This is a letter from liberal House members to Pelosi:
We write in strong agreement with your unwavering defense of the Democratic programs that form the bedrock of America’s middle and working classes, and which are overwhelmingly popular. On July 7, you made very clear that “We are not going to balance the budget on the backs of America’s seniors, women and people with disabilities” and that “we do not support cuts in benefits” for vital safety-net programs. We agree completely.
Especially in these tough economic times, we should not be cutting Social Security, Medicare, and Medicaid benefits that millions of our constituents paid into and depend on. Such benefit cuts should be off the table in current debt discussions.
Our Republican colleagues should be embarrassed by their insistence that unless Social Security, Medicare and Medicaid benefits are cut, the nation will default on its debts. Middle-class families have sacrificed enough, and a deal that pushes the American Dream further out of reach, in order to pay for extending tax breaks for the rich and corporations, is simply unacceptable.
We stand united with you in insisting that benefit cuts for working families, our seniors, children, and people with disabilities must be off the table, and we stand united with you in fighting for millions of Americans who need Democrats to be firmly on their side.
And here’s Ms. Nancy:
House Democratic leader Rep. Nancy Pelosi of California said, “I could never support any arrangement that reduced benefits for Medicare. Absolutely not,” she told CBS’ “Face The Nation,” emphasizing a position she and other Democrats had laid out at their own meeting with Obama.
I believe the liberal House members and Pelosi are drawing a clear distinction between cuts to beneficiaries and cuts to providers and others. Benefit cuts is what they oppose. That’s important because it’s being reported as House liberals opposing cuts to Medicare, and that isn’t what they’re saying.
Two things: I am aware it doesn’t matter what House liberals or Obama are saying if the objection is to cuts of any kind to Medicare during a recession. I am also aware that it doesn’t matter what House liberals or Obama are saying if the objection is to having a deficit reduction discussion at all. I get that.
In addition, we’ve been here before, so I see the political problem. The last time Democrats reallocated funding from Medicare Advantage to the broader ACA, media and conservatives launched a wildly successful lie campaign on those cuts and Republicans won seat after seat in 2010 on “500 billion in cuts to Medicare”. People read that (understandably) as cuts to their individual benefits, but, of course, Medicare Advantage has two sides, beneficiaries and federal payments to private insurers.
I live in Ohio and I received the direct mail. I saw the ads. I’m politically active locally and I talked with senior citizens about the cuts to Medicare Advantage contained within the ACA. They were all brutally misinformed. Media and conservatives can spin the 2010 elections any way they decide, but in Ohio, in my county, it was the lied-about cuts to Medicare Advantage that put conservatives in power. That’s what happened.
I assume that will probably happen again. Media and conservatives will lazily or deliberately misinform and any cuts to Medicare by Democrats will be (successfully) portrayed as a cut to Medicare benefits. I get that, too. All I’m doing here is reading what they’re saying, and they aren’t saying “no cuts of any kind to Medicare”. None of them are saying that, including the members of the progressive caucus.
One more thing. I think any proposed, floated, rumored, whatever cuts to Medicaid should be put in context of the ACA, because 17 million people are going to be added to Medicaid. Two facts on that, that may or may not be relevant, and that you may want to put into the mix when reading what they’re saying on Medicaid going forward:
Medicaid enrollment shot up during the economic downturn, but $100 billion from the federal stimulus package helped states pay the tab. However, that funding ended June 30, and now “states are struggling with what they can do,” said Laura Tobler, a policy analyst at the National Conference of State Legislatures. The health law bars states from restricting eligibility for the program.
Additional stimulus funding for Medicaid is ending.
Under the health care law, more than 16 million additional people will become eligible starting in 2014, with the federal government picking up most of the cost.To entice more physicians to accept Medicaid patients, the law raises rates for primary care doctors in 2013 and 2014 to match those paid by Medicare, the federal health program for the elderly. States, on average, currently pay Medicaid providers about 72 percent of what Medicare pays.
The ACA raises Medicaid rates to providers.
harlana
Stinkin’ meddlin’ liberal progressives!! I hate them with the white-hot heat of a thousand suns! ;)
boss bitch
The caucus should tell their supporters to stop helping Republicans push the lie that Dems are cutting benefits.
bystander
Thanks for parsing this out, Kay. No way not to get the sense that Congress is trying to tinker with something that is a Rube Goldberg machine on steroids. Seems like there’s a heck of a contradiction buried in those last two items you note.
And, is it unreasonable to speculate that if they reduce the return to providers, they will also reduce the pool of providers? I don’t get the sense that it’s been stipulated that the docs themselves will face these cuts, but that’s not clear to me, either.
Thanks for fleshing out a bit of the scorecard going forward.
Kay
Well, last time they ducked it, because it’s a hard argument to make. IMO, the media-conservative misinformation was so entrenched, so quickly (along with all the other lies they were fighting; death panels, etc) that they simply gave up and thought it was better to let it lay. It’s a judgment call. Keep bringing it up (defending) and risk solidifying the lie with one more repeat or just move on and sell something else (offense)? They chose offense (positive). That’s always a hard decision.
However. The death panels never materialized, nor did the brutal cuts to Medicare, so maybe media and conservatives have lost credibility on the “Democrats are after your Medicare” bullshit. I don’t know.
Kay
Broadly, in the future, I have to say I don’t see how that happens. If I combine Medicare and Medicaid (under the ACA) I am talking about the vast majority of insured people in the US. How can providers simply abandon that entire market? Can they? Are they going to have enough patients?
Specifically, if I look at what the Biden plan (supposedly) contains, the cuts are to uncompensated care (hospitals). Uncompensated care payments were ending under ACA anyway (because it will no longer be uncompensated) , so that “cut” looks like kabuki/bullshit for Tea Party consumption to me.
Zach
The number one indicator of conservative ignorance is the idea that they can drastically cut a program providing health care to one in five Americans without severe political consequences.
The Snarxist Formerly Known As Kryptik
@Kay #4:
There’s also the significant problem of the non-liberal Dems in congress all too often backhanding the rest of the party in endorsing the language, if not the policy outright, of the GOP, either because they’re true believers, or desperately still want to believe in that long lost MacGuffin of bipartisanship and camaraderie.
That, I find, is a wee bit more of a problem then “supporters helping Repubilcans push the lies’. You know, since fuck all when do you actually see liberal supporters outside of Hamsher (who is often invited if only for caricature’s sake) actually get the kind of face time that 1) GOP supporters of all psycho stripes get, and 2) the Blue Dog Dems and the like pushing the exact same kind of lies, except glowingly and supportively?
Rick Taylor
Thanks for sharing that letter, Kay. It makes me feel better about what Democrats are up to, though by now I’m pretty much confused. I’m in the camp of, Democrats should never have started negotiating in a setting where Republicans were taking the position of, do what we want or the country gets it. But since the President has decided to go down this road, it’s a bit late to be turning back, and this is the sort of thing I’d hope to hear. While I agree there’s a distinction between benefit cuts and cuts, the devil is obviously in the details. Under what circumstances would cuts to providers be passed down to seniors. Also, for political purposes the distinction is not as important; primary challengers will treat any cut as a cut.
kay
I had this silly, naive idea at the start of the (fake) health care debate that we were going to hear from non-professional pundits ( ie:patients and providers). I thought: how great that will be! We’ll hear from the people that actually use the health care system, and aren’t paid to push anything! Nope. Not a word.
I’d settle for that, I really would. I think we’d do fine with just those voices.
kay
I’m confused too, and I don’t know anything more than you do. I’m just reading statements, lately, like a transcript, and I’ve had some success with that.
I consider the words around people’s ACTUAL statements to be “filler” :)
The Snarxist Formerly Known As Kryptik
@Kay #9:
Well, who the fuck cares about those kinds of people?! If they were important, they wouldn’t be on Medicare, would they?! GED: GOP erat demonstrandum.
The Spy Who Loved Me
I’ll be glad to stand corrected, but in trying to get to the bottom of things, you say that the ACA raises Medicaid reimbursement rates to PCPs to the level of Medicare. On the other hand, what you don’t say, is that in order to arrive at the expected cost they did for ACA, didn’t they eliminate the so-called Doc fix, which would result in about a 25% reduction in reimbursement rates to physicians? If that is, in fact, the situation, how would this improve access to primary care? Wouldn’t more and more PCP’s not only still not take Medicaid patients, but also cut back on new Medicare patients as well?
My own PCP does not accept Medicaid, and stopped taking new Medicare patients over three years ago. When asked why, she told me that reimbursement rates were less than the cost to treat them and she just could not afford to take any more on.
cathyx
I think it’s left vague and confusing on purpose. That way they can’t be pinned down with having said definitive statements and being held to them.
kay
It’s really common to discuss health care in terms of beneficiaries and providers, if you’re reading people who know anything about how public health care programs work. That’s the language they speak. I don’t think they’re spinning. It’s just fact. There’s beneficiaries and providers, and we can’t really have an informed discussion ignoring that distinction.
It’s not accidental timing, either. There is a raging battle ongoing, right now, with various providers lobbying Congress furiously, but that’s almost a constant. It’s always there, behind everything health care related. It’s 1/6 of the economy. There’s going to be wrangling over that much money, and the question is “who pays whom, and how much?” Remember: that’s without even delving into HOW do we pay (insurance), because these programs are single-payer.
slag
Reading posts like this one remind me how untenable our democracy seems to be at times. We want a government that can do its job of maintaining an efficient, effective safety net. But then communicating the necessary nuance of that task to the general public is nearly impossible. Even for people trying to pay attention, it’s sometimes really hard to get the broad strokes, let alone the subtle ones.
I’m finally realizing that it’s not just that Republicans spend their energies on good messaging at the expense of good governing. It’s that good messaging and good governing are–in themselves–diametrically opposed to each other. And when you can only have one of those two things, a democracy like ours cannot function indefinitely. Our current survival seems dependent on little more than happy accident.
Shit. Does this thought make me a glibertarian? But I don’t want no corporate overlords!!
Triassic Sands
I’m a little uneasy because all the statements I’ve seen from Pelosi have been about Medicare, not Medicaid. Obviously, I haven’t seen everything Pelosi has said, so I can only hope she is as unyielding on Medicaid as she claims she is on Medicare.
Valdivia
Thanks for this great post Kay. So much out there this just clarifies a lot and gives the lay of the land.
boss bitch
I’m not talking about face time on TV. I’m referring to all those liberal blogs sending letter after letter, and writing post after post that Obama and/or Democrats are going to “gut” and “slash” entitlements. These people never have to make it on TV but all that shit makes it to Google and can be used by Republicans. As in ‘oh look even Obama’s “base” says he’s cutting your benefits.’
RinaX
Thanks, Kay. Having some knowledge of the insurance industry and Medicare in general, your post is pretty much along the lines of what I felt would be proposed. Unfortunately, as you said, it can be difficult to try to explain these distinctions, and the current political environment doesn’t help.
And far too many “progressives” as well. Like these:
But hey, gotta get those contributions somehow…
Bruce S
Only slightly off-topic, apparently the New York Times editors joined the “Professional Left” this morning…
http://titanicsailsatdawn.blogspot.com/2011/07/worst-time-to-slow-economy.html
nancydarling
Kay, Thanks for this post. You are absolutely the best ‘splainer I know of! Glad you are on our team hear at BJ. Can you address this question of mine from mistermix’s thread in some future post?
Here is a Dean Baker link that kth provided:
http://mrzine.monthlyreview.org/2011/baker080711.html
I’m not getting Baker’s math but maybe I have a misplaced decimal
FlipYrWhig
Thanks, kay, this was admirably lucid.
mb
Actually, what Pelosi/liberals are willing to vote for may well matter a lot. I think it is most likely that we are going to end up with a deal that will need the bulk, if not all, of the House Dems to pass. If they would threaten to sit on their hands and vote present they could have significant leverage.
vernon
There’s also investors. No one EVER talks about them.
Our healthcare system is profit-driven: the most powerful class takes a hell of a lot of money off the top. I don’t see how we can have an informed discussion without acknowledging their stake in the issue (and their influence on policy, which, though usually ignored, is of course unrivalled).
Carol from CO
It’s my understand that the cuts to Medicare/Medicaid will be to what is paid to hospitals and nursing homes. I don’t think they dare tackle cuts to physicians. No matter how you look at it cuts to providers will be a hike in what beneficiaries have to pay and therefore a cut to income. It will also mean access is cut off either because they can’t afford the hike or because providers decline treatment to medicare patiens.
The fact that the dems apparently aren’t considering deals with big pharma to cut cost of part D means the progressive caucus is being just as disingenuous as Obama when he says he won’t cut benefits.
agrippa
The number one indicator of conservative ignorance is the idea that they can drastically cut a program providing health care to one in five Americans without severe political consequences.
The GOP, more likely than not, do not expect there to be any consequences. If they any of them are thinking about the matter at all. Which is likely.
Rick Taylor
So that the bulk of Republicans could vote against it on principle, and Republicans could run against Democrats on their vote, and even on the specific cuts that are proposed.
Rick Taylor
It seems Nancy Pelosi proposed just having a clean vote on raising the debt limit. This immediately got her branded as “not serious.” This is how insane things have become.
toledored
What’s ACA?
John Puma
I’ll stipulate that the “effective message-challenged” Dems may have lost many House seats in the mid-term due to the false conflation of actual provider cuts with the threat of benefit cuts.
But, did not the Dems (perhaps using the 2010 experience, perhaps accidentally) get the lying GOP snakes whining when Ryan’s budget benefit cuts were well publicized and riled up the public enough to get them hounding GOP reps at town hall meetings?
Mnemosyne
@ Rick Taylor
Is it just me, or is it pretty clear in that article that the “anonymous” quotes that Newton-Small has are from Hoyer or Hoyer’s allies? And isn’t he the same Steny Hoyer who tried to oust Pelosi as minority leader after the election?
Especially this quote:
Yeah, no anti-Pelosi spin there.
bob h
The Tony Awards need a new category: most nauseating Kabuki Theater. The two political parties win handsdown.
kay
Ha! Look who’s here. Was here. I’m honored. Mr. Toledo checks in.
Late, as usual :)
ACA=Affordable Care Act. I know. I need an editor.