health care.  Most of the discussion about "entitlements" burdening our economy are based on utter disinformation or near-total ignorance.  Replacing Medicare with vouchers - or even raising the eligibility age - will explode health care costs.  Not just out-of-pocket for seniors, but in aggregate.

The "cure" of cutting Medicare and Medicaid can only mean one of two things - exploding health care costs as private insurers pick up market share and hospitals are burdened with the uninsured flooding emergency rooms, or people simply going without essential health care. 

There is definitely a need to control health care inflation in relation to our overall economy, but privatization via vouchers or raising the Medicare age take us in exactly the wrong direction, as the chart shows. Medicare and Medicaid do the best job of cost-control, compared to private insurance.

Although Mitt Romney is as credible as a used-car salesman, there's at least one thing that we know is at stake Nov. 6

Mitt Romney has proven himself the "Etch-a-Sketch" candidate on any and every issue, but James Suroweicki @ The New Yorker explains at least one thing we can count on if this slippery character manages to hedge and edge his way into the White House:

Mitt Romney can be a hard man to pin down. But there is one thing that he’s been clear about: if he becomes President, he will repeal Obamacare. That simple promise, more than any other that Romney has made, illuminates what is most at stake in this year’s election. The campaigns may spend most of their time talking about taxes and jobs. But health care is where the election’s outcome will have the most immediate and powerful impact on how Americans live. 

Putting jobs first

Robert Borosage @ Campaign for America's Future:

What we have here is a failure to communicate. Poll after poll shows that voters are concerned most of all about jobs and the economy. Yet in Washington and on the campaign trail, attention has turned to deficits and how to get our books in order.
Voters live in the midst of a devastating social calamity: More than 20 million people in need of full-time work, wages falling, insecurity rising, poverty at record levels. The few jobs being created pay less than those that were lost. Suicides are rising. Stunningly, even the life expectancy of lower-educated white men and women is falling.

The chattering classes, largely oblivious to the scope and depths of the misery, are focused instead on the so-called “fiscal cliff,” the automatic spending cuts and tax expirations scheduled to kick in after the elections, unless a lame duck session of Congress acts. Their conversation centers on the terms of austerity. Will Republicans let top end Bush tax cuts expire? Will there be a grand bargain with Medicare and Social Security on the table? The presidential candidates are pressed on their plans to balance the budget, not on their plans to get the economy going.

This has left Ben Bernanke, the conservative Republican who heads the Federal Reserve, virtually alone in issuing ever more pressing alarms.

“The weak job market should concern every American. High unemployment imposes hardship on millions of people and it entails a tremendous waste of human skills and talents,” he said earlier this month. “Five million Americans have been unemployed for more than six months, and millions more have left the labor force, many of them doubtless because they’ve given up on finding suitable work.”

The Federal Reserve has adopted extraordinary measures – committing itself to sustaining low interest rates until the recovery is well in place. It is now considering a “jobs trigger” – announcing that it would continue to act aggressively until unemployment level comes down to 5.5 percent.

But there are limits to monetary policy. Interest rates are already low; companies aren’t hiring because they don’t see demand for their products. They lack customers more than they lack credit.

"A slick salesman..."

Economist Mark Thoma @ NY Daily News:

When Mitt Romney introduced Representative Paul Ryan of Wisconsin as his running mate in the presidential election, he emphasized that Ryan “has become an intellectual leader of the Republican Party” on economic policy. But a close examination of Ryan’s monetary and fiscal policy proposals makes it hard to understand why he is held in such high regard.

Ryan’s views on monetary policy are, by his own admission, heavily influenced by Ayn Rand’s Atlas Shrugged. Concerns about inflation – currency debasement – are prominent in Rand’s novel, and those concerns drive Ryan’s monetary policy proposals. For example, Ryan introduced legislation in 2008 to replace the Fed’s dual mandate to stabilize both inflation and employment with a single mandate to stabilize inflation. Under Ryan’s proposal, the Fed would ignore employment when making policy decisions.

Ryan’s lack of concern over employment is disconcerting, but it’s at least possible to find economists who support a single inflation mandate for the Fed. It’s much harder to find anyone who will support another inflation prevention policy Ryan has proposed, a policy similar to a gold standard.