It was refreshing to hear all those unambiguous declarations from President Obama on Wednesday. “I will not” let Medicare become a voucher program or deprive families with disabled children of needed benefits. “We will” reform government health-care programs without disavowing the social compact. “I refuse” to sign another renewal of the Bush tax cuts for millionaires. Republicans “want to give people like me a $200,000 tax cut that’s paid for by asking 33 seniors each to pay $6,000 more in health costs. . . . And it’s not going to happen as long as I’m president.”
Okay, there weren’t any lines with the simple heat of “Mr. Gorbachev, tear down this wall” or the terse power of “Make my day.” But Obama’s budget manifesto represented a significant warming of his usually cool rhetoric. He said he wanted to find common ground but instead devoted much of the speech to drawing lines in the sand.
And thank goodness. If ever there were a time when lines desperately needed to be drawn, it’s now.
Before we get carried away with praise, let’s remember that even as he gets in touch with his Old Testament side, Obama is playing defense. Republicans have already forced him to accept budget cuts that he abhors, and it’s a given that more slashing and burning will follow. Obama noted the questionableness of choking off government spending at a time when the economy is struggling for altitude. Yet he proposes doing just that — which means his GOP opponents are setting the agenda.
Let’s also remember that those tax cuts for the rich were as unjust, outrageous and totally unacceptable last fall as they are today. Which many commentators noted (ahem). Before someone caved to Republican demands and signed legislation extending the millionaires’ tax break for two more years. That someone being Obama.
The president glossed over this inconvenient history. What he managed to do admirably, however, was distinguish between his vision of America and the one sketched by Rep. Paul Ryan (R-Wis.) on behalf of House Republicans. It was, as Obama’s critics charge, a political speech — and rightly so. The questions at the heart of the battle over spending and entitlements are, after all, fundamentally political.
It’s not just a matter of drawing a graph in which the line called “expenditures” meets the line called “revenue.” The question is how this intersection is made to occur. Ryan’s plan and Obama’s plan both reduce the deficit by about $4 trillion over the next decade, but they do so in starkly different ways.
Perhaps the clearest example of the difference is how the two plans would handle Medicare and Medicaid, the chief drivers of the deficit. Obama wants to maintain both programs as entitlements. He believes, as I do, that we have a collective interest in ensuring that the elderly and the poor receive the health care they need and deserve. He sees this as a matter not just of compassion but of common sense: We’ve already fallen behind other industrialized democracies in major health indicators, including life expectancy, and we certainly won’t “win the future” by becoming an unhealthier nation.
Republicans apparently believe it’s enough to ensure that state-of-the-art medical care is available to those who can afford to pay for it. Under Ryan’s plan, Medicare and Medicaid could no longer be described as true federal entitlements. This is no exaggeration, because under neither program would adequate health care be guaranteed. Seniors and the poor would, increasingly, have to fend for themselves.
The Republican plan would turn Medicare into a voucher program that subsidizes the purchase of private health insurance. So what if an individual’s insurance premiums are not covered by the voucher? So what if health costs, and premiums, continue to skyrocket? The free market will surely take care of all that, somehow or other.
On Medicaid, Republicans want to shift the burden to the states, giving them block grants and essentially telling them to take care of the indigent however they choose. Some states would be diligent in providing adequate medical care. Some would not.
Is this the kind of America we want? How selfish are we, really? How selfless? To what extent does this churchgoing nation take the biblical instruction to “love thy neighbor” seriously?
These are the kinds of basic choices we face. There are two plans on the table now. Only one of them — Obama’s — appeals to the better angels of our nature.