Paul Ryan's Buget Appeal to the April Fools

I see Paul Ryan picked an approropriate day to release his (and by "his" I mean something created by others then handed to him as the pitchman) plan to balance the budget in ten years.

Ryan's budget, called the "Path to Prosperity," has almost no chance of passing the Democratic-controlled Senate but is expected to serve as a campaign manifesto for Republicans in November's congressional elections.

It's a predictably Republican plan. The rich get their path to greater riches, and guess who picks up the tab? April fools!

It proposes to kill President Barack Obama's 2010 healthcare reforms and revives cuts in social programs such as the popular Medicare entitlement for the elderly that Ryan, who chairs the House Budget Committee, has proposed in other recent budgets.

Let me think for a moment... didn't we have a Republican claim that he was going to balance the budget in ten years, roughly fourteen or so years ago? How did that work out for us, again?

Let me remind you why ten year plans to balance the budgets are the refuge of liars and cowards:

1. Congress cannot bind future sessions of Congress. The only budget that matters is the one they pass this year.
   
   If you believe that the Republicans, given the opportunity, won't embrace deficit spending like kids in a candy store, you've missed the entire modern history of the party.

2. Unexpected events happen.
   
   If you have been asleep for the past decade or two, you may have missed a couple of wars, a global economic meltdown, and the like, but believe it or not they affect the budget.

3. Budget projections rely upon assumptions that may be reasonable in the short-term, but are unreliable in the longer term.
   
   A few years ago, for example, healthcare inflation was assumed to remain out-of-control for decades to come, yet suddenly it appears to be in check. (Ryan's response, of course, is to propose eliminating the Obama-era legislation that has played a role in that change).

4. Budget deficits aren't the real issue. The issue is whether government spending is responsible, not whether the budget is balanced every year.
   
   When the economy is in a downward spiral, it makes sense to try to stimulate growth. When the economy is booming, it makes sense not just to balance the budget but to pay down the national debt. The Republican Party takes the opposite approach, with irresponsible tax cuts and over-the-top spending during boom times, then embracing austerity during recessionary periods... if a Democrat is in the White House. The responsible approach is to keep the growth of the nation's debt under control over the long-term while maintaining flexibility for times of recession and crisis.

5. "Ten years" means no one has to be responsible.
   
   This is a typical coward's refuge. Promise to deliver something over such a long time frame that nobody has to take responsibility. If a "ten year plan" were to pass for the coming fiscal year, not only will President Obama be out of office when it comes time to deliver, but his successor will be out of office (or at the very tail end of his term). And I guarantee that his successor would have many excuses for why the plan failed, and how it's somebody else's fault, assuming anybody even remembers it.

And all of that assumes that the budget is put together with honest numbers. When dishonest politicians use distorted figures, the projection is worthless from day one.

If this weren't another childish stunt for the April fools, Ryan would offer a meaningful budget for the coming fiscal year, no hocus pocus, wishful thinking, or outright mendacity about "ten years from now". And he would be honest, "I want to cut social benefits for ordinary, working people right now, so that I can afford to continue the tax levels and spending programs that best serve the special interests that favor my political party. If my budget plan fails, the result will be that ordinary people pay a significant price, but those special interests remain on the Path to Prosperity. I will never vote to restore a penny of social spending cut in the name of this program, even if not one of the projections I'm making prove true, because the entire point of this exercise is to cut those programs."

Marc Thiessen, as Usual, Gets Things Completely Wrong

I suspect Marc Thiessen's intelligence is no worse than average, but he's certainly not afraid to look stupid:

Politicians and commentators on the left have been publicly flogging Rep. Paul Ryan (R-Wis.) for daring to talk about poverty in America’s inner cities. The charges have been so vicious and scurrilous (accusing him of using racial “dog-whistles” and language “deliberately crafted to appeal to white racists”) that their only purpose can be to send a message to Ryan and any other Republican who would dare follow his lead: Keep your hands off our issue. Poverty belongs to us. Stay away or we will brand you a racist.

(Insert obligatory Jay Smooth video here.)

Ryan’s attackers worry that if Republicans follow his lead, it will expose the failure of the left’s approach to poverty. For decades, Republicans gave Democrats a near-monopoly in the fight against poverty. And like most monopolies shielded from competition, the Democrat-led war on poverty failed. We have spent trillions of dollars on anti-poverty programs, and today the number of Americans living at or near poverty is higher than it was in 1964.

Yeah.... Ryan's critics are terrified that his war on poverty, and by that I mean policy proposals that would make it even harder to be poor, is going to win him votes from... um... I guess it would be nobody?

Ryan’s attackers are also worried that if Republicans make helping the poor and vulnerable a priority, Democrats can no longer win elections by waging class warfare and painting the GOP as uncaring champions of the wealthy. They want the Republicans to follow the example of Mitt Romney, who declared in 2012, “I’m not concerned about the very poor. . . . We will hear from the Democrat Party [on] the plight of the poor. . . . But my campaign is focused on middle-income Americans.”

I cannot recall the last time a Democrat had to "wage class warfare" or "paint the GOP as uncaring about the poor". The GOP hangs that brand on itself. But for somebody as (willfully?) obtuse as Thiessen, perhaps that's a difficult distinction to draw.

Ryan understands that if Republicans abandon the poor to the Democrats, they will hurt the poor — because Democrats have all the wrong answers for the problems of poverty. But they will also hurt themselves. Because no one — in the middle class or any class — wants to support a party that does not care for the most vulnerable among us.

Stuff and nonsense on both fronts. First, however flawed anti-poverty efforts of the past have been, the reason Thiessen can hang most of the responsibility for those programs on the Democrats is that the Republican approach to poverty (including Ryan's approach) hinges on cutting benefits for the poor. For example, the Republican Party is in a tizzy, right now, because their food stamp cuts aren't going to be as deep as they had hoped. Maybe in Thiessen's alternate universe, nothing says "We love the poor" like food stamp cuts.

Second, the Republicans have made something of an art form of distinguishing the "deserving poor" (i.e., poor people who, on the whole, vote for Republicans) from the "undeserving poor" (i.e., poor people who, on the whole, tend to vote for Democrats). A smarter man than Thiessen would admit that Ryan's foul-up was in making too explicit that many of those his party deems "undeserving" fall within a particular demographic,

We have got this tailspin of culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work, and so there is a real culture problem here that has to be dealt with.

If Thiessen wants the Republican Party to keep making statements like that, let's just say, if his thesis about voter concerns is correct he'll do nothing but harm to his party.

Jennifer Rubin Finds a Mirror

Jennifer Rubin, who people say is smart but who nonetheless rattles off a predictable set of talking points and often makes hare-brained assertions, comments on Ted Cruz,

Smarts don’t always equate to common sense. In the case of Sen. Ted Cruz (R-Tex.), there is an inverse relationship between the two. I’m told by smart lawyers that he has a sharp legal mind, can think on his feet and has remarkable recall for facts, cases and even page numbers of the briefs. But his political judgment has become distorted by ambition.

Hm...

Her illustration of Cruz's 'smarts' reminds me of an anecdote about a lawyer who was similarly famed for his ability to provide pinpoint citations, on his feet, in court. Somebody asked him, eventually, how he managed to recall cases and even page numbers with such specificity. "I make them up. Nobody ever checks." But with a bit less cynicism, having a good memory - even an eidetic memory - is proof of good memory, not intelligence. Cruz may well be as smart as some people say, or he may be smart in the same sense that Newt Gingrich and Paul Ryan are touted as intellectual giants among their Republican peers. When the pond is that shallow, you don't need to be a particularly big fish to stand out - and sometimes all it takes is for you to be the one people see because it's sticking its head out of the pond with its mouth constantly open. I'm also reminded of a certain trial lawyer who once ran for President, who strikes me as having been deemed a great trial lawyer by virtue of having a well-rehearsed presentation of a particular type of big money case, and who retired into politics when that particular line of litigation dried up. Or a certain TV host who brags about her conviction rate for homicide prosecutions, never mind that homicide cases are often open-and-shut with defendants going to trial only because they have nothing to lose. You have to look beyond the surface to find out if somebody truly is as brilliant as he and his friends claim him to be.

Rubin notes that Cruz was spouting nonsense about how Mitt Romney was the greatest guy in the world before he lost, at which point she contradicted her prior claims about him and denounced his deep flaws without appearing to notice the contradiction. No, wait, that was Rubin. She notes that Cruz is pretending that the President might sign a bill defunding the PPACA/Obamacare, and purporting that the public won't blame the Republicans if they shut down the government.

Well, maybe he understands something else. Perhaps he is as smart as his admirers claim and he is wildly ambitious, hoping to draw attention and fundraising dollars for his windmill-tilting scam. Later in the CNN interview he made it clear he was playing to the base on this one... And who better to pull the tsunami to shore than Cruz, right? Send money! Come to his events! Become outraged when the “unprincipled” Republicans won’t support him!

Read his blog! Oh, wait...

Cruz is emblematic of a group of conservative hucksters peddling outrage and paranoia who contend that the strength of the political resistance they generate is equivalent to their own importance, and that one dramatic, losing standoff after another is the pinnacle of political success. Alas, they confuse their own fame with achievement and divisiveness with progress.

And if that doesn't work out for him in politics, maybe Fred Hiatt can give him a job?

Rubin suggests that Cruz would be better off following the lead of Speaker Boehner, and "trying to put the monkey on the Democrats’ backs (as the speaker of the House is doing) in the Obamacare fight". Nobody has ever accused Boehner of being a genius, but perhaps Rubin should take note of the fact that pretty much every aspect of Obamacare is popular, save for the mandate which is a necessary part of the popular provision that requires insurance companies to provide coverage without respect to preexisting conditions. Pushing a fantasy about defunding Obamacare is probably more sensible than crossing your fingers and hoping that the mandate proves so unpopular that people are willing to throw the baby out with a few inches of bathwater.

A political loner and man of rhetoric, not of action or achievement, he bears a striking resemblance to the current Oval Office resident. Each considers himself the smartest man in any room (inducing annoyance and resentment among his party members) and each fails to understand rhetoric is not effective governance.

Projection, much? Seriously, how many people other than Rubin look at Cruz and say, "Wow, he's just like President Obama"? This would be one of those "predictable talking points and hare-brained assertions" to which I previously alluded.

If I read more of Rubin's pontifications, I might know who she is pushing as the next Republican presidential nominee. Perhaps somebody who, unlike Mitt Romney, doesn't see himself as God's gift to the country and the smartest man in the room, who scurries away from his own record whenever it becomes politically inconvenient? Because Rubin doesn't seem to like those characteristics in candidates she doesn't support....

Paul Ryan's Playing Dumb Again

One hardly knows what to say.

"The question is, is [President Obama] going to go out on the campaign trail and start campaigning against us again like he has been since the election?" [Paul] Ryan said on MSNBC's "Morning Joe."...

"Look, I ran against him, so we have different views. But at least we started talking. This is the first time I ever had a conversation like that with him. So I think that's a good, constructive start. The question is, is there follow through? The question is, does the campaign start back up or does the engagement continue in a real, constructive and promising way? I don't know the answer to that question. Time will tell."

Ryan seems to remember that he is a politician, and seems to recall having run against the President in a recent election. I assume he also recalls losing that election. But is he simply pretending to be stupid or does he sincerely not understand that he and the President are in different political parties, and that he is presently campaigning against the President's agenda?

If A Case Can Be Made for Ryan's Medicare Vouchers, How About Making It

Sometimes I get a bit tired of how bad analysis can be in a "leading" newspaper. Here's what passes for the work of a "health care correspondent" in the National Journal, on Paul Ryan's latest budget stunt:

The plan would not eliminate traditional Medicare. Democrats have gotten political mileage from accusing Ryan of wanting to “end Medicare as we know it.” That is not the same thing as ending Medicare. Ryan’s plan would give seniors a fixed amount of money that they could use to buy traditional Medicare coverage or a private plan with similar benefits. It would convert the program from a single-payer monolith into a marketplace of competing plans. But unlike his budget of two years ago, it would not remove traditional Medicare from the menu of options. Here’s where the “as we know it” part comes in: Because traditional Medicare would have to compete on price with the private plans, there’s a chance it could become too expensive for every senior who wants it to buy it. The plan, which limits how much the payment can increase each year, could also shift costs to even those seniors who buy the cheapest option in the marketplace.

I think it would be more accurate to say that mediocre reporters have gotten mileage out of snarking at an accurate description of Ryan's Medicare plan which, as any healthcare correspondent should know, has been repeatedly revised due to a recognition that current Medicare recipients would go ballistic if it had been implemented as originally proposed. Seriously, if you buy the conceit that Ryan's privatization plan doesn't change Medicare, but merely gives you ample money to buy full Medicare coverage along with any number of additional private plans, why do you think Ryan continues to be such a coward about the implementation of his plan - pushing off full implementation for a decade? Why wouldn't seniors rejoice at the new choices, rather than being anticipated to recoil with such horror that implementation must be put off into the distant future? If the Ryan plan breaches the promise of Medicare to current recipients, how clueless do you have to be to believe it won't change anything for future recipients? How clueless do you have to be to go along with the pretense that Medicare as we know it could be sustained under his voucher plan?

The author, Margot Sanger-Katz, suggests that under Ryan's voucher plan "there’s a chance [traditional Medicare] could become too expensive for every senior who wants it to buy it". A chance? Could? Is she completely ignorant of the genesis of this plan?

If you believe that the purpose of the Ryan plan is to save money - that Medicare costs too much, and that the voucher plan will significantly curtail spending - how difficult is it to figure out that the savings have to come from somewhere. Ryan and his party engaged in some pretty egregious demagoguery against Obama's cuts to Medicare providers - cuts designed to ensure a consistent level of care for seniors. Those cuts... remain part of Ryan's proposed budget. But that's not enough cutting. From where does Ms. Sanger-Katz believe additional savings will be derived? As should be obvious, Ryan's plan is to ensure that the "fixed amount of money" grows at an artificially capped rate well below the rate of medical inflation.

It's also pretty astonishing that Ms. Sanger-Katz is unaware that the Ryan voucher plan is designed to shift healthier seniors out of Medicare - that is, now that he's willing to allow some form of Medicare to continue to exist. Returning to an earlier point, Ms. Sanger-Katz bashed Democrats for supposedly getting "political mileage from accusing Ryan of wanting to 'end Medicare as we know it.'" If the original plan did not end Medicare as we know it, because his vouchers would happen to be called "Medicare", why is Ms. Sanger-Katz claiming that its the continued ability to buy "traditional Medicare coverage" that keeps Ryan's plan from ending Medicare as we know it? If she believes that to be the case, as is implicit in her argument, then it's time for her to respect the facts and admit that the Democrats were correct

As for the goals of the voucher plan, as should be obvious, healthy seniors with lower healthcare costs are more profitable for private insurers. The sickly, money-losing senior citizens are a population that insurers don't want to serve and have never wanted to serve. Ms. Sanger-Katz would apparently have us believe that she has no comprehension of why Medicare exists in the first place. Seniors who need a lot of medical care will end up on "traditional Medicare" (if they can afford the premium), with the result being that Medicare's per patient costs will rise at a much higher rate than the private plans that are able to cherry-pick from a healthier population. While Ms. Sanger-Katz does not hold herself out as an insurance correspondent, she should still be able to figure out that the operative words are not "chance" an "could".

If Ms. Sanger-Katz knows the basic facts, she should admit them. From there, she could describe the probable impact of Ryan's proposed cuts and voucher plan and, if she nonetheless believes the cuts to be appropriate and a voucher plan to be a reasonable alternative to single payer, lay out the policy case for the Ryan plan. If I give her the benefit of the doubt based upon what she instead wrote, I have to regard her as credulous and lazy - as willing to take at face value representations from hyper-partisan politicians that, if made to a better reporter, would instead inspire a series of probing follow-up questions, or at least the performance of basic research to determine if she's being sold a bill of goods.

The Elderly Cannot Be Informed Consumers of their Most Expensive Care

I am not sure how I came to the page, but in going through the proliferation of articles I had opened in my browser with the intention of "getting to this later", I found "Saving Medicare from Itself" written in mid-2011 by Avik Roy of the Manhattan Institute. For the most part the article simply rehashes the conventional wisdom about Medicare - if costs continue to significantly outstrip inflation, the program cannot be sustained.

Given that Roy started out by, in effect, preaching to the choir, he had what should have been a relatively simple task. Use the available facts and data to point to possible solutions to the problem of healthcare inflation. I know that some argue that the problem of healthcare inflation is going to cure itself - that the changes that led to the rise in costs reflect the significant evolution of the industry and, as we exit the era of new blockbuster drugs and improvements in medical technology become more incremental, inflation will tame itself. But history is a better teacher than wishful thinking - or as Burgess Meredith put it... - we have to plan as if healthcare inflation will continue to rise. And you know what? If we find ways to make healthcare significantly more affordable without compromising quality, even if the cost curve cures itself we'll be much better off as a society.

If Roy believes his own thesis, then one of his arguments should be, "We should look at how other industrialized nations are able to offer a comparable quality of care, with comparable outcomes, at a much lower cost, and at least think about doing what they're doing." Alas, Roy is not so much interested in advancing good policy as he is in advancing the agenda of reducing the scope of Medicare.

Roy argues,

The largest driver of Medicare cost inflation is the fact that retirees bear little of the expense for their own care. As a result, seniors have no incentive to avoid unnecessary or overpriced treatments. Rettenmaier and Saving have shown that, between 1960 and 1985, growth in health expenditures was highest in those categories of spending in which consumer cost-sharing was lowest (such as hospital care), and lowest where consumers were most responsible for their own expenses (like prescription drugs, which were not covered by Medicare during that period).

If that actually were the cost, you should see a different rate of medical inflation for non-elderly populations. You should see yet another, much lower rate of medical inflation for procedures that normally fall outside of insurance coverage. And you should see a much higher rate of inflation in industrialized nations that offer universal or near-universal healthcare coverage. But... you don't.

Roy overlooks the fact that people are inevitably going to be poor consumers of healthcare services. They like their doctor, so they keep going back to their doctor - and while the relationship will benefit many patients, others will keep going back to a doctor who is providing substandard care or who is opportunistically ordering unnecessary tests and procedures, perhaps through self-referral, in order to maximize his revenues. How does Roy suggest that the average elderly person determine whether the doctor she trusts is providing sufficient care, or if a different doctor might offer equivalent care at a lower price or better care at a higher price that nonetheless results in a net savings?

But more than that, where does Roy imagine that the savings will come from? If we're talking about seniors with chronic health conditions, they are going to need diabetes supplies, oxygen, catheters and the like. No way around it. Does Roy believe that individuals can get better pricing on care, supplies and services than an insurance company or government agency that can negotiate a discount? If so, I would like to see him connect that theory to the reality in this country, where the uninsured pay the highest prices for their medical care. If I were to be less charitable, I might ask whether Roy's intention is that the elderly have to choose the care, medication and equipment they need, versus paying their bills, buying food....

One has to ask if Roy's goal is to bend the cost curve, or if it's simply to shift medical costs from Medicare onto elderly individuals. If we presuppose that the elderly can afford the care that they require, it remains fair to observe that a cost shift does not actually address either the cost of the healthcare system or healthcare inflation. It simply means that instead of the money coming from Medicare, it will come from a senior's savings. Or their children's savings. Because unless the goal is deprivation, the money has to come from somewhere.

The problem with Roy's argument actually goes much deeper, when you consider the times when the elderly can easily run up five and six figure medical bills. A senior falls and fractures her hip. A senior has a heart attack or stroke. A senior collapses and is diagnosed with acute kidney failure. They can be in a hospital with a five figure medical bill before they're even able to consider whether they're in the most appropriate care center with the most appropriate doctor and most appropriate treatment plan. When you suffer a catastrophic health issue, odds are you are going to have to rely upon some combination of serendipity and the good intentions of others to get you to a point of medical stability - Roy's conceit that it is possible to address this type of issue by giving seniors an incentive to shop around for the best deal isn't realistic.

Roy complains that the same general problem holds true across the board:

The same holds true for all consumers of health care — not just the elderly. Medicaid and the system of employer-based health insurance both provide a great deal of first-dollar insurance coverage, meaning that consumers do not pay directly for services they receive and therefore have no clear sense of relative costs and values. In 1960, individuals paid directly for 52% of national health expenditures, but by 2008 that share had declined to just 12%. Americans are shielded from the real costs of their health care; as a result, it costs too much.

Except here's the thing: Insurance companies have been experimenting with copayments and deductibles to try to save money. And that cost-shifting has been relatively successful. However, on the whole, the net cost to the consumer has gone up. Why? Because when you have comprehensive insurance and your doctor says, "You need a CT scan", somebody from the medical center calls up your insurance company to see if it's covered. If the answer is "No," the patient is likely to receive a less expensive test that is covered by insurance. On the other hand, if the patient does not have that invisible intermediary, there's nobody to come back with, "Why not start with an ultrasound (or other test that might either confirm or refute a potential diagnosis) and we can see if the CT remains necessary once we have the results." They simply hear their doctor saying, "You need this," and so they pay for it.

Which brings to mind another contributing factor: the doctor may not have any idea what the tests, procedures, and medications he orders cost. In fact, there's a large, lucrative industry built around trying to convince doctors to prescribe expensive, patented medications, or to use new medical technologies, implants and devices. Perhaps that would be mitigated in part if more patients were overtly cost conscious, but I doubt it - it's not realistic for doctors to keep track of the relative cost of myriad treatment options, and to try to guide patients through their choices - particularly at those times when the most expensive care decisions are being made. Even if we assume that the information is available, accurate and that the patient is capable of understanding the financial information. It's simply not realistic.

Note that Roy also assumes that the fact that "In 1960, individuals paid directly for 52% of national health expenditures" while now "but by 2008 that share had declined to just 12%" means that people are choosing to obtain care that the don't actually require. A big part of the difference comes directly from Medicare - a program that was created in no small part because the elderly were being underserved by the health insurance market. We also now diagnose and treat a wide range of chronic health issues that were barely on the radar screen, or even unknown to medicine, back in 1960. We also offer a wide range of medical treatments that significantly improve the quality of life that were in their infancy or largely unavailable in 1960. A big part of the difference comes from the fact that, as a society, we have decided that certain medical care should be provided to people even when they cannot afford to pay a cent toward that care - hence programs like Medicaid and laws like EMTALA.

Roy makes little effort to advance his position that healthcare costs would decline if consumers were required to pay for a greater percentage of their care, and as I noted the data suggests that costs could actually increase. Roy does not attempt to document that the care is unnecessary, or the mercenary argument that if we apply a cost-benefit analysis we as a society will be better off even if we deny people access to necessary medical care.

At the end of his article, Roy reveals himself to be little but a foot soldier for the Romney/Ryan "reform" plan - not a policy analyst, but a political advocate. His first recommendation is right out of the political coward's playbook - "Don't change anything for anybody aged 55 or older." That's not about making good policy or protecting people - it's about votes. If in fact his second proposal, cost sharing (i.e., increasing what people have to pay for the care they receive) leads people to "make sensible decisions about whether to pursue treatment", it will do so for somebody who is presently 55 or older. If in fact his third proposal, means testing, is a reasonable measure, there's no reason to exempt the present generation of wealthy Medicare recipients from that standard. Worse, cost-sharing is unlikely to work, and means testing is not likely to produce appreciable savings.

Roy's next proposal is to "index the Medicare retirement age to life expectancy", that is, to make people wait longer to qualify for Medicare. Never mind that a significant population of seniors already postpone medical treatment until they qualify for Medicare. Never mind that the cost of postponed treatment can mean that the overall cost of Medicare goes up, or that more people will end up either on Medicaid, or become eligible for Medicare through SSDI instead of through reaching the retirement age. If there is a valid argument that actual savings could be realized, Roy hasn't tried to make it, relying instead upon supposition.

Roy's first meaningful proposal is to work harder to eliminate fraud from Medicare. Except everybody wants to eliminate fraud. Doctors and clinics get sued and prosecuted for Medicare fraud. Roy's solution? To privatize administration of Medicare. He may as well argue that we should wave a magic wand. There is no reason to believe that privatized administration will reduce fraud, and every reason to anticipate that it will increase costs.

Roy's ultimate proposal is that we implement a Ryan-style voucher plan for Medicare, while allowing seniors to buy insurance through a health insurance exchange. You know, the sort of exchange that's "the end of the world" as part of the PPACA, but for some reason is the height of market efficiency for a post-Medicare voucher program for the elderly.

Roy closes by attempting to put Medicare "in context":

Addressing this problem would require reforming and integrating Medicare, Medicaid, the employer-sponsored system, and the individual market (and would therefore require replacing Obamacare with a very different set of health-care reforms well beyond Medicare). It would involve addressing the runaway costs of defensive medicine and medical-malpractice litigation. Such changes would of course be extremely difficult to undertake, as the heated ongoing health-care debate amply demonstrates.

Roy wants to "integrat[e] Medicare, Medicaid, the employer-sponsored system, and the individual market"? That sounds a lot like what would be accomplished through "single payer". So no, that's actually not what Roy wants. Were Roy and his brand of analyst serious about reform they would be looking around the world at how other industrialized nations have responded to the same issues and proposing that we emulate their success. Instead they urge us to ignore our lying eyes, drink the Kool-Aid, and double down on our history of failed market-based (non-)solutions.

Note also Roy's introduction of the canards that "defensive medicine" and medical malpractice play a significant role in the current problem, and his prevarication that they are "runaway costs". They weren't important enough to address in his plan to save Medicare, but how can you close out a political argument like this without dropping them in for good measure? A serious analyst would put the prevention of malpractice and maloccurrence on the agenda, while recognizing that any effort to push the "runaway malpractice costs" like would reveal him as a dilettante. The current system compensated a very small percentage of malpractice victims, and is very accurate at weeding out unsupported claims. There's no indication that so-called "defensive medicine" could be eliminated even if doctors enjoyed absolute immunity - and if you look at the facts even the most sweeping "tort reform" measures, such as the laws in Texas that come close to giving doctors immunity, do not affect the manner in which doctors order tests and procedures. What changes things? The sort of salaried arrangement used by facilities like the Mayo Clinic and the Cleveland Clinic. Go figure.

Strip away the window dressing and the argument boils down to, "Medical care costs too much and costs are rising too quickly. I have no solutions, so I propose eliminating any form of group health insurance, giving poor people vouchers that they can use to pay for individual insurance policies, and calling it a day."

What the Election Means for Medicare Reform

Yesterday, Diane Rehm's panel included Julie Hirschfeld Davis, congressional correspondent for Bloomberg News, and Amy Walter, political director for ABC News. I didn't catch much of the show, but I did catch the following atrocious analysis. Starting with Walter:

However, fixing some things about Medicare certainly are doable. And, you know, we had a big fight in this election about Medicare. Now, the interesting point is, you know, both sides can see victory there. On the one hand, the Romney ticket lost and, of course, on that ticket was Paul Ryan, who made the issue of Medicare a centerpiece of his budget. The so-called voucherization as Democrats would say, premium support is how Republicans would argue, lost in one sense.

Given her position, it is difficult for me to believe that Walter is unaware of the fact that Paul Ryan himself referred to his reform proposals as creating vouchers. The reason that the Republicans don't want to use that term has nothing to do with its being a fair description of their plan, and everything to do with how it polls. We saw exactly the same game played back when G.W. Bush was trying to "reform" Social Security - the Republicans called their plan a privatization plan, and when the public recoiled at the term they started talking instead about "personal accounts" and purported that their own original description of the plan was a partisan slur.¹

By the same token, who used to refer to the Ryan Plan as a voucher plan? You guessed it.² "Premium support" is the poll-tested term he would have preferred be substituted for the one he personally originated in relation to his own plans, and which he knows to be accurate. A political director for the news division of a major network should clarify the facts, not play along with Ryan's semantic games.

On the other hand, it didn't lose that badly. I mean, it's not as if the issue was the defining focus of this campaign, and in some cases, while the president was ahead on Medicare, in the final tally, it was not by such a tremendous percentage that Republicans can look back and say, boy, that was really dangerous. We shouldn't have brought that up at all. In fact, they can say, we didn't get beat that bad on it.

Here, Walter is simultaneously arguing that Medicare was not "the defining focus of this campaign" - that is, the President's victory cannot be ascribed to his position on Medicare - and that the Republicans "didn't get beat that bad on it". You can't have it both ways. If most voters were motivated by issues other than Medicare, although you can draw the conclusion that proposals to voucherize Medicare aren't going to destroy a campaign as long as they remain in the background, it tells you nothing about what would happen if they were perceived as the defining focus of a campaign.

Then Davis takes the argument from bad to worse:

The other thing is that if you look at the groups that Mitt Romney and Paul Ryan won, seniors were a big part of it. I mean, it's been the case in the past that you couldn't talk about this without being really afraid that you were going to alienate an important voting constituency. It -- we didn't really see it happen in Florida or anywhere else, really, for Mitt Romney. And now, you could argue that Medicare wasn't the primary issue in this election. But it was certainly very much in the conversation.

And as Amy said, when Paul Ryan became the vice presidential pick, it was a major item on people's radar screen. And they didn't pay for it among older voters. So that is an indication, I think, for Republicans that they can maybe do this and maybe even for Democrats and not get -- pay such a huge political price if they do it the right way.

Surely Davis has a long enough memory to recall what actually happened. Romney promised not to touch Social Security for anybody who is presently retired or will be retiring over the next decade. Sure, some were smart enough to figure out that he intended to voucherize the program for younger workers, but many did not, and many who did either didn't care about the younger workers or felt that Romney's procrastination put the issue so far into the future that it wasn't relevant to their vote. On top of that, Romney engaged in shameless demagoguery about Obama's proposed cuts to Medicare spending, pretending that they were cuts of benefits to seniors and that the President wanted to take away the benefits of good, retired people who had earned them in order to give health insurance to lazy, poor people.

You cannot draw the lesson from Romney's campaign that it is safe to propose major changes to Medicare without risking alienating "an important voting constituency", namely the seniors who presently receive or who are about to receive Medicare, because Romney did not actually take that risk. A courageous political leader who sincerely believed Medicare needs to be turned into a voucher program for the good of the country might have done so, anyway, but Romney was anything but courageous and it remains difficult to discern whether he has any sincere beliefs.

Also, Davis has to know that before the election Ryan was a relatively obscure person outside of the Beltway and Tea Party circles, that his "budget" is hogwash, and that most voters don't believe accurate descriptions of what Ryan proposed to do through that budget. Ryan's selection as Romney's running mate meant about as much to Medicare policy as Palin's selection meant for foreign policy. The election is over - there's no need to pretend otherwise.
------------------------
1. G.W. Bush wrote in "Decision Points,

Democratic leaders alleged I wanted to "privatize" Social Security. That was obviously poll-tested language designed to scare people. It wasn't true. My plan saved Social Security, modernized Social Security, and gave Americans the opportunity to own a piece of their Social Security. It did not privatize Social Security.

As should be needless to say, the term "privatization" came from organizations like Cato and FreedomWorks, not the political left. Further, when he created the President's Commission to Strengthen Social Security, back in 2001, the members of the commission understood that the President wanted them to at least partially privatize the system. Here's an exchange between Committee member Leanne Abdnor (straight out of Cato) and Roger Hickey, from the Institute for America’s Future:

MS. ABDNOR: But just real quickly. In your statement you said that our mandate, as given to us by the President is, in other words, to privatize Social Security?

MR. HICKEY: That is the way I understood it.

MS. ABDNOR: My question is does that mean that a total -- does privatization mean that the President wants to dismantle, completely dismantle the program? Is that your understanding?

MR. HICKEY: No. I think I have specified that he has mandated you to partially privatize the system.

MS. ABDNOR: But not dismantle the system. Correct?

MR. HICKEY: I don’t think the President intends to dismantle the system. No.

MS. ABDNOR: I’m sorry?

MR. HICKEY: I don’t think the President intends -- thinks that he is giving you a mandate to --

MS. ABDNOR: Okay. And the reason I say that is because a lot of people, when they hear the term privatize, they interpret it as we are going to do away with Social Security and dismantle it all together and replace it with that. I just wanted to be clear what your interpretation of that was. So, thank you.

MR. HICKEY: no. My point that I tried to make in my testimony clearly is that I think when you go down this road, when you pull on the string on part of an integrated system, the whole thing does start to unravel. Nobody has explained to me how you are going to be able to maintain survivors benefits, for example, and disability benefits when you are tampering with the retirement benefit, if, in fact, you do that. I do think that there is a danger of going down the road of private accounts, that the whole system starts to unravel and that you have something akin to dismantling of the system. But I think that you have been asked to look at privatizing a portion of the Social Security system, and I think -- I hope that you will think through the implications of that.

MS. ABDNOR: Absolutely. But if I understand your answer, no, you don’t mean to say that you believe the intention of the commission of the President is to completely to dismantle, but it could lead to that?

MR. HICKEY: Yes.

Ms. Abdnor was aware of the possible public reaction to the term "privatization", but she accepted the term as a fair description of the President's goals for the Committee.

2. And in the manner of G.W., Ryan accused people who used his words to describe his plan as using "a poll tested word designed to scare today's seniors".

Divine Right

Who are you going to vote for?

"Game Changing" October Surprises that Never Happened

Breaking News, Big Scoop from Matt Drudge: A powerful political insider claims to have an Ann Romney "Whitey" tape. Rumored content:

"Why vote for whitey when you can vote for 'whiter than whitey'?"

David Brooks reveals his shocking discovery that on the eve of the first debate the candidates were replaced by hideous space aliens. Nobody who saw the debate is surprised - the big surprise is finding out that Paul Ryan and Joe Biden weren't "body-snatched". The candidates then agree that the country should build a giant space cannon, with the polls split 50:48 on whether or not it should be aimed at the planet Kolob.

Donald Trump produces a real Obama birth certificate, resulting in the following exchange,

Trump: Barack, I am your father.

Obama: No. No. That's not true. That's impossible!

Trump: Search your dreams of your father, you know it to be true!

Obama: Noooooooo.......

A secret audio recording is found in which Romney explains why he is running for President,

"It was back when I was still running a small business and was barely pulling in eight figures. We still only had two, maybe three houses, but we were optimistic about the future so we packed the kids into the car and went house shopping. We were driving down Pennsylvania Avenue in D.C. when one of the kids, I think it was Taggart, pointed at the White House and said "Can we buy that one?" Ann laughed, but I said, "You know what...."

David Brooks Rejects Moderation - Anything to Get a Tax Cut

David Brooks pens a predictably partisan "analysis" of how Mitt Romney would supposedly govern as a "center-right moderate". Not in the sense of Brooks' recent definition of "moderate", but in the sense of the guy who stakes out a position between two extremes and calls himself a "moderate".

Now let’s try to imagine the world if Mitt Romney were to win. Republicans would begin with the premise that the status quo is unsustainable. The mounting debt is ruinous. The byzantine tax and regulatory regimes are stifling innovation and growth.

Brooks told us that a moderate is informed not by politics or philosophy, but by history. What does history tell us about Republicans and deficits? It tells us that they campaign against deficits and then, once elected, run up deficit spending to unprecedented heights. Brooks may want to believe that "this time will be different", but that can only be because his eyes are clouded by his own wishful thinking and political partisanship.

Brooks is also not being honest with his readers. He pretends, "", but he knows that's a lie. He knows that a lot of government regulation that stifles innovation was created and is maintained at the behest of businesses that don't want competition. He knows that the tax code is complex, byzantine, not because it's necessary to include that level of complexity, but because a simple tax code makes it difficult for large corporations and phenomenally wealthy individuals (such as Mitt Romney) to avoid taxes. Brooks knows that Romney made his fortune by exploiting tax loopholes, by larding up businesses with debt and deducting the interest

Dos Brooks truly believe that Romney is going to take away the loopholes that allowed him to get $100 million into his IRA? That he's going to do away with carried interest, the loophole that allowed him to have his massive income taxes as capital gains? That he's going to shut down the loopholes that make private equity funds so profitable? Not in this lifetime. You need only look at who is funding Romney's run for the White House to know that there's a zero percent chance he's going to do any of that.

Does Brooks believe that Romney is terrified of disclosing his tax returns because they'll disclose his scrupulous, honest nature, his self-sacrifice, his interest in closing tax loopholes? Only if he's on crack. Most likely, Romney is concealing the fact that he took advantage of the tax amnesty on dubious offshore bank accounts - an important tool in tax avoidance and one that Romney has made no mention of eliminating.

Which tax loopholes is Romney going to close? He refuses to specify - and of the ones he's mentioned in the abstract they all inure to the benefit of the middle class. Which government spending is Romney going to cut? He mentioned PBS - but history tells us that he won't cut PBS (even if such a cut mattered in the greater scheme of things). He has talked about cutting or privatizing FEMA. I suspect that, as I type, Brooks can look out of his window and get a sense of how likely that is to happen. Seriously.

What history indicates is that Romney will follow the path of George W. Bush. He ran on a promise to cut taxes, those who paid for his campaign are going to want him to deliver on those tax cuts, and he will do so without regard for the deficit or national debt. To the extent that people remind him of his pledge to cut spending to offset the tax cuts, history says he'll talk about growth and cuts to occur in the future - it's a ten year plan, remember? And history tells us that ten years later when, just as with G.W.'s tax cuts, the Romney plan turns out to be bunkum and to have put the nation into an even deeper fiscal hole, you can expect David Brooks to be telling us to vote for the next Republican because "he's going to govern from the center-right and this time he really will balance the budget."

Republicans would like to take the reform agenda that Republican governors have pursued in places like Indiana and take it to the national level: structural entitlement reform; fundamental tax reform.

You'll excuse me for asking, but how many Republican governors are there in the state of Indiana? Last I checked, Indiana followed the crazy model of only having one governor at a time. And what is the gist of Indiana's tax reform? To limit property taxes and overcome the loss of revenue by increasing the state sales tax? How in the world does Brooks propose to translate that type of reform to the federal government? Does Brooks even understand how taxes work? And other than jumping on the money-losing "drug testing for welfare recipients" bandwagon, what "structural entitlement reform" are we talking about?

I recognize that as a Republican partisan Brooks is happy to pretend that conclusory statements and platitudes constitute policy proposals, and is happy to suggest that "We'll balance the budget by doing things we're not going to tell you about" is an actual plan to balance the budget, but get real.

These reforms wouldn’t make government unrecognizable (we’d probably end up spending 21 percent of G.D.P. in Washington instead of about 24 percent), but they do represent a substantial shift to the right.

Recall how, when pressed for specifics about his tax reforms, he announced that his solution was to just "pick a number" - an entirely random number?

And so, in terms of bringing down deductions, one way of doing that would be say everybody gets -- I'll pick a number -- $25,000 of deductions and credits, and you can decide which ones to use. Your home mortgage interest deduction, charity, child tax credit, and so forth, you can use those as part of filling that bucket, if you will, of deductions.

That's not even close to serious. On top of that, Romney is promising massive increases in military spending. History tells us that when Republicans promise to cut taxes, they cut taxes. When they promise to increase spending, they increase spending. And when they promise to balance the budget... it never happens. There is absolutely no reason to believe that Romney will reduce government spending. He may shift it around, he may make life even easier and more lucrative for those at the top, but cut it? Sorry, David, those were numbers, not beams of sunshine, that Romney pulled out of his posterior.

At the same time, Romney would probably be faced with a Democratic Senate. He would also observe the core lesson of this campaign: conservatism loses; moderation wins.

But if Romney wins, that won't be the lesson of the campaign. The lesson will be that you can lie your way into the White House, all the while being enabled by columnists like David Brooks, because you promise an agenda that they like - one that keeps them and their peers, and the even richer elite they so admire, in their positions of wealth and privilege. You'll note that Brooks isn't pointing to anything Romney has said or done to paint his portrait of what's likely to happen, and he's intentionally ignoring history. Why? Because honesty loses elections, and Brooks wants Romney to win.

Only a few days ago Brooks was lecturing us that "Moderates start with a political vision" derived from history and "is not just finding the midpoint between two opposing poles and opportunistically planting yourself there". Yet now we're suddenly to regard as "moderate" a "center-right" Mitt Romney who gets legislation through the Senate by staking out a position between the Republicans in the House and the Democrats in the Senate and asking, "Is this a good enough way to split the baby?"

This is funny, as well - and false:

Romney’s prospects began to look decent only when he shifted to the center.

This election has been close from the outset. While Romney did dip in the polls after the Republican National Convention, his subsequent "bounce" has been much more a return to the baseline than anything else. And yes, his latest reinvention of what he believes and what he stands for seems to have helped him move back to the status quo ante, I think it's much more fair to say that his demagoguery, his race-baiting surrogates like John Sununu, and his exploitation of the financial crisis and mendacity about the recovery have helped him build what is in no small part an anti-Obama vote. He can't win as Mitt Romney, so he's running as "But I'm not Barack Obama". To the extent that people believe Romney stands for something, it's wishful thinking - "For no good reason, I'm sure Romney agrees with me on issue X, and that the dozens of other positions he's taken on the subject were all self-serving lies." A Romney victory would be a sad indictment of our political system, and frankly also of how it is covered by people like David Brooks.

A President Romney would look at the way Tea Party extremism had cost the G.O.P. Senate seats in Delaware and Nevada — and possibly Missouri and Indiana.

Even before his latest reinvention of himself, candidate Romney was aware of the dangers of being too closely identified with the Tea Party movement. But again, Brooks is forgetting his history. The Tea Party movement isn't a new thing - on the whole it's little more than a new name for a faction of the Republican Party that has been around for decades. Republican presidents have a long history of making broad promises to that faction, while being pretty modest about advancing that type of ideology when in office. Why? Because, as Brooks knows, the presidency is a national office. While Romney may represent a new extreme in how far a party nominee may go in pandering to an extremist element when seeking the nomination, then adopting a contradictory agenda when running for office, the rest is par for the course.

Brooks fails to mention that the danger the Tea Party poses to the Republican Party comes not at the level of the White House, but at the level of the primary. In states that have a significant Tea Party movement, candidates like Rick Santorum seem viable. Even long-term senators like John McCain start trembling in their shoes at the thought of a Tea Party-driven primary challenge. An honest Brooks would acknowledge that the newly center-right Romney may well be able to peel off some Democrats to support his agenda, but if he strays too far from the Tea Party line he's apt to lose as many Republicans, perhaps more. That could be paralyzing for any "moderate" or "centrist" agenda.

You know what else? Whether they win or lose in certain state races, the Tea Party has never been closer to having its agenda implemented by the Republican Party. There's no reason to believe they're going to back off.

To get re-elected in a country with a rising minority population and a shrinking Republican coalition, Romney’s shape-shifting nature would induce him to govern as a center-right moderate.

"Romney’s shape-shifting nature".... What a description. It's the description of a man with no core, a man with no backbone, and yet Brooks seems excited at the prospect of his becoming President. Let's take another look at history, shall we? Twelve years ago we had a Republican President who was going to usher in immigration law reform - he saw the handwriting on the wall, and was going to build ties with the Latino community.

We had a prominent Senator who also favored immigration reform and championed the DREAM Act - one John McCain. Let's recall, shall we, how much the President accomplished toward immigration reform.... He made immigration more difficult. And what of that Senator? Eight years later he was running against the immigration policies he once championed, and as time has progressed he has moved further and further away from his former positions. He also used to champion campaign finance reform... fat chance that he or President Romney are going to get behind that idea.

Seriously, it's safe to say that a man like Romney - a man who appears to care for absolutely nothing but advancing his own interests - will govern in a manner he believes is likely to result in his being reelected. But history is instructive, and there's far less reason to believe that Romney wants immigration reform as compared to Bush, and there's no reason to believe that Romney will succeed where Bush failed. Beyond that, what does Brooks imagine Romney will do to appeal to "a country with a rising minority population"? Apologize for all of the race-baiting he and his surrogates have engaged in during his campaign?

To get his tax and entitlement reforms through the Democratic Senate, Romney would have to make some serious concessions: increase taxes on the rich as part of an overall reform; abandon the most draconian spending cuts in Paul Ryan’s budget; reduce the size of his lavish tax-cut promises.

Brooks is, in essence, repeating himself. And we're back to this notion that the Republican Party is going to break with history and suddenly prioritize balancing the budget over cutting taxes for the rich. I mentioned the head count in my last post, 236 out of 242 Republican Members of Congress, and 40 out of 47 Republican Senators, have signed Grover Norquist's anti-tax pledge. The numbers may change slightly after the next election, but not significantly. Also, there is no reason to believe that Romney is going to decide that the best way to win reelection is to tell his largest donors, "You know what? Obama was right about taxes as well." Some degree of compromise may be required for him to get his tax cuts through a Democratic controlled Senate, but he will make it a priority to keep of that promise to his donors (and, frankly, to himself).

As for "the most draconian spending cuts in Paul Ryan’s budget", Romney has already abandoned them. When it comes to how he'll balance the budget, he won't get more specific than cutting PBS. Romney and Ryan are both cowards - they have both failed to explain who would feel the bite from their proposed cuts. And while Ryan proposed turning Medicare into a voucher program, and Romney proposes to push forward with that idea, the cowards have pushed the implementation of that reform so far into the future that they'll be long out of office before anything changes. They are not serious about balancing the budget and as much as Brooks attempts to fool himself - or is it only others that he's trying to fool - they will not hesitate to run up the deficit and the national debt. And when they do so, they'll claim "It's all Obama's fault."

You gotta love this:

The bottom line is this: If Obama wins, we’ll probably get small-bore stasis; if Romney wins, we’re more likely to get bipartisan reform.

All of four days ago, Brooks was telling us about the difference between being "moderate" and being "bipartisan", in that column and at the start of this one Brooks told us that Romney's latest reinvention of himself involved advancing a "moderate and sensible agenda", and yet here he is, admitting that his favorite spineless pretzel of a politician is not advancing "moderation", but is embracing the shallowest form of "bipartisanship", "finding the midpoint between two opposing poles and opportunistically planting [him]self there".

Romney is more of a flexible flip-flopper than Obama.

Yes, Brooks sees that as a good thing - a basis for endorsement. "You can't trust a word out of his mouth and you'll never know what he stands for (other than himself), so vote Romney."

He has more influence over the most intransigent element in the Washington equation House Republicans.

You'll excuse me for asking, but what evidence can Brooks offer that Romney will have any influence over House Republicans?

He’s more likely to get big stuff done.

If by "big stuff" you mean "tax cuts for the rich", yep. If you mean addressing any of the nation's most serious problems, Romney is expressly campaigning on a platform of leaving the hard stuff for the next guy - even if he serves a full eight years. He'll start the country on the path to have the budget balanced... in ten years. He'll start the process of privatizing and voucherizing Medicare and the first people who get vouchers instead of insurance will receive them... in ten years.

Romney is a coward, and he'll govern as a coward. If that makes Brooks comfortable, I am hard pressed on that evidence to believe that Brooks cares about anything other than getting a tax cut.

The Following Songs Go Out To....

To Mitt Romney, for his courageous leadership on women's rights:

To Paul Ryan, for his dedication to volunteer work:

Obama & Biden - They'll Clean Your Clock

If You're Going to Fake Manual Labor... Fake it Right

Thinking back to Good Will Hunting, there's a scene in which Matt Damon is supposedly mopping a floor. He does so by sloshing a huge amount of water onto the floor them moving it around with the mop. You can't blame the actor. Who would have expected Matt Damon to have janitorial experience, after all. But you would think somebody associated with the shooting of that scene would know how to mop a floor, and I find it difficult to believe that a "technical adviser" would have been difficult to find.

Ah, but that was a long time ago. What brings the memory to mind? Paul Ryan's latest bad acting job:

Paul Ryan claims to have spent "a summer washing dishes", using a Hobart dishwasher. Apparently the dishwasher didn't even once break down, lucky for him, or the patrons of the restaurant would have been put at risk. Why do I say that? Because Paul Ryan doesn't know how to wash dishes - even clean ones.

Ryan is presumably referring us back to the summer he spent as a teenager working at a McDonalds Restaurant. That restaurant would have had a three-compartment sink, just like the one in Ryan's staged photo op, just in case the Hobart broke down. And if he was in fact the dishwasher, Ryan should have been trained how to use that sink.

The proper method of washing dishes is not: "Pretend to wash a clean dish, rinse thoroughly and pass it to a small child." Instead you use all three compartments of the sink - the first is for your hot soapy water, the second for clean water for rinsing, the third for your sanitizing solution. You wash, then rinse, then sanitize. Pretty simple, right?

It's a shame that Ryan didn't show up when there were people to feed or dishes to wash. He might have learned something. Instead, oh my, what a lesson he was giving to his children.

Update: Ryan's team is now claiming that the dishes Ryan washed were in fact dirty. Ryan's defenders contend that this means that the photo op was not "faked" - a claim that, under the facts, is unworthy of response. But here's the thing: If the dishes were dirty, it's all the more important that they be cleaned properly. The person who left the dirty dishes for Ryan should either have ensured that Ryan knew how to wash dishes, or should have stayed there to instruct him because what Ryan did on camera was and remains a health code violation.

Why a Coward's Path to Medicare Reform Won't Work

I've made no secret of what I think of policy proposals that are not slated to take effect until after an election or, worse, after the next President is in office. Granted, sometimes the timing issues are a bit more complicated than they might appear at first blush. The "Bush tax cuts" were scheduled to expire after ten years not because Bush wouldn't have preferred to make them permanent, but because they were passed through reconciliation and thus had a ten year shelf life. Obamacare was implemented in phases not because there was concern about earlier implementation, at least on the part of the Democrats, but because of insistence that the bill be revenue neutral. The staged implementation allowed the financial projections to show revenue neutrality over a ten year period. Which is not to say that I don't think that the Obama Administration felt some relief when the least popular aspect of the plan was pushed to 2014, a happy side-effect of the bitter pill.

In stark contrast are policy proposals over issues that a President fears would be damaging. George W. Bush promised that his policies would lead to an independent Palestinian state during his second term because he didn't want to fall flat on his face trying to force a resolution before his reelection, taking advantage of any suckers who supported his reelection based upon his feigned interest in the issue then all-but-dropping it after his reelection.

The more difficult issues of our time, it seems, are placed on the coward's schedule. The ultimate cowards of our current election cycle are Mitt Romney and Paul Ryan, who are deliberately creating a conflict between generations in order to try to grease their way into the White House. They have made clear that they want to turn Medicare into a voucher program and would prefer to do so immediately, but they don't have the courage to stand behind those convictions.

Instead they claim that they will pass legislation that will take effect a decade from now, long after their assumed second term ends, that will leave untouched the Medicare benefits of anybody over the age of 55 but will give any younger person a voucher inadequate to pay for equivalent coverage - and with the voucher structured to lose value over time in relation to the projected future cost of health insurance. They pretend that they will make up some of the shortfall by reducing the value of the voucher for wealthier seniors, but know full well that the amount they could save through such a measure would be a relative pittance.

You know what else? Other than the fact that health insurance companies don't care to insure seniors, with their unpredictable and often high medical costs as well as end-of-life care, their present proposal sounds an awful lot like "Obamacare for seniors, with a public option." Funny how they're not worried about "individual mandates", public competition with private insurers, and the like when it's their proposal. That's not really a big surprise, though, given that Romney still supports Romneycare - his real objections to "Obamacare" are that (a) objecting could help him defeat a Democratic president and (b) it might work.

Back to the coward's time line. As anybody who knows anything about how our system of government works can tell you, Congress passes spending measures on a year-by-year basis. Congress meets and passes new legislation each year. If this year's Congress passes a law that attempts to bind future congresses, a future congress is free to change or repeal that law.

Why do Romney and Ryan quiver in their boots at suggesting to today's older voters, those age 55 and older, as well as current Medicare recipients that their benefits should be transformed to a voucher program? Simply put, those voters have more money and influence as compared to most other voter blocs, they like and want Medicare, and they vote. Romney and Ryan are happy to try to scare those voters with demagoguery about bureaucrats deciding what care they will get, or budget cuts that don't directly affect benefits and which they, themselves, have endorsed. But when it comes to telling that population, "Medicare costs the nation too much, you paid for it but not enough as compared to what you're getting, and it's only fair that you share the burden of our reform," nope, not happening. They propose continuing what they claim to be an undeserved windfall to today's seniors, while imposing what they claim to be an unreasonable burden on everybody else.

So let's move nine years into the future. Assuming Romney and Ryan win the election, they'll be out of office. And their Medicare reform? It won't yet be in effect. The voters they're presently terrified of confronting will be 65 and older. And an entirely new population of voters will be between the ages of 55 and 65, and the new generation of politician will be every bit as terrified of those voters as Ryan and Romney are right this very minute.

It appears to be the hope of Romney and Ryan that, when confronted with that anger, rather than repudiating the never-implemented Medicare reform, politicians a decade from now will look at the budget picture and say, "Let's just put this voucher thing into effect for everybody." More likely, they'll either say, "Let's put this off another ten years." Faced with enough voter anger, as the deadline becomes real and the weakness of the replacement benefit becomes obvious, they'll say "Oh well, I guess we won't be implementing that plan after all."

Either way, the most likely impact of the cowardly reform schedule is that rather than making tough choices, politicians of the next decade (for most of which Romney and Ryan hope to be leading the pack) will slough off the idea that they need to do any hard work to fix Medicare for the long term because, "Several years from now our reform will come into effect and the markets will magically fix all of this stuff." That is, Romney and Ryan are giving themselves an excuse to do nothing constructive and to show no leadership on the actual issues facing Medicare, knowing full well that their cowardice on the issue could create immense difficulty for the administrations that succeed them.

Perhaps they hope that their fiscal policies will leave the government in such bad shape that it cannot afford to perpetuate Medicare. But if that's the case, they should admit up front that they are offering a recipe to harm and weaken our nation, not one that will give it an strong economic footing. If, on the other hand, they believe their budget plans will improve the nation's finances, what are the odds that their successors are going to take the heat for decisions Romney and Ryan were too cowardly to implement when, just like Romney and Ryan, they can push the issue off onto a future administration.

Promising the Moon then Passing the Hard Work to Congress Isn't Leadership

A central theme of the Romney/Ryan campaign is that they don't have to be specific about the more difficult aspects of their otherwise pie-in-the-sky plans because they're simply going to delegate the task to Congress.

"Here's our specific proposal for a $4 - $5 trillion tax cut, inuring largely to the benefit of the wealthy. Now it's your job, Congress, to find the loopholes to close and deductions to eliminate to make our plan revenue-neutral.

I have forgotten. Which branch of government controls the purse strings again? Which branch of government is infamous for its pork and earmarks, for not wanting to cut anything that might alienate a constituent or wealthy donor? Which branch of government has two-faced "budget experts" who publicly decry stimulus spending while privately pleading for stimulus dollars to be sent to their districts? Which branch of government delegates its difficult budgetary tasks to committees and forces "up or down" votes on committee reports, because that allows its members to avoid taking personal responsibility for any resulting pain? (Give me a "C", give me an "O", give me a "N"....)

This would be the same Congress that created those deductions and loopholes? This would be the same Congress that passed, with "budget expert" Paul Ryan's support, authorization for two unfunded wars and the massive unfunded entitlement expansion, Medicare Part D? This would be the same Congress that has passed each and every budget that has added to our national debt? When he's not campaigning, and professing deep regret for his career of deficit-expanding votes, Paul Ryan is very much part of the problem.

If Romney and Ryan believe what they're saying, they're fools. But you know what? They're not fools. They're hoping that the rest of us are fools, and that a pliant media continues to go along with their game.

To be leaders in this context, Romney and Ryan don't have to take a "my way or the highway" approach. They simply need to put together a credible proposal and say, "If Congress can improve on this, that would be great, but as you can see this really can work." You know what else? If they're deferring to Congress, with Paul Ryan being the GOP's "budget expert" in Congress, Ryan should be able to speak for the House majority right now. If this proposal were to come before the Republican majority in the house, what would Ryan endorse right now? It's a fair question, and one a leader would not be afraid to answer.

Were they honest, they would admit that they're not willing to risk their political futures by telling the truth - that even if we assume there are enough loopholes and deductions to close, there is simply no way that Congress is going to take responsibility for inflicting that kind of pain. If they were courageous they would stand behind their convictions and state exactly what their plan entails, accepting the political consequences. Were they leaders they would produce an actual plan and present it to Congress and the nation. But alas, they're none of the above, so they pretend that its enough to pass the buck to Congress, knowing full well that Congress will demur.

When a Politician Talks About Reproductive Choice

If a politician is directly asked whether, in the event of his election, people should be worried about the loss of reproductive choice, and he answers anything but "no", whatever else he may appear to be saying his answer is "yes".

Whether you find that disturbing or reassuring is an entirely separate issue.

Will Paul Ryan's Budgetary Lies Haunt Romney

They will, if the media does its job. The media should hold Romney's feet to the fire until he identifies enough loopholes and deductions he will ask Congress to close to make his "budget" work.

Ryan was repeatedly challenged to identify the tax deductions he and Romney propose to eliminate to "pay for" their massive tax cut. Predictably, Ryan refused to identify a single one. Even when asked if he would protect the mortgage interest deduction for households earning less than $100,000, he refused to answer.

Here's the thing: There's no way on God's green Earth that Romney and Ryan are the know-nothings they pretend to be on this subject. They're cowards, not idiots. They have specific deductions in mind - probably not enough to make their proposal work, but they do have ideas. They won't name them - beyond some lame demagoguery about Obamacare (which is projected to decrease the deficit) and PBS (whose federal funding is less than a rounding error) - because they're afraid that specifics will cause their bad arithmetic to turn them into budgetary laughing stocks, that their proposed cuts will prove so unpopular that candor costs them the election, or more likely both.

It was fascinating to hear Ryan complaining that the CBO wasn't able to score a speech by President Obama, because they had neither been asked to score anything nor given data to score, and because the speech itself was short of specifics. You know what? To the extent that a politician is making a budget or spending proposal I agree with Ryan that the specifics should be shared, and I agree that when those specifics are produced the CBO should score them. Where I don't agree with Ryan is that the rule should only apply to Democrats. Man up, Mr. Ryan, and submit your latest, detailed budget proposal to the CBO for scoring.

You have to appreciate the audacity, presenting a caricature of Obama's tax proposals then whining that taxes on the wealthy won't be sufficient to close the deficit (as if anybody claimed they were), and in almost the next breath pretending that you can pay for Medicare at its present levels by trimming benefits for the wealthy. You know what? When you target the wealthy it's either class warfare or it isn't, and you promise on top of that "class warfare" to fix the most significant budgetary problem we face, projected Medicare costs, by reducing benefits for wealthy people you are engaging in the very act you misattribute to the other side - because as you've already admitted, the dollars aren't there.

And to keep resorting to the tired distortion about the "$716 billion cut" to Medicare that Ryan included in his own budget, pretending that in Democratic hands a cut he explicitly endorsed through that adoption will devastate seniors? Talk about chutzpah.

Ryan kept complaining that accurate descriptions of his proposals would scare people, suggesting that it was wrong to scare voters. Clever, really, and I expect some people will actually fall for it.

The Expectations Game and the Presidential Debates

"Have we been telling you that our guy's great? Well, actually, he kinda sucks."

Both sides play expectation games - better to be underestimated and have your middling performance seen as a victory (Sarah Palin vs. Joe Biden) than to be expected to dominate and stumble. But this could be a case study. Following up on Chris Christie's bluster,

New Jersey Gov. Chris Christie says on CBS’ "Face the Nation" that Romney is going to do "extraordinarily well" in the debate and that after Wednesday night, "this whole race is going to be turned upside down."

Paul Ryan insists, in essence, "No, Romney's not a great debater, has never debated a single opponent, the President has been on a public stage for six years [don't ask what Ryan has been doing], and the debate's actually a pretty minor event."

The GOP vice presidential candidate calls President Barack Obama "a very gifted speaker" who’s been on the national stage for several years.¹

Ryan also is making the point that Republican nominee Mitt Romney has never been in a one-on-one presidential debate.²

Ryan tells "Fox News Sunday" that the race is close and he expects it will stay that way until Election Day on Nov. 6.

I suspect that from Christie's perspective, Romney needs to excel in order to change the trajectory of his campaign, so he's expressing what he hopes to see. Ryan, on the other hand, wants an debate that isn't completely embarrassing to Romney (an outcome nobody expects to occur) to be taken as a draw, and anything better than that to be perceived as a victory.

Meanwhile, the President's campaign is advancing a less blustery version of Christie's message - Romney's a great debater who repeatedly beat his opponents in the primaries. (Compare and contrast, for example, the banter of boxers in a title match.)
---------------
1. And Romney has been doing exactly what for the last couple of decades of his life, starting with his Senate race against Kennedy? A shrinking wallflower, he.

2. A pretty thin distinction. He's been in one-on-one debates when seeking both state and national office.

Truth is, Romney Could Have Done Worse

I recently elicited a comment on my description of Paul Ryan as an example of how"the media and party can sometimes elevate mediocre people to undeserved heights".

Just curious what you think....calling Paul Ryan mediocre and seeing him become the VP nominee.

Never mind that Ryan's continued rise exemplifies my point.

However, recent events suggest that Ryan could offer something important to the ticket, assuming Romney is willing to listen: an ear for politics. Ryan has, at this point, build himself a national reputation as an idea man and budget whiz based upon little more than spin. You can't do that unless you pay careful attention to the direction of the political winds. Romney seems perfectly willing to blow whichever way the polls tell him to go, but he appears to lack any instinct of when to stand against the wind, or when he's going too far. That is to say, he seems to have a proverbial tin ear for politics.

Right now, it's Romney who is pulling the Sarah Palin act (while she literally cheers him on from the sidelines), pushing the latest iteration of her "Obama pals around with terrorists" calumny, while Paul Ryan - the guy who gave up a good chunk of his reputation by "taking one for the team" with his ridiculous, mendacious convention speech - is playing the part of McCain. Sure, he's being politically opportunistic, and after a reasonable initial statement has reverted to platitudes, but he has chosen to leave it to clowns and hacks like Sarah Palin and Reince Priebus to look ridiculous.

Romney, alas, was one of the first out of the clown car.

David Brooks, True to Form

I had a discussion with somebody about David Brooks this morning. He was asking me what I thought of various newspaper columnists, and couldn't quite remember the name, but "David" was enough. He mentioned that he thought Brooks was a pretty clever guy who put his own spin on things. I agreed. I asserted that whatever the spin was, Brooks should be recognized as the partisan he is - reiterating a point that I've made here that when he gives advice to Democrats on what they need to do to win elections it's consistently bad (for Democrats) - whether he's advising Democrats or Republicans on strategy they should adopt, he's in fact giving advice that he believes will help the Republicans win the next election. My friend agreed, but expressed in essence that Brooks is a breath of fresh air as compared to other partisan columnists (his example was Peggy Noonan).¹

When I followed a link to his latest piece, I thought for a moment, "Perhaps David Brooks is going to prove me wrong." He starts out with a valid point: It's time for President Obama to tell us what he plans to do in his second term, and why he deserves a second term. Sure, he puts a light Republican spin on Obama's history, and gives undeserved praise to Paul Ryan², but underneath that, in relation to the President, how can you argue with this:

It’s not clear what he is passionate to do if he is elected for another four years.

But from there, pure reversion to form.

First, global warming. President Obama has occasionally said he’d like to do something about climate change if he gets a second term. Given the country’s immediate economic and fiscal problems, this seems obtuse to me. But if this is really where Obama’s passion lies, he should go for it.

In other words, even Brooks can't hold a straight face when telling Obama to focus his second term agenda on global warming - yet it's his number one suggestion. When you read Brooks' specific proposals, you can't help but wonder if he's already viewed the attack ads the Republicans hope to be able to run on the issue.³

Brooks' next idea is that the President should attack capitalism. Seriously - Brooks is claiming that a President whom the Republicans have bashed based upon zero evidence of not understanding capitalism, of hating capitalism, of being a socialist (if not a communist), of hating rich people... all that nonsense... should make an attack on capitalism the centerpiece of his reelection campaign. The attack ads would write themselves.⁴ Again, Brooks can't help but smirk,

This agenda wouldn’t appeal to moderates, or people like me, but it’s huge, it’s serious and it would highlight a real problem.

It's a serious problem that David Brooks can describe but... doesn't care about? Brooks is mostly correct that his ideas "wouldn’t appeal to moderates, or [Republicans]", which translates into an admission that Brooks expects that such an approach would cost the President votes.

Brooks then suggests that the President should embrace wholeheartedly the report of the chairs of the failed Bowles-Simpson Commission, and finally bring to this country the sort of bad policy and austerity measures that have caused Great Britain to have a double-dip recession. After admitting that even the Republicans at most pay "lip service" to Bowles-Simpson - having apparently forgotten that Paul Ryan served on the commission and voted against the final report - he proposes that Obama could endorse a witches brew of ideas from Simpson-Bowles that even the Republicans view as toxic.

At first blush you might respond, "Well, at least the Republicans wouldn't be able to run attack ads against a plan that's to the right of Paul Ryan's deficit-increasing proposals," but nope. The ads will be running the next day, "See? We told you that Obama was taking away your Medicare and now he's also going to slash your Social Security benefit!" It's also amazingly transparent, "You really want to win this election? Well, first thing you gotta do is give the Republicans everything they want, and don't ask for anything in return." I realize that's not far from how beltway pundits define "bipartisanship" on Social Security and Medicare, but by this point does anybody still believe Brooks is sincere?⁵

--------------
1. This is more than damning Brooks with faint praise. As tiresome as his faux-centrism can be, unlike with many of his peers you often have to read more than the headline in order to know what Brooks is arguing and the conclusion he's going to reach.

2. Brooks wrote,

During this time, you knew what Barack Obama was about, where his priorities lay. But, since 2010, that has not been the case. Since then, Representative Paul Ryan has been driving the Washington policy debate with his plan to cut spending and restructure entitlements.

If we define "Washington policy debate" as "the issues over which beltway pundits" obsess, perhaps that's fair. But (a) Ryan's budget is junk - cowardly junk - and the debate has been anything but policy-oriented. Ryan's budget is a political statement, not a policy statement, and those who advocate its merits either do not understand it or share Ryan's political goals.

Ryan has scurried away from certain elements of his budget, particularly the manner in which he proposed privatizing and voucherizing Medicare, without any explanation for how his new voucher program is superior as a matter of policy - but it's pretty obvious how it's superior as a matter of politics.

3. First up, "He could vow to double down on green energy and green technology." Republican Ad: "Soyndra, Soyndra, Soyndra, Soyndra. Soyndra! Soyndra, Soyndra. I'm Mitt Romney and I approve this message."

4. First up, "He could vow to strengthen unions". No mention of how that might work, save in Republican attack ads.

5. Brooks laments,

I wish he’d rise above the petty tactical considerations that have shrunk him over the past two years.

Now what was it that happened two years ago that made things in Washington so petty... We had an election and then something happened that let the Republican agenda dominate in the House of Representatives and (further) stymie Obama's agenda... oh, what could it be....