Both men have also twisted themselves into knots to distance themselves from previous positions, so that voters can no longer believe anything they say. Last week, both insisted that they would save Medicare by pumping a huge amount of money into the program, a bizarre turnaround for supposed fiscal conservatives out to rein in federal spending.
The likelihood that they would stand by that irresponsible pledge after the election is close to zero. And the likelihood that they would be better able than Democrats to preserve Medicare for the future (through a risky voucher system that may not work well for many beneficiaries) is not much better. THE ALLEGED “RAID ON MEDICARE” A Republican attack ad says that the reform law has “cut” $716 billion from Medicare, with the money used to expand coverage to low-
income people who are currently uninsured. “So now the money you paid for your guaranteed health care is going to a massive new government program that’s not for you,” the ad warns.
What the Republicans fail to say is that the budget resolutions crafted by Paul Ryan and approved by the Republican-controlled House retained virtually the same cut in Medicare.
In reality, the $716 billion is not a “cut” in benefits but rather the savings in costs that the Congressional Budget Office projects over the next decade from wholly reasonable provisions in the reform law.
One big chunk of money will be saved by reducing unjustifiably high subsidies to private Medicare Advantage plans that enroll many beneficiaries at a higher average cost than traditional Medicare. Another will come from reducing the annual increases in federal reimbursements to health care providers — like hospitals, nursing homes and home health agencies — to force the notoriously inefficient system to find ways to improve productivity.
And a further chunk will come from fees or taxes imposed on drug makers, device makers and insurers — fees that they can surely afford since expanded coverage for the uninsured will increase their markets and their revenues.
NO HARM TO SENIORS The Republicans imply that the $716 billion in cuts will harm older Americans, but almost none of the savings come from reducing the benefits available for people already on Medicare. But if Mr. Romney and Mr. Ryan were able to repeal the reform law, as they have pledged to do, that would drive up costs for many seniors — namely those with high prescription drug costs, who are already receiving subsidies under the reform law, and those who are receiving preventive services, like colonoscopies, mammograms and immunizations, with no cost sharing.
Mr. Romney argued on Friday that the $716 billion in cuts will harm beneficiaries because those who get discounts or extra benefits in the heavily subsidized Medicare Advantage plans will lose them and because reduced payments to hospitals and other providers could cause some providers to stop accepting Medicare patients.
If he thinks that will be a major problem, Mr. Romney should leave the reform law in place: it has many provisions designed to make the delivery of health care more efficient and cheaper, so that hospitals and others will be better able to survive on smaller payments.
NO BANKRUPTCY LOOMING The Republicans also argue that the reform law will weaken Medicare and that by preventing the cuts and ultimately turning to vouchers they will enhance the program’s solvency. But Medicare is not in danger of going “bankrupt”; the issue is whether the trust fund that pays hospital bills will run out of money in 2024, as now projected, and require the program to live on the annual payroll tax revenues it receives.
The Affordable Care Act helped push back the insolvency date by eight years, so repealing the act would actually bring the trust fund closer to insolvency, perhaps in 2016.
DEFICIT REDUCTION Mr. Romney and Mr. Ryan said last week that they would restore the entire $716 billion in cuts by repealing the law. The Congressional Budget Office concluded that repealing the law would raise the deficit by $109 billion over 10 years.
The Republicans gave no clue about how they would pay for restoring the Medicare cuts without increasing the deficit. It is hard to believe that, if faced with the necessity of fashioning a realistic budget, keeping Medicare spending high would be a top priority with a Romney-Ryan administration that also wants to spend very large sums on the military and on tax cuts for wealthy Americans.