Medicare: My “Correspondence” With Eugene Robinson

Last week, Eugene Robinson, a columnist with the Washington Post who I used to read quite a bit of when he wrote for the Daily News here in New York, penned a column in which he repeated the President’s position that the Medicare cuts in the Affordable Care Act are not to benefits, merely to provider payments.  After reading it, I sent him the following e-mail, entitled “Serious Medicare Question”:

Mr. Robinson,

I’m what you would probably call a swing independent; I’ve never voted Republican in a national election (mainly because I vehemently disagree with the party on social policy) but am registered independent and look at each election and each candidate on its and his own merits.  After reading your column today (linked from RCP), and knowing that you are a serious man yourself, I am hoping you will provide a meaningful response to the following question:

I keep hearing the Democratic Party’s argument that the cuts to Medicare in the Affordable Care Act are not cuts to benefits, but merely to provider payments.  And every time I do, I cannot help but agree with the Republican riposte: that cuts to provider payments – particularly cuts that the CBO says would render many Medicare providers, including 1 in 6 hospitals, non-profitable – are guaranteed to impact benefits by reducing access to care.  Private providers facing such cuts in reimbursement rates – and a widening spread between Medicare reimbursements and other payments, along (likely) with rising overhead – are likely to either dramatically reduce the number of Medicare patients they see, stop taking Medicare entirely, or go the opposite route and become a business that looks to make up in volume what it lost in profit (resulting in less attentive, and therefore worse, care).  What reason is there to believe any other outcome is possible?

And I’ll be honest.  As a lawyer, the more I see people repeating the “it’s not a cut to benefits” line without addressing the argument that it is an indirect cut to access to and quality of care, the more convinced I am that there simply is no way to reasonably address that argument.

So I ask you, as a serious and well intentioned columnist who I know wouldn’t print an article he did not believe to be true: how do you address that Republican argument, such that you feel comfortable telling your readers that the Affordable Care Act cuts won’t impact benefits?

Thanks in advance

To date, I’ve received no response.


Lawrence Summers’ (Unintentional?) Case for Entitlement Reform

Today’s Washington Post includes an opinion column from Lawrence Summers, the former Harvard President, Treasury Secretary (under Clinton) and economic adviser to President Obama (2009-2010), entitled “The reality of trying to shrink government.”  Perhaps unintentionally, the column forcefully underlines why important government programs such as Medicare, Medicaid, and Social Security must be fundamentally reformed, and soon.

According to Summers, while “there is a widespread view in both parties that it is feasible and desirable that in the future the federal government should be no larger as a share of the overall economy than it has been historically,” that is “unlikely to be achieved,” for a variety of reasons:

  1. Demographic changes and increases in life span mean that the proportion of the elderly in our population will dramatically increase, from 1 elderly person for every 4.6 workers (the current ratio) to 1 for every 2.7.  (For comparison purposes, the ratio in 1940, as Social Security was just being implemented, was 42 workers per retiree.)  According to Summers, the result will be a 5.6% increase in federal spending;
  2. As debt piles up and interest rates return to historical norms from their current, artificially low positions, the amount the government spends on debt service will significantly increase – from 1.7% of GDP in 2007 to 3.2% of GDP in 2020.  Note, Summers presents this increase as a percentage of GDP; as the GDP in 2020 will likely be far greater than the GDP in 2007 – 2007 GDP was $13.8 trillion,  while the CBO projects a 2020 GDP of $22.8 trillion – meaning the real dollar difference he is predicting will be much greater than a 1.5% increase.  In raw dollars, he is talking about spending increases of $495 billion;
  3. The costs of goods and services paid for by government tend to inflate at a higher rate than the costs of other goods and services, meaning that federal spending, relative to GDP, will need to rise by at least another 3%;
  4. We have been putting off necessary expenditures on infrastructure and future liabilities (such as pensions), and those expenditures can’t be put off for ever.  When we finally start spending on them, government spending will increase;

Based on this, Summers concludes:

[F]or the next three decades the United States will confront the reality that major structural changes in its economy will compel an increase in the public sector’s fraction of the total economy unless the functions that the federal government has long performed are substantially scaled down

All of this, together, is a powerful argument that “the functions that the federal government has long performed” must be “substantially scaled down.”  In fact, if it weren’t for Summers’ background, and the fact that he opened his column by asserting that decreases in spending were unlikely to happen, I’d have assumed that was the argument he was making.  It may well have been.

Regardless of Summers’ intent, however, the facts he highlights are cold, hard, and must be dealt with.  Medicare, Medicaid, and Social Security cannot be allowed to continue on their current path; if they do, they will eventually and inescapably swamp the economy that provides their funding.

And that is, without doubt, a hard truth.  Medicare, Medicaid, and Social Security are the products of laudable policy goals and morally valuable priorities – the need to care for those less fortunate than the general population, for the vulnerable who cannot (not merely will not, but cannot) care for themselves.  But the choice we face is not between having those entitlements and losing them.  It is between losing them without destroying the economy (i.e. cutting them now, by choice, and in the least painful ways possible, while replacing them with more sustainable programs that achieve some if not all of the same policy objectives), or losing them when they destroy the economy, and take the rest of the country down with them.

Put it that way, and it’s really no choice at all, is it?

I Am the Swing Independent – and Hopefully the Future

So, here I am.  A political junkie without political affiliation, a staunch centrist with a desire to serve but no idea how to get there from here.  I could join a political party, work my way up the ranks, and see how far I can climb . . . but political parties are part of the problem, in my opinion, not the solution.  I’m not a Democrat.  I’m not a Republican.  I’m an American.

If more people thought that way, the political life of this country would run much smoother.  Instead, voters look at politics the way they look at team sports: pick a side, and root like hell for your team to win.  Forgive their flaws, magnify their virtues, and always attack, demonize, and defeat the opposition – while magnifying their flaws and ignoring their virtues.  The politicians, meanwhile, seem to view politics as a career rather than a calling, governing as a means to getting elected rather than getting elected in order to govern.

I’ve had enough of that.  Talking to other people around the country, I’m not the only one.  Hopefully, the swing independents are the wave of the future.  At the very least, it’s time to make some noise.

The New York Times Gets It Wrong On Voter ID

Pennsylvania Judge Robert Simpson just declined to issue a temporary restraining order preventing Pennsylvania’s Voter ID law from going into effect, likely ensuring that Pennsylvania voters will, in fact, have to provide picture identification when they go to the polls this November.  Today, the New York Times Editorial Board condemned the decision, arguing that the Voter ID law will disproportionately impact minorities and puts in place “barriers to full citizenship.”  The heart of the Times‘ argument is in these paragraphs:

[Judge Simpson] wrote in his ruling that requiring a government-issued photo ID card to vote “is a reasonable, nondiscriminatory, nonsevere burden when viewed in the broader context of the widespread use of photo ID in daily life,” as if voting were equivalent to buying a six-pack of beer or driving a car.

The requirement will have a disparate impact on minorities, who tend to lack government IDs at a higher rate than the general population and tend to vote Democratic. Judge Simpson acknowledged he was aware of the remark by Michael Turzai, the Pennsylvania House Republican leader, that the voter ID requirement would win the state for Mitt Romney in November. But there was no proof, he said, that other lawmakers shared that view, and, even if partisan interests were part of the motivation for the law, they are not enough to invalidate it.

There is no evidence that Judge Simpson contorted law and precedent to reach his conclusion. He even described Mr. Turzai’s comment as “disturbing” and “tendentious.” But his ruling, in a case brought by potentially disenfranchised voters, is a clear and disturbing illustration of the way Republicans have manipulated legislation for their own ends, placing a veneer of civic responsibility on a low-minded and sleazy political ploy.

The critical mistake in this argument – and the reason why moderates, independents, and voters generally are behind Voter ID laws – is perfectly encapsulated in the coda to the first paragraph quoted above.  No, voting is not “equivalent to buying a six-pack of beer or buying a car.”  Yes, it is far more important than either.

And that is precisely why rules that guard against fraud by imposing reasonable and easy to meet requirements on voters are so popular.

Let’s be honest.  It isn’t all that hard to obtain a government issued picture ID.  In Pennsylvania, anyone can get a photo ID by simply filling out a form, bringing along acceptable proofs of identification – a social security card, one of a birth certificate, naturalization certificate, or passport, and (for people older than 18), two of various documents identifying your address (utility bills, lease, mortgage, etc.) – and pay a processing fee of $13.50.

Assuming you did not have a copy of your birth certificate and social security card, the additional cost would be $10 for the birth certificate.  Replacement social security cards are free.

In other words, the “barriers to full citizenship” the Times is complaining about, along with others opposed to Voter ID laws, are the time it will take to fill out a form and locate documents, and a $15 or, worst case, $25 expenditure for a document that, frankly, is a necessity of modern life in any event.

Bottom line, the requirements are not onerous.  And, in light of that, it appears as though those complaining about Voter ID laws are taking the position that it is wrong to demand even the barest level of diligence and responsibility from citizens.  The Times focuses on citizens’ rights, without paying any attention to citizens’ responsibilities.

And that’s a position that just doesn’t resonate with three-quarters of the country.

Thank God for that.