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Monday, Nov 9, 2009
What Bush has planned for America if he wins.
Aug 25, 2004 | President Bush's plans for a second term threaten a devastating series of far-reaching challenges to the viability of the Democratic Party itself. Under Bush's slogan of an "ownership society," the Republicans intend a long-term effort, using changes in Medicare, Social Security and taxes to pit better-off and worse-off Democrats against each other, offering all-but-irresistible incentives for some to desert the others -- and any progressive national coalition. Congressional Democrats reeling from the impact of the last four years of Republican government in the White House and Congress (apart from the brief Democratic-controlled Senate in part of 2001-02) will find no respite in the platform's subtext about the party-splitting wedges ahead. A second-term Bush agenda will constantly impale Democrats on the dilemma of abandoning their poorer, sicker, older and minority groups, or seeing their better-off, healthier and younger members lured off to the other party. If it sounds like a political nightmare for the Democrats, that's because that's what it is planned to be.
Medicare
A prime provision of the Republican platform touts Bush's Medicare act of late 2003, focusing public attention on the drug benefit provisions and such nice-sounding themes as providing more healthcare choice and having a free market in healthcare. Meanwhile, the Republicans distract attention from the less visible part of the 2003 act, the Medicare Modernization Act (MMA), which made the most radical alteration to Medicare in years. These Medicare maneuvers occurred with the typical Republican stealth; the act was written in a closed-door conference committee that excluded meaningful Democratic input and rammed through Tom DeLay's House of Representatives by a single vote late at night as the rule for debate was extended for hours while moderate Republican doubters were coerced with threats.
Traditional Medicare unifies seniors into a group that can come together to defend it because it enrolls everyone in its public fee-for-services plan. The MMA begins the political splitting of seniors by adding a new private Preferred Provider Organization option, dubbed in Orwellian fashion "Medicare Advantage."
Medicare Advantage drains Medicare's total funding by giving away billions in lopsided subsidies to the private insurers who provide such plans, with the expectation that they can pocket most of those subsidies as profits and yet still offer incentives to some seniors to join. For example, such plans can provide the seniors they entice to sign up with a drug benefit plan without all the cutoffs and ceilings that make Bush's standard Medicare drug benefit plan a hollow offering for many seniors. But the insurers enroll only the healthier and better-off seniors into these plans. As a result, traditional Medicare, which must carry an increasingly concentrated share of the costlier patients, gets perceived as overspending per patient. This benefits Bush's corporate backers in the insurance industry who have the healthier, inexpensive beneficiaries to generate profits without any particular efficiency by the insurer itself.
Then, another part of Bush's MMA sets up "premium support demonstration projects." Under the new rules, competition between traditional Medicare and private plans will sharply force up the premiums seniors pay for traditional Medicare. At their start, these projects will affect about 6 million of the 41 million people in Medicare and will expand later. When Republicans have their way, the harsh consequences, such as 30 percent hikes in premiums, would be imposed on seniors who, for geographic and other reasons (for example, they live in Democratic voting states, they are working poor), Republicans see no reason to spare. Again, in these project sites, healthier and wealthier seniors, who can take the risk of leaving traditional Medicare, would depart for private insurers.
Once that happens, the whole senior population would be split into two antagonistic camps. The sicker and poorer group would be forced to stay behind in traditional Medicare, which would suffer increasing underfunding. However, the healthier and wealthier group of seniors moving into Bush's private plans would be well taught to identify their interest with the Bush-supporting private insurers. Both the insurers, and this group, would see merit in supporting tough cost-savings in the traditional Medicare group -- treating it increasingly the way stingy states treat Medicaid beneficiaries.
Some tough measures against traditional Medicare's increasingly beleaguered beneficiaries may include folding some poorer Medicare beneficiaries into their state's Medicaid program -- a rough fate in states that take full advantage of potentially lax federal oversight -- or perhaps even moving some parts of the Medicare population further toward the Republican ideal of a capped voucher system. Once the Republicans have such a capped voucher system, they can make further cuts from time to time that put all the fiscal pain of the system's limits, including its industry subsidies, on those who can least bear it.
Politically, the healthier and wealthier group would eschew the classic seniors' thoughts that traditional Medicare deserves protection and that Republicans are not protecting it. That political trend would become especially strong because the MMA includes a fast-track provision that could be traditional Medicare's death warrant. This provision, in circumstances that portend a larger Medicare draw upon general revenues, puts Republican-style changes, like benefit cuts, on a fast track through the House, rigged to work even if miraculously the Democrats regain procedural leadership. Democratic-style changes, like restructuring the self-serving drug industry, would of course be stymied. With traditional Medicare seeming to be doomed, those who could would depart, not defend it.
In every election thereafter, an alliance of drug companies, insurers and other Republican supporters would spend heavily in floods of easily understood, simplified advertising to label the Republicans as Medicare's saviors through so-called choice for beneficiaries, while labeling the Democrats as draconian tax increasers (who would also be implicitly stigmatized as defending minorities). As Medicare's beneficiaries increasingly separate into two classes, one of them susceptible to Republican lures, a unified and vigorous Democratic defense of Medicare would either crack up or lose key support through desertion.
