When ABC News’s Jonathan Karl asked Congressman Paul Ryan, the Republicans’ exciting new Budget Action Hero, “What do you say to nervous Republicans who say that this is a political Kamizake mission?”, Ryan replied, “They didn’t come here for a political career. They came for a cause.”
Having just completed a new installment of the Disunion saga, I couldn’t help but think of James Chesnut, the senator from South Carolina, who, on the eve of the presidential election of 1860, told a crowd in Charleston that the election of Lincoln would present them all with the choice between submission to an anti-slavery government, or defiance. “For myself, I would unfurl the Palmetto flag, fling it to the breeze, and. . . ring the clarion notes of defiance in the face of an insolent foe.’’ Five months after that speech, Chesnut was in the chain of command that gave the order to fire on Fort Sumter. Four years after that, Chesnut ended up without a cause or a career, or a country, or the civilization in which he had been raised. Whenever I hear stirring words, I think that what should be stirred with is a grain of salt.
Count me in with Dana Milbank, who wrote in The Washington Post that “Ryan’s proposal isn’t a budget. It’s a manifesto for the anti-tax cause. The GOP plan reduces the government’s revenues by $4 trillion over 10 years because of tax cuts, including a lower top rate for businesses and the wealthy.” The end result: a proposal to balance the budget that increases the federal debt by more than $8 trillion over the next 10 years, and it continues federal budget deficits until nearly 2040. Yikes! And as Jonathan Chait points out in The New Republic, the plan features a massive tax cut for the rich. “Ryan does not want to talk about the tax cut . . . because they unravel the entire rationale for his proposal. Americans overwhelmingly oppose cuts to Medicare and Medicaid. Ryan understands he can only make his plan acceptable if those cuts are seen as necessary to save the programs. And certainly some level of cutting is necessary. But Ryan’s level of cutting goes far beyond what’s needed to preserve those programs, and it does so in order to clear room for a very large, regressive tax cut. He is making a choice — not just cut Medicare to save Medicare, but also to cut Medicare in order to cut taxes for the rich.”
Medicare, of course, is (in the words of Dave Leonhardt of The New York Times, “ hugely popular welfare program,” one which rewards the typical household with “several hundreds of thousands of dollars” more than recipients of this largesse pay in. Which is why it’s popular.
I have no problem with that. This kind of program enabled my parents to live for more than two decades in independence and good health. The problem, of course, is that people are living longer; and that medical science is finding medications that treat many of what had long been accepted as the chronic conditions of old age like shaking legs and limp penises, all of which cost money; and that a distressingly increasing number of us, now about one in eight, end up suffering a slow, nightmarish, ghastly death from dementia. Which in addiiton to be being tragic, terrifying and soul-deadening, is really expensive.
In Slate, the ordinarily incisive Jacon Weisberg, no fan of Ryan’s overall plan but appreciative of Ryan’s willingness to tackle Medicare, underestimates the impact of Ryan’s proposal to turn Medicare into a plan where the government helps pay seniors to buy medical insurance. “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.”
The problem is that seniors don’t inhabit the health care world the rest of us live in–they’re sicker. Surely Weisberg knows people in their seventies: their various ailments and conditions are the focus of their lives. (I’m 57, and I’m bored to death hearing myself talk about my blood pressure medication.) It’s rough enough on working people to navigate the world of health insurance: think what it’s like for people when they have to work a phone tree and can’t see the numbers on the buttons of their phones, and are incipiently senile.
So here is the real game: insurance companies will be cheaper because they will deny coverage. Insurance companies already routinely limit treatments and deny care, even when coverage is provided. As my wife discovered during a short stint working for an insurance company, it’s cheaper for them to first deny coverage or a payment and then pay on appeal–if there is an appeal–than it is to approve coverage right off the bat.
Sarah Palin and the Tea Party people were outraged by the “death panels” in President
Obama‘s health care reform law–a provision that offered payments to doctors who provided end-of-life counseling. Will they say anything about this? I can tell you that under Ryan’s plan, you won’t get anything as satirically over-the-top as a death panel. Instead you’ll get the soul-less suit George Clooney played in Up in the Air, the slick, empty guy who has come this time, not to lay you off, but to explain that Dad is too far gone to merit the expense of that procedure. Or that cold medication. Or that cheap plastic breathing tube.
Which may be what we end up having to do in order to avoid bankrupting ourselves. Too sentimental to do Dad the favor of clocking him with a big rock, too ruggedly individualistic to turn things over to a government commissar, too cheap to fund researchers to find a cure, too selfish to prepare while we’re healthy arrangements for our own departures should we become mind-dead–we’re going to leave it to a slick, smooth-talking, smooth-faced representative of the corporate bean-counters at Life Is for the Living, Inc., who will ever-so gently inform our loved ones that is no longer an economic justification for our continued existence, but who, for a small fee, would be happy to help them prepare a memorial DVD.
There is no simple way to solve this. I just resent the Republicans coming after the pot of money that was put to such good use by members of my family, instead of going after the pot that belongs to buccaneers like John Paulson or the Koch Brothers or Hank Greenberg.