How The GOP Plan To Kill Medicare And Medicaid Would Work

How The GOP Plan To Kill Medicare And Medicaid Would Work


Brian Beutler and Benjy Sarlin
April 5, 2011, 9:26AM

Rep. Paul Ryan (R-WI)
On Tuesday, House Budget Committee Chairman Paul Ryan (R-WI) will introduce a 10-year budget proposal that would over time eliminate Medicare and Medicaid and replace them with less generous health care plans for the elderly, poor, and disabled. The reviews are in, from experts and advocates, and it looks like there's gonna be a fight.

Phasing Out Medicare

Starting with Medicare, Ryan's critics attack his plan as a step back from the single-payer system that, despite looming financing problems, serves the elderly very well.

"There ought to be a TV show called 'That 90s Show,'" said David Cutler, a Harvard economics professor and one-time adviser to President Obama. "What Paul Ryan has in mind is to recreate the managed care era, do for the elderly what we rejected for ourselves."

Republicans will be loath to admit this, but the system Ryan has in mind for Medicare works a lot like dread 'ObamaCare,' too. He developed it in concert with Alice Rivlin, who used to run the Office of Management and Budget for President Clinton. They propose giving the elderly a menu of private insurance options (think the health care exchange) and then subsidizing those plans based on need (think insurance credits). Thus, in addition to all the questions Republicans will have to answer about the plan from experts and stakeholders, they'll have to explain why the health care law is terrible for working adults, but a great idea for retirees.

"I keep talking to Paul and trying to convince him of that," Rivlin told Ezra Klein recently. "But even if he agreed with me, he couldn't say so."

If the goal is to save the government money, Ryan's plan can work -- but not by figuring out cheaper, smarter ways to deliver health care to the elderly, but by dramatically curtailing benefits.

"Our existing efforts to privatize Medicare have failed," Jonathan Gruber, a leading health care economist, and architect of the health care law, said in an interview. "We don't have a good track record, but in principle it could be a good idea [but] the savings doesn't come from all the good things from competition -- it comes from cutting Medicare over time."

Princeton health care expert Uwe Reinhardt has called the plan "radical," for precisely this reason.

"[F]or all those older Americans who voted GOP last year because those nasty Democrats were going to cut Medicare, I have just one word," wrote New York Times columnist, and Nobel-winning economist Paul Krugman: "suckers!"

He's referring to ads like this one, which Republicans used to great effect to help win historic victories in the November midterms.

Those cuts were unpopular, but trivial compared to what Ryan's proposing.

Eliminating Medicaid

The reviews are even worse for Ryan's plan to turn Medicaid into a block grant program. Ryan would eliminate the federal parameters governing the program and instead have Washington send states lump sums of money to put towards health care for the poor. In some states, that will mean patients -- the poor, disabled and elderly -- will suffer dramatic benefit cuts, particularly during tough economic times.

Seventeen Democratic governors have signed a letter to congressional leaders strongly opposing the block grant idea. New York Gov. Andrew Cuomo (D) wrote a separate letter attacking the plan as well.

"It's a hidden way to cut Medicaid," Gruber said. "I don't see the argument for it at all."

AARP seems if anything more concerned about the Medicaid proposal than the Medicare plan.

"A wholesale overhaul of Medicaid to block grants would likely lead to reduced benefits and eligibility, resulting in powerful negative repercussions for the millions of Americans who rely on Medicaid for their health and long term care," Nora Super, AARP's director of federal government relations for health, tells TPM.

Medicaid is often conceived of as a less luxurious version of Medicare for the poor, but many elderly Americans benefit from both. The GOP has been at war with AARP over its support of the health care law.

The Bottom Line

Ryan's plan would succeed at taking huge amounts of national health care spending off federal books. And that will leave Democrats facing questions about how they propose to reduce health care costs. After all, that will have to happen one way or another if the United States wants to avoid a fiscal crisis in the coming years.

"The better way to do it is not to shift costs but to cut costs, especially in a sensible way," said Cutler, the Harvard expert.

That could include using government purchasing power to force provider costs down, changing the tax code, or even patent reforms. Cutler and other experts point out that some of the most promising cost-cutting ideas are built into the health care reform law as pilot programs, and if one or several of them turn out to be unusually effective costs could drop, health care cost inflation could decrease, and a fiscal nightmare scenario could be averted.

"If there are 27 ideas in the bill, all you need is one of them to work and then you've saved money," Cutler added. "It's a kind of interesting thing. You just need something that really really works and you can build on."

The problem, as Gruber pointed out, is that determining what works best isn't easy, and when you figure it out, politics gets in the way.

"The science is highly uncertain. We don't know on a large scale how to slow the growth rates of federal costs without harming health," he admitted. "Nobody's figured out how to take [working] examples and scale them up."

That's when politics get in the way. During the health care debate, for example, Congress angrily rejected a Preventative Services Task Force finding that mammograms for women between the ages of 40 and 49 shouldn't be automatic.

If all else fails, then blunter measures may be necessary.

"Medicare is a dominant player in the medical market place, and what it needs to do is find a way to use that market power to reduce its cost growth, but to do it in an evidence-based way," said Harold Pollack, a public health expert at the University of Chicago. "The idea that Medicare should be an open spigot to pay providers is insane."

Conyers: We Cannot Turn Our Back on Federal Prosecution of TerroristsColin Powell, Former FBI Director Sessions, and Marine Generals Agree With Conyers: Federal Trials Are OK for Terror Cases

Conyers: We Cannot Turn Our Back on Federal Prosecution of TerroristsColin Powell, Former FBI Director Sessions, and Marine Generals Agree With Conyers: Federal Trials Are OK for Terror Cases


(Washington)—Today, House Judiciary Committee Ranking Member John Conyers (D-Mich.) issued the following statement in response to the Attorney General’s announcement that the Department of Justice will refer Khalid Sheikh Mohammed and the 9-11 co-conspirators to the Defense Department for military commission prosecution:

Today the Attorney General announced that the alleged plotters of the September Eleventh attacks will be referred to the Defense Department for prosecution in military tribunals.

I regret this decision. Thousands of American civilians were killed that day on U.S. soil and in airplanes above our skies. Our federal courts are the strongest, most reliable venue for bringing justice to those who perpetrated these terrible acts. Military Commissions – even as improved in 2009 – are untested. They bring great legal risk. And they cause unnecessary friction with our allies around the world.

By contrast, our federal courts are time tested. They produce strong verdicts and stiff sentences that we know can withstand appeal, and which have earned respect around the world from friend and foe alike. We cannot turn our back on this essential tool in the fight against evil and terror, which is bigger than any five defendants.

That said, I do understand the position in which the Administration finds itself. For better or worse, Congress has made it impossible to bring these individuals to court for trial. This intrusion on prosecutorial judgment is shameful. And the political demagoguing on this issue, like many other questions of terrorism, has been an embarrassment to the Congress.

Like the Attorney General, I too am frustrated that almost a decade after 9/11, these alleged co-conspirators have not been held responsible. This is another tragic legacy of the Bush Administration’s failed approach to matters of national security. From the secret prisons in which KSM and others were held for years, to the flawed military commission system that the even the Rehnquist court was not willing to uphold, to the waterboarding and other tortures that have made prosecution especially difficult – our ability to win swift and sure justice in these cases has been needlessly strained.

Our federal courts have a proven track record handling hundreds of complex terrorism cases over the years. It was a US federal court that imposed the death sentence on Timothy McVeigh for bombing the Murrah building in Oklahoma City. It was a federal court that in 2000 sentenced the Kenya and Tanzania Embassy bombers to prison for life without parole. It was a federal court that sent Omar Abdel-Rahman away for life for the first World Trade Center bombing. The Bush Administration itself recognized this, taking the case of shoe bomber Richard Reid to federal court and reporting in its final budget request to Congress that “Since 2001, [the Department of Justice] has increased its capacity to investigate terrorism and has identified, disrupted, and dismantled terrorist cells operating in the United States. These efforts have resulted in the securing of 319 convictions or guilty pleas in terrorism or terrorism-related cases arising from investigations conducted primarily after September 11, 2001.”

Military and law enforcement professionals also agree. For example:

· Former Secretary of State Colin Powell – “Let's get this population of 192 [at Guantanamo Bay] sorted out. I have no problem with them being tried here in the United States.”

· Marine Corps Generals Joseph Hoar, Charles Krulak and 31 fellow officers -- “[C]ritics claim that a trial in federal court will provide a platform for these terrorists to spread their message of hate. On the contrary, we are confident that these trials will showcase America at its best, a nation of laws. In the war of ideals, we can only lose if we forfeit ours.”

· Former FBI Director William Sessions – “If we're looking for justice for the victims of terror, if we're looking to securely lock up those who have committed or sought to commit terrorist acts against American citizens, our federal courts provide the proven and reliable way to ensure that justice. The federal courts have a demonstrated track record in bringing terrorists to justice.”

· Former Bush Administration Deputy Attorney General Jim Comey and Office of Legal Counsel Head Jack Goldsmith – “One reason commissions have not worked well is that changes in constitutional, international and military laws since they were last used, during World War II, have produced great uncertainty about the commissions' validity. This uncertainty has led to many legal challenges that will continue indefinitely -- hardly an ideal situation for the trial of the century. By contrast, there is no question about the legitimacy of U.S. federal courts to incapacitate terrorists. Many of Holder's critics appear to have forgotten that the Bush administration used civilian courts to put away dozens of terrorists, including "shoe bomber" Richard Reid; al-Qaeda agent Jose Padilla; "American Taliban" John Walker Lindh; the Lackawanna Six; and Zacarias Moussaoui, who was prosecuted for the same conspiracy for which Mohammed is likely to be charged. Many of these terrorists are locked in a supermax prison in Colorado, never to be seen again.”

Conyers: Looming Government Shutdown Reveals House Leadership’s Fiscal Irresponsibility and Willingness to Put Americans At Risk

Conyers: Looming Government Shutdown Reveals House Leadership’s Fiscal Irresponsibility and Willingness to Put Americans At Risk


(Washington)—Today, House Judiciary Committee Ranking Member John Conyers, Jr. (D-Mich.) criticized conservative House Leadership for failing to take active steps to avert the looming government shutdown---one that would have a potential of hosting a devastating impact on the American people, particularly lower and middle-class individuals.

Mr. Conyers’ statement is as follows:

Based on their absolute refusal to compromise on the Federal budget, Tea Party adherents in the Republican party will force the government to shutdown at the end of Friday,” said Conyers. “Just last week, Tea Party Republicans traveled to the Nation’s capital to urge the House Republican Majority not to compromise with Democrats in funding the government. Unfortunately, out of fear of alienating their Tea Party friends, House Republican Leadership appears to lack the political will to put the interests of our country first.

While Tea Party Republicans insist on hard-line calls for fiscal responsibility and many other House Republicans demand social policy provisions, the impact of their actions reveals their fiscal irresponsibility and willingness to put other Americans at risk. Hopefully history will not repeat itself.

As demonstrated by the five-day government shutdown in November 1995 during the House Republican majority, American taxpayers lost an estimated $750 million, according to ABC News. The processing of Social Security and Medicare checks was delayed. Other adverse consequences of the shutdown, as reported by the nonpartisan Congressional Research Service, included –

• Veterans being deprived of multiple services, ranging from health and welfare to finance and travel.

• The Centers for Disease Control and Prevention ceasing disease surveillance.

• Delays occurring in the processing of alcohol, tobacco, firearms, and explosives applications by the Bureau of Alcohol, Tobacco, and Firearms.

• 368 National Park Service sites, national museums, and monuments were forced to close, resulting in a loss of 9 million visitors. This, in turn, reduced tourism revenues to local communities.

• Up to 30,000 applications by foreigners for visas and 200,000 U.S. applications for passports were not processed. As a result, U.S. tourist industries and airlines reportedly sustained millions of dollars in losses, according to Congressional Research Service.

House and Senate Judiciary Committee Leaders Focus On Fighting Online Infringement

Contact: Nicole Triplett (Conyers) – 202-226-5543

Date: April 4, 2011

Erica Chabot (Leahy) – 202-224-7703
Kim Smith Hicks (Smith) – 202-225-3951
Kathryn Rexrode (Goodlatte) – 202-225-5431
Gabby Adler (Berman) – 202-225-8110

House and Senate Judiciary Committee Leaders Focus On Fighting Online Infringement

(WASHINGTON) – Today, House Judiciary Committee Ranking Member John Conyers, Jr. (D-Mich.) joined leading members of the Senate and House Judiciary Committees to speak to reporters on Capitol Hill about the continuing harm online infringement and counterfeits pose to American jobs and the economy. Mr. Conyers, Senate Judiciary Committee Chairman Patrick Leahy (D-Vt.), House Judiciary Committee Chairman Lamar Smith (R-Texas), Congressman Bob Goodlatte (R-Va.), who chairs the House Judiciary Subcommittee on Intellectual Property, Competition and the Internet, and Congressman Howard Berman (D-Calif.), were joined on Capitol Hill by representatives from business and labor organizations. They spoke about the impact of online infringement on the American economy. According to estimates, intellectual property theft costs the U.S. economy more than $100 billion every year, and results in the loss of thousands of American jobs.

“Online infringement and the sale of counterfeit goods cost American creators, producers, and businesses billions of dollars and results in hundreds of thousands of lost jobs. This theft is unacceptable at any time; it is devastating in our current economic climate,” said Leahy. “Protecting American intellectual property on the Internet is not uniquely an industry or labor concern; it is not uniquely a Democrat or Republican concern. It is an American concern, and addressing it is crucial to our economic success and job growth.”

“The success of our economy is in part tied to the success of America’s intellectual property industries. IP industries provide an estimated 19 million jobs to American workers and account for more than 60% of U.S. exports,” said Smith. “Unfortunately, the online theft of America’s intellectual property results in billions of dollars in lost revenue and thousands of jobs. From movies and music to software and medicine, IP theft drains our economy and puts lives at risk. We must do more to combat the theft, marketing and distribution of America’s intellectual property to ensure that the profits and jobs these industries generate stay here at home. If we can reduce the impact of IP theft on the U.S. economy, we can not only save jobs, we can gain jobs.”

“The Internet has regrettably become a cash-cow for the criminals and organized crime cartels who profit from digital piracy and counterfeit products,” said Conyers. “Millions of American jobs are at stake because of these crimes, which is why my colleagues and I will be coming together to carefully craft legislation. Congress must act to protect property rights and American jobs by targeting the truly bad actors and their revenue streams, and do so in a way that continues our nation’s commitment to due process and freedom of speech.”

“It is encouraging that both sides of the Capitol are eager to work to enact stronger IP protections for our nation's authors and inventors. The House Intellectual Property Subcommittee will work in a bipartisan fashion to create new, meaningful IP protections and bolster existing ones at a time when U.S. copyright industries are facing disastrous threats from online theft. I intend to deal with this issue aggressively and will consider all ideas and concerns from interested parties,” said Goodlatte. “The intellectual property industry is one of the U.S.’s top exporters and threats to the IP industries are threats to our economy that will affect American jobs.”

“The theft of American Intellectual Property not only robs those in the creative chain of adequate compensation, but it also stunts potential for economic growth, cheats our communities out of good paying jobs, and threatens future American innovation,” added Berman. “Today I remain as committed to this fight as ever, and I look forward to working with my colleagues – both Republicans and Democrats to protect American businesses, workers, and innovators.”

The members of Congress were joined Monday by Peter Bragdon, the Senior Vice President and General Counsel of Columbia Sportswear, and Paul E. Almeida, the President of the Department for Professional Employees, AFL-CIO. The DPE is a coalition of 23 national unions representing more than four million professional and technical people.

Identifying effective ways to combat online infringement has been the subject of hearings in both the Senate and House Judiciary Committees this year. The Senate held a hearing on February 16, and the House held a hearing on March 14. The House will hold a second hearing on the subject on Wednesday.

Conyers Calls for Increased Focus on Education and Jobs for At-Risk Youth at Historic National Forum on Youth Violence Prevention

Contacts: Nicole Triplett, 202-226-5543

Date: April 4, 2011

Conyers Calls for Increased Focus on Education and Jobs for At-Risk Youth at Historic National Forum on Youth Violence Prevention


Decries Mindless Budget Cutting as Penny Wise and Pound Foolish


(Washington)—Today, at the first National Forum on Youth Violence Prevention, House Judiciary Committee Ranking Member John Conyers, Jr. (D-Mich.) issued the following statement emphasizing the need to increase funding for education and jobs programs for at-risk youth:

“Getting tough” on crime may have seemed logical or at least politically expedient, but research and experience clearly demonstrates that we cannot “arrest our way out of the problem” of youth violence. Our nation has the highest incarceration rates in the world -- with more than 2.3 million people behind bars -- a disturbingly disproportionate share of whom are poor and minority. In fact, 1 out of 9 African American men between the ages of 20 to 34 in this country are in jail or prison at this very moment.

That is why I have co-sponsored and strongly supported legislation that provides for training and jobs for at-risk youth, such as “Youth PROMISE” Act (The Youth Prison Reduction for Opportunities, Mentoring, Intervention, Support and Education Act), the new Humphrey Hawkins Full Employment Act, and the Second Chance Act.

Today’s conference illustrates the folly of mindless budget cutting at the federal, state, and local levels that reduce or eliminate important critical juvenile justice and youth violence prevention programs. These penny-wise, but dollar-foolish cuts will inevitably lead to much higher costs associated with increased expenditures to deal with greater incidents of crime and victimization, more substance abuse, exacerbated mental health conditions, higher unemployment, and the need for more prisons. As Congress and the President attempt to work together on the budget for the next year and one half, I would urge them to heed the lessons of this conference.

I am very pleased that among the cities selected to participate in this forum, Detroit is here. I welcome the presence of Mayor Dave Bing, who will describe Detroit’s Youth Violence Prevention plan, which is built on strategies that have a distinct focus on building opportunities for youth, promoting positive youth development and preventing youth violence.

Rep. Conyers offered welcoming remarks today at the National Forum on Youth Violence Prevention, a two-day conference in Washington D.C. The Conference offers an opportunity for federal, state, and local officials as well as legislators to come together and share experiences about programs that work to prevent youth violence. Representatives from DOJ as well as the cities of Detroit, Boston, Chicago, and Memphis offered specific presentations about their at-risk youth programs. For more information on the Conference’s youth violence prevention initiative and how it affects cities like Detroit, please refer to http://www.findyouthinfo.gov/topic_preventingViolence_detroitBrief.shtml.

Conyers Stops Child Abuse

Conyers, Jackson-Lee Outline Potential Harm and Systemic Risks of Proposed NYSE Mergers

Contacts: Nicole Triplett, 202-226-5543                                                                                  
Friday, April 1, 2011  

Drew Stout, 202-225-3816                                                                                        

                                                                                                                                

Conyers, Jackson-Lee Outline Potential Harm and Systemic Risks of Proposed NYSE Mergers

Mergers Would Decrease Jobs and Consumer Choice---Unacceptable for Current Economic Climate

(Washington)—Today, at the Intellectual Property Subcommittee Hearing on “Competition and Consolidation in Financial Markets,” House Judiciary Committee Ranking Member John Conyers, Jr. (D-Mich.) and Congresswoman Sheila Jackson-Lee (D-Texas) raised their concerns of the potential economic harm that would result from the proposed mergers of either the New York Stock Exchange (NYSE) with Deutsche Boerse or the NYSE with the National Association of Securities Dealer Automated Quotation (NASDAQ).

We are generally against any mergers of this size.   Mergers of this size must prove to the American people the immediate value they bring to job creation and stabilizing the economy.  The potential for harm, systemic risks, outweigh any perceived gains in efficiency. Moreover, analysis of the consolidation in the financial exchange markets does not change relative to who the buyer is.  We are against NYSE merger with Deutsche Boerse but we are equally against NYSE merging with NASDAQ.  At a fundamental level, both mergers would result in fewer jobs and less choices for consumer and public traded companies.

Specific to a merger with Deutsche Boerse, the proposed merger would create massive transnational regulatory issues that the world has yet to create the infrastructure to regulate specifically which entity could effectively oversee and regulation a transnational combined company of this complexity and how much control would the US have over such transnational regulators?  No entity exists right now to accomplish that necessary goal.

Merger between NYSE and NASDAQ would be akin to General Motors merging with Chrysler, such a horizontal merger in the United States should not take place, whether in the automobile industry or the financial services industry.   Such a merger would result in a loss of jobs in New York and around the country, at a time when NY and the entire US cannot tolerate additional job losses.  Moreover, the merger would lead to less choices for consumers in their investment choices and to companies seeking listings.

This is not a “failing industry” so that defense against competition concerns is not useful.  This is simply about increasing profit by creating greater leverage for the financial exchanges.

Moreover, the question should be whether the mere existence of dollars to spend by the purchaser is sufficient enough to allow a merger to go forward.  The determining factor should be an examination of the value it brings to the American people, and how anti-competitive it would ultimately be. 

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