I have noted in previous blogs both Democrats and Republicans are proposing spending less on Medicare. By enacting the Accountable Care Act (the health care reform bill) Democrats passed and President Obama signed into law large reductions in Medicare spending. Differences in the parties’ approach to spending reductions will probably dominant the political debate beyond 2012.
The election appears to offer a rare opportunity for voters to make a significant choice that is both “philosophic” and quite practical and concrete in its outcomes. The challenge we voters face is the slippery, deceptive nature of political rhetoric.
Let’s begin with Professor Cutting’s distillation of the differences between the Republican approach of Congressman Ryan and President Obama’s approach in the current debate and in the Accountable Care Act.
Simplifying quite a bit, I came up with the following: Ryan wants to control costs by introducing market mechanisms into the Medicare system, whereas Obama wants to control costs by having government agencies exercise various sorts of control over medical practices.
Ryan’s own formulation of the difference is worth noting because it makes claims that we are likely to hear repeatedly.
The Republican plan, “is to give seniors the power to deny business to inefficient providers. Their plan is to give government the power to deny care to seniors.”
His rhetoric is deceptive in two ways. Replacing Medicare with a voucher, or subsidy, that fails to cover the cost of health care will mean that many seniors will not be able to afford care, or as much care as is currently provided at no cost to seniors. In this sense the Ryan approach denies care by increasing its cost beyond the means of many seniors. See my piece about the Bloggingheads debate involving Glen Loury.
Secondly, the Democrats’ Accountable Care Act is about weeding out ineffective practices by providing incentives for using effective medical practices through the creation of Accountable Care Organizations and spread of comparative effectiveness research into medical practices. The Democrat approach is focused on “getting the incentives right” by replacing the perverse incentive of service and procedure based payments to payment based on making people healthier. Republicans want to change the incentive structure by forcing seniors to pay a portion of their care.
Contrary to expectations Professor Cutting’s review of the consequences of the two policies did NOT result in a stalemate. He concluded “that the empirical probabilities supported Obama over Ryan”, a conclusion however, which he declared to be based on “soft, (relatively malleable) facts”.
Reaching agreement by focusing on the facts is no magic formula. As Cutting notes, much of the passion behind the Republican approach is based on firm conviction. Additional facts are no longer required. At such times, we are left persuading those who are open to persuasion, and then we vote!
We can and should argue about convictions, but this can seldom be done fruitfully in the context of specific policy disputes. Once we’ve pushed the debate on Medicare or any other policy matter to the point where convictions become the sole basis of disagreement, it is time to vote.