• Both of these things can’t be true, ctd.

    Avik Roy responds to my previous post on this topic. Ezra Klein adds his two cents.

    I think both are right, to a point. The ACA takes the $700+ billions in Medicare spending reductions and plows them into providing health insurance for the poor. I’ve never said otherwise. But it’s part of a plan, whose details are out there and passed into law, which also adds in other spending cuts and new revenue streams in order to reduce the deficit overall.

    The Romney budget, which lacks all sort of specifics, purports to cut Medicare less, and – according to Avik – plow those into deficit reduction alone. If that’s the case, then I don’t see how things don’t get even worse for his math. Ezra appears to be writing on that, and I’ll update if he does. (UPDATE: Here it is)

    But the point is this. This could be a debate on how cuts to Medicare should be used and how they should be made, not which party is serious about cutting Medicare. I’m having that debate. Ezra is having that debate. Avik claims to be having that debate. But the campaign he’s representing sure isn’t.*

    *I’m not claiming the Obama campaign is having that debate. But I have absolutely, positively no influence over them at all.


    • I’m curious when folks are going to start asking to what extent Ryan’s Medicaid funding levels can support long-term care for the elderly. Given the massive cuts prescribed by both Romney and Ryan to Medicare and Medicaid (not even getting into Social Security cuts) in various iterations of their policies, you simply can’t square what they’re proposing with the current state of affairs in which elderly folks get a not-completely-terrible standard of living no matter what their ability to pay is. Absent some other fundamental reforms to lower costs a lot or new programs in individual states, the Ryan/Romney funding levels seem to promise that millions of elderly people suffering from dementia and other ailments will have to be provided for by their children. This would be a return to the state of American life a half century ago in an era when people are living considerably longer.

      Medicare is one thing, but many rather wealthy families are better off because of older family members’ long-term care Medicaid benefits. Yet, I imagine that if Priorities USA put out an ad saying that “In Mitt Romney’s America, millions of middle-class Americans like you will burden their children with their healthcare needs in old age” would instantly earn Kessler’s four Pinnochios because it just can’t be that bad.

    • Have you read John Stossel’s latest book, ‘NO They Can’t’?

      Makes a lot of sense. E-editions at Amazon.com

    • FYI Aaron — I don’t run the Romney campaign, nor do I speak for it. I’m just an outside adviser. The campaign gets advice from many people. However, I think it’s pretty clear which of these two campaigns is campaigning on substance.

      • I’m certainly not going to get into a debate on your last point, although I don’t believe it’s as clear as you think. It’s one of those things on which we’ll just have to disagree. But I do think – as I’ve said before – that the campaign is trying to have it both ways here.

        I also know you’re not running the campaign, and I’m not holding you responsible for it.

    • Part of the debate which Aaron references has a questionable assumption at the heart of it —

      namely, that Medicare actually can cut $700 billion over 10 years.

      Cuts in fee schedules mean nothing, if there are no controls on utilization.
      George Halvorson showed this 15 years ago in his book Strong Medicine.

      Also, Medicare continues to base reimbursements on employment costs and living costs in an area. This results in cost-plus spending and has for years.

      There have been attempted cuts in Medicare on very small items like
      scooters, and these measures were met by successful lobbying.