Mediscare Redux: Is McConnell holding debt ceiling hike hostage to Ryan Medicare plan?
“The radical GOP has not given up on its drive to kill Medicare. Now, Senate Minority Leader Mitch McConnell is trying to tie the debt ceiling vote to ending Medicare. He’s willing to let the United States default on its obligations – putting our economy in peril – to take needed health care coverage away from our seniors. McConnell’s approach is unconscionable. The GOP Medicare Plan must be taken off the table – and Republican Senate candidates have a responsibility to tell McConnell to stand down. Sign below and demand that Republican Senate candidates side with seniors, not GOP party leadership.”
--From a petition on the Web site of the Democratic Senatorial Campaign Committee
Last week, we looked in depth at a “Mediscare” ad concocted by the National Republican Campaign Committee, apparently designed to counteract the impact of the equally misleading –and successful-- “Mediscare” campaign waged by Rep. Kathy Hochul (D-N.Y.). We recommended that TV viewers simply mute the sound whenever a Medicare-related ad by either political party appears on the screen.
Frankly, we did not plan to write on Medicare so soon again, but the language of the DSCC petition (above) leaves us little choice. It’s strong, take-no-prisoners stuff: The GOP plans to “kill Medicare” and Senate Minority Leader Mitch McConnell (R-Ky.) is willing to let the United States go into default “to take needed health care coverage away from our seniors.”
In a few short sentences, the DSCC essentially says: The House Republican budget plan would eliminate Medicare, would take health coverage away from seniors today, and that McConnell has tied the debt ceiling vote to approval of this plan.
It sounds scary but is it true?
The current Medicare system, in place since the mid-1960s, is essentially a government-run health care program, with hospital and doctors fees paid by the government, though beneficiaries also pay premiums for some services as well as deductibles and coinsurance. The new system envisioned by House Republicans would transform Medicare into a competitive market for people who are now younger than 55, while they say the current system would remain in place for people who are older. (Democrats disagree; more on that below.)
Retirees would get from the government what Rep. Paul Ryan (R-Wisc.), the chairman of the House Budget Committee, calls “premium support” — a set payment adjusted to inflation; they would use that money to pick from a range of plans offered by insurance companies through what is termed a Medicare exchange.
The Congressional Budget Office, when it examined the plan, raised serious questions about whether the premium payment would be adequate over time. The CBO analysis estimated that by 2030, the government would pay just 32 percent of the health care costs, less than half of what the federal plan currently pays. The other 68 percent of the plan would have to be shouldered by the retiree. (The CBO estimated that if traditional Medicare stayed in place, the government would pay 70 to 75 percent of the costs.)
“The Republican plan would take away needed coverage for seniors by eliminating the guaranteed benefit and force millions of seniors into the private marketplace, where they will be forced to pay an average of $6,000 more per month – more than most seniors could ever afford,” said DSCC spokesman Matt Canter. He said it is appropriate to say the GOP proposal would “kill Medicare” because it would “kill Medicare as we know it.”
We think this is overkill. Democrats were justifiably upset when Republicans claimed the new health-care law was a “government takeover of health care” when in fact most nonpartisan analysts would say it is a relatively modest change modeled on the health care system enacted by then Massachusetts Gov. Mitt Romney (R) five years ago. That demagoguery, however, does not give Democrats license to make the same kind of overheated charges, especially for a plan that would not take effect until 2022.
A more complicated question is whether the Ryan plan would also affect people over the age of 55, even though Republicans say the current system will be unchanged for people in or near retirement.
Canter justifies the phrase “take needed health care coverage away from our seniors” by noting that as part of the budget, Republicans plan to repeal the Obama health-care law, which included a fix to the so-called “doughnut hole” that requires about 14 percent of seniors to pay 100 percent of prescription drug costs after a certain level of spending is reached. He cited a recent National Journal article making this case.
This is debatable. The Republican response is that the health-care law includes other provisions that will raise prescription drug prices and that the “doughnut hole” fix has only begun to phase in.
In any case, it is a stretch to focus on this provision (and a couple of other issues) and then make a sweeping claim that leaves the impression that all seniors would be affected immediately. A repeal of the health law (which Obama would veto) could have some effect on some seniors in Medicare, but Republicans are right that the core of Medicare—government-run health care for the elderly—would remain unaffected for people over 55 for many years to come.
Finally, the petition hinges on the claim that McConnell is holding the debt ceiling bill hostage and demanding that House Republican Medicare plan be adopted. Canter provided some examples to support this claim, including an exchange where McConnell, on NBC’s “Meet the Press” on May 29, said that the Ryan plan was “on the table.”
“Our position is that he should drop it and say it is not on the table. If he’s done that, then that is new and big news,” Canter said.
However, when the full conversation is reviewed, McConnell essentially concedes the Ryan plan is a nonstarter in the negotiations.
“How many times you ask me to kind of craft what the Medicare fix should be like, I’m not going to give that answer to you today, because that’s a subject to be negotiated with the president of the United States,” he said. At another point, McConnell says: “I’m personally very comfortable with the way Paul Ryan would structure it in the out years. But we have a Democratic president. We’re going to have to negotiate with him on the terms of changing Medicare.”
Moreover, the National Journal last week profiled McConnell and his demands for the debt ceiling. The magazine reported: “One of the few demands not on the debt-ceiling ransom list is inclusion of the Ryan Medicare plan (transforming it in 10 years from fee-for-service to direct, means-tested patient subsidies)—even though 40 of 44 Senate Republicans voted for the proposal.”
The Pinocchio Test
In every case, the DSCC has pushed its rhetoric to the breaking point, just as the National Republican Campaign Committee did in its television ad. There’s certainly a worthwhile debate about whether the Medicare changes proposed by Ryan would help or hurt Medicare, and whether too much of a burden would be shifted to beneficiaries. But it is not true to claim Republicans are trying to “kill” Medicare, that their plans would affect all seniors immediately and that acceptance of only this plan is the price Obama must pay to win a debt ceiling increase.
UPDATE, June 15: This article certainly generated a fair amount of commentary, especially in the liberal blogosphere. Talking Points Memo weighed in with a critique, which you can find here. Our former colleague David Weigel also made an interesting observation in his column for Slate.
We welcome constructive criticism, which keeps us on our toes. TPM has our response to their critique. We wish they had noted that we have also been critical of how Republicans speak about the Ryan plan and Medicare. You can find four examples here, here, here and here.
The Fact Checker, PolitiFact.com, and Factcheck.org don’t always see eye-to-eye and certainly don’t form a cabal. But, for what it is worth, on this issue, we happen to be on the same page, as can be seen here and here.
Watch McConnell on Meet The Press