I've said it before and it's still true: If Republicans were really worried about the market's confidence in our finances, they'd have strengthened the cost controls in the Affordable Care Act and, whatever else they wanted to do to the bill, loudly embraced things like the excise tax and the Independent Payment Advisory Board. As it is, they've steadily tried to persuade the market to ignore the cost controls we've passed and assume instead that Congress won't follow through when it promises to pare back the tax breaks for employer-provided healthcare or allow a commission to actually get Medicare's spending under control.
This is true, but only in a narrow, almost trivial, sense.
Let’s imagine an alternative reality in which Democrats put forward stand-alone proposals to take a sizable chunk of money out of the Med Advantage program and plow every dime of savings into restoring the overall fiscal solvency of Medicare.
Let’s say, too, that Barack Obama, Nancy Pelosi, and Harry Reid said, “You know what? We’re still not confident we’ve got this whole healthcare cost curve thing under control. So we’re going to establish an Independent Payment Advisory Board to gradually impose a smarter, more cost-effective reimbursement scheme on Medicare.”
How much would you wager that a fair number of Republicans would have been receptive to such proposals?
Obviously, no such offers were ever made. The point of Obamacare was to secure coverage for 30-40 million people--and that, as the president himself admitted at the February “summit,” is going to take a lot of money. To be more precise, about $1 trillion, over 10 years, in new insurance subsidies and expanded Medicaid and Children’s Health Insurance Program (CHIP) outlays.
This is the figure that set Republicans’ jaws into a slack position. Call them heartless and indifferent to the suffering of the uninsured, if you must. But, at least in this case, don’t call them unserious about deficit reduction because they’re skeptical of theoretical cost-bending measures in the context of almost $1 trillion (and possibly more) in new spending.
By Klein’s reasoning, a patient should be pleased to hear the news that, after his arms and legs are amputated, he’ll be a few pounds lighter.
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