It arrived 28 years after George Orwell predicted, but now we really have reached his 1984. In that famous novel, the banners in the state of Oceania read “War Is Peace,” “Freedom Is Slavery,” and “Ignorance Is Strength.” Winston Smith would have chuckled knowingly at the scene in mid-August in The Villages, the 98 percent white and heavily Republican central Florida planned community where Mitt Romney and Paul Ryan stood in front of a large banner reading: “Protect & Strengthen Medicare.”
Ryan’s budget plan, which comparatively few Americans know much about, would do just the opposite. Health-care costs, most experts agree, would rise much faster than Ryan’s subsidies under the plan, meaning that seniors would be paying more out of pocket. There is also the fact that Romney’s own Medicare plan, to spend the $716 billion the Obama administration wants to save, would deplete the Medicare trust fund by 2016, requiring either tax hikes or dramatic benefit cuts. If that’s protect and strengthen, I’ll take abandon and weaken.
But the banner wasn’t even the biggest lie being served up at the Villages. The gold went to Ryan’s dredging up of the old “death panel” charge—the new health-care law, he said, would create a panel of experts empowered “to cut Medicare in ways that will lead to denied care for current seniors.”
Death panels were a lie then, in 2009, in that perfervid summer of town-hall hysteria, and were named the “Lie of the Year” by the independent fact-checking group Politifact. Others said much the same. So how do Ryan and his supporters defend this claim? Because the new law does establish a body called the Independent Payment Advisory Board (IPAB). The way things are going in Washington, it will never even come into existence—more on that later. But if it does, this body of 15 presidentially appointed experts will indeed be given the responsibility to recommend Medicare cost savings, beginning most likely in 2018, if certain cost-reduction targets aren’t reached by then.
Medicare must save money. The Social Security Trust Fund is solvent well into the future; the Medicare variant will run dry in 2024, or, if Romney really has his way, the frighteningly close 2016. Costs under the original fee-for-service system—the more services, the higher the reimbursements, regardless of outcome—have gone crazy. New approaches are desperately needed, like the promising Accountable Care Organizations—networks of doctors and hospitals that can, it is hoped, offer better-coordinated care to seniors that will keep them healthier while tamping costs down. Sure it’s an experiment. But we need experiments, and pronto.
It’s understandable that seniors would greet any change with anxiety. What isn’t understandable, or excusable, is politicians cynically hyping that anxiety and converting it into outright fear. But that is just what Ryan is doing—while at the same time, remember, proposing his own Medicare plan that will undoubtedly raise seniors’ out-of-pocket costs! That’s some twofer.
Killing off IPAB will become a rallying cry in Limbaughland.
The IPAB will have a hell of a hard job: It will have to identify savings that do not harm care. The new law says expressly—on page 409, if you want to check it—that the IPAB’s proposals “shall not include any recommendation to ration health care.” But that’s assuming the panel even comes into existence. Its members will have to be confirmed by the Senate, and given what we’ve seen on that front since 2009, there seems little chance, if President Obama is reelected, that the Republicans will permit approval of even one member of this board. Killing off IPAB will become a rallying cry in Limbaughland, and we’ll likely see a replay of 2009, when previously rational GOP senators like Chuck Grassley started tweeting about killing grandma.
And if IPAB doesn’t exist? It will basically be up to Congress to control Medicare costs. Now that inspires confidence, doesn’t it? And so we face a familiar situation. We have an enormous, and enormous complex, public problem that requires attention. One side is at least trying to do something about it. The other side is doing nothing but poking around for weaknesses so it can peddle lies and stoke fear, all for the purpose of diverting seniors’ attention from its own plans. And meanwhile, of course, we already have death panels that have the power to deny coverage to sick and dying people. They’re called “insurance companies.”