09.27.09

The Right's Shameless Gambit

Once the party of fiscal sanity, the Republicans are now wailing that the Democrats' health-care plan cheats seniors out of money. Matt Miller on how they scare grandma.

Connoisseurs of hypocrisy will always find plenty to savor in political debate. But even by the debased standards of modern Washington, the Republican charge this week that Democrats will “hurt seniors” by trimming future Medicare costs is demonstrably false—and exposes as a sham any GOP claim to care about fiscal sanity.

"It’s disingenuous to say Congress can cut this much spending from Medicare without having an adverse affect on seniors' access to care," said Sen. Jon Kyl (R-AZ), as the Senate Finance Committee took up Chairman Max Baucus’ pivotal bill on Wednesday.

The notion that the Democrats’ tiny brake on runaway costs will “hurt” anyone—except members of the Medical Industrial Complex accustomed to being paid for ineffective care—is absurd.

But it’s Mr. Kyl who is being disingenuous. Consider some facts: Medicare will spend about $500 billion this year. Under the proposals that Republicans say will bring “rationing,” Medicare will spend about $860 billion in 2019, or 73 percent more than today. Instead of spending $7.1 trillion on Medicare over the next decade, as is currently forecast, Democrats propose spending roughly $6.7 trillion, or about 94 percent of that sum. This means Democrats propose to slow the annual growth rate of Medicare spending from a projected 6.6 percent to about 5.9 percent.

As context for this piddling restraint, recall that the U.S. spends 17 percent of GDP on health care today versus 10 to 11 percent among other advanced nations. American does this without achieving better health outcomes than do others, and while leaving nearly 50 million people uninsured. Meanwhile, there are huge regional variations in the utilization of procedures and services that researchers agree bear no relation to quality or results. Some credible analysts say that as much as 30 percent of U.S. health spending is ineffective.

At a moment when health economists in both political parties have concluded from such facts that American health spending is radically inefficient, the notion that the Democrats’ tiny brake on runaway costs will “hurt” anyone—except members of the Medical Industrial Complex accustomed to being paid for ineffective care—is absurd.

Privately, of course, Republican leaders know this—they’re just reaching for what they hope will be a potent political club to deny President Obama a big health-care win. And, to be sure, Democrats are past masters at “Mediscare” campaigns themselves, having unleashed one against Newt Gingrich in the mid-1990s to devastating effect. As a matter of policy, Democratic attacks back then were misguided (as I argued at the time); in any event, two demagogic “wrongs” don’t make a “right.” What makes the GOP’s phony charges particularly damning today is the way they reveal the party’s avowed concern for “fiscal responsibility” to be hollow.

As anyone who’s looked at the question soon realizes, it’s impossible to be serious about budget deficits and America’s fiscal future without tackling the outsize growth of health costs. Measured against the scale of the problem, the current Democratic plans are, if anything, overly timid. That the GOP has chosen to puff them up into this month’s version of their “death panel” boogeyman shows Republicans simply aren’t serious about fiscal policy anymore. Or, to put it more precisely, the party’s desire to foil the president politically trumps whatever interest it once may have had in sound public finance.

This depressing instinct has become a pattern. Republicans pitilessly caricature Democratic calls for “comparative effectiveness” research as the road to rationing—as if it weren’t obviously a good idea to better understand the relative value of various treatments in the most costly and inefficient health-care system on earth. Republicans didn’t even think about offsetting the costs of the massive 2001 Bush tax cut for the well-to-do, or the $1 trillion America has spent in Iraq, or the hundreds of billions of dollars President Bush spent (sensibly) adding prescription-drug coverage to Medicare. The old-fashioned conservative habit of actually paying for major policy initiatives never seems to occur to Republicans anymore. Far better, contemporary GOP logic holds, to borrow the cash from China and ask the kids to pay it back.

Whatever political sleights-of-hand President Obama deploys himself, one thing is clear: By putting his party’s head on the chopping block with candid calls to trim Medicare and raise taxes to pay for ambitious health reform, Obama and the Democrats have shown a commitment to fiscal prudence that Republicans can’t even be bothered to feign anymore.

Matt Miller is a management consultant, a senior fellow at the Center for American Progress, and the host of public radio’s popular political week-in-review, Left, Right & Center. His new book is The Tyranny of Dead Ideas.