Much has been said about the supercommittee’s failure to reach agreement on taxes. But equally important, although less discussed, was the breakdown over health-care reform.
James Capretta raises two key points on that score. In both, we see that the parties have swapped positions: liberals are defending the status quo, while conservatives are pushing for change.
The first issue concerns ObamaCare. Capretta explains:
The problems start with the Patient Protection and Affordable Care Act (PPACA). That law — passed on an entirely partisan basis in 2010 — has significant implications for future federal tax and spending policy. It is often overlooked that the PPACA, among many other things, imposes a very large tax hike, amounting to more than $500 billion over a decade and eventually reaching more than one percentage point of the gross domestic product (GDP) on an annual basis, according to the Congressional Budget Office. Of course, these taxes were put into the legislation to partially pay for the $1 trillion in new spending the law also set in motion, but it is undeniable that imposing such a large tax hike in the health law has made it more difficult to consider further tax hikes for deficit reduction.
The president and his allies want to wall off the PPACA from the larger budgetary debate and limit whatever adjustments are to be made to the non-PPACA elements of the federal budget. That’s awfully hard for Republicans to swallow, especially since the president has said frequently that “everything should be on table.” Evidently, that admonition is directed at Republican priorities, not his own. The premise of the super committee was that bipartisan accord will be necessary for progress on the budget, but it will be near impossible to build a bipartisan budget deal on a foundation that includes a partisan health care plan.
In this regard, nearly all of the mainstream reporting has taken for granted that ObamaCare is off limits from budget cutters. Reporters and the left punditocracy have declined to even recognize that the real “intransigence” was not on the part of Republicans (who offered up more revenue) but on the part of Democrats who insisted that ObamaCare remain pristine (despite the serial revelations that the plan is not unfolding as anticipated) and who refused respond with a serious counteroffer on tax reform.
The second issue revolves around Medicare. The Republicans last spring presented Rep. Paul Ryan’s premium support plan. Then in the supercommittee they offered the Rivlin-Domenici plan that would have allowed seniors to opt for traditional Medicare. But, as Capretta points out, the Democrats’ answer is to keep traditional Medicare and simply limit fees to providers, a recipe for shortages and denial of care:
The president and the Democrats have a completely different vision for the program. They would not move the program toward competition and choice but would instead rely on payment rate reductions, some of which have already been enacted in the PPACA. The president also supports empowering a panel — called the Independent Payment Advisory Board, or IPAB — to enforce caps on Medicare spending with further rate cuts as necessary.
If you insist that Medicare remain a government run and completely reimbursable program (even for the wealthy), you really don’t have any option but to ration — that’s what the IPAB is all about.
Republicans haven’t done a very good job of highlighting these aspects of the health-care debate. But, in fact, they have a good message to tell. They are willing to try reforms of various types to preserve Medicare for future generations. That’s a remarkably “progressive” position, when you think about it.