The Serious Pain (For You, Not Me) Caucus

There was no question that an ostensibly liberal pundit was going to come out with loads of praise for the boldness of Paul Ryan’s appallingly regressive, transparently fraudulent attack on the Great Society. Whoever had Jacob Weisberg in the pool, collect your winnings! The core of the defense is some inherently reactionary question-begging:

But they’ve been little better than Republicans when it comes to confronting the nation’s long-term fiscal imbalance, which is driven by the projected growth in entitlement spending.

First of all, we have the ages-old routine of conflating Medicare and Social Security spending, although one is a major potential problem and one isn’t. (It won’t surprise you, either, to find out that Weisberg seems to like the idea of “gradually raising the retirement age to 70” — tolerable for well-compensated journalists, not so much for coal miners and people who clean restrooms for a living.) Second, we have the massive upper-class tax cuts of the aughts mysteriously excluded as sources of fiscal crisis. And third, there’s a failure to recognize the possibility that the alleged problems with Medicare and Medicaid might stem from the fact that America’s “free market” health care system covers fewer people at far greater expense with no better results than any other liberal democracy.

So why does Weisberg like Ryan’s plan to end Medicare?

Ryan’s alternative to Medicare hardly seems as terrible as Paul Krugman makes out. Seniors would enter the health care world the rest of us live in, with co-payments, deductibles and managed care. Eventually, cost control would require some tough decisions about end-of-life care and the rationing of high-tech treatments that have limited efficacy. But starting with a value of $15,000 per year, per senior—the amount government now spends on Medicare—Ryan’s vouchers should provide excellent coverage. His change would amount to a minor amendment to the social contract, not a fundamental revision of it.

Truly remarkable is Weisberg’s blase and almost certainly false assumption that seniors will just be able to purchase insurance on the private market. Why on earth would he believe it? Does he really think it’s uncommon for people over 65 to have medical problems that cost substantially more than $15,000 a year and will either be denied insurance or have to drain their savings or go without needed medical care? Can he really deny that uninsured seniors will become an increasingly greater problem as the vouchers become less valuable, which is they only way money will be saved?

And even if we were to accept Weisberg’s premise that Medicare benefits need to be cut, he utterly fails to justify vourcherizing Medicare, which will increase the ratio of rent-seeking to actual medical benefits while doing nothing to control health care costs. At least with the ACA this indefensible entrenchment of rent-seeking was borne out of the necessity of buying off existing stakeholders given our institutional system. But why on earth would we dismantle an efficient, popular public insurance system that already exists?

And, in addition to the details, we have the remarkable assertion that hammering the poor and middle class to finance upper-class tax cuts is “brave, radical, and smart.” Well, radical I might give you, but Ryan’s plan is the inverse of brave or smart.  Unicorn-sighting isn’t a plan and upward transfers of wealth require no courage.