Las Vegas Sun

March 28, 2024

Debate over health care still far from a resolution

As far as Democrats are concerned, the debate over how to restructure the country’s health care is now over. As far as Republicans are concerned, it’s only just begun.

The Senate voted overwhelmingly, 87-12, on Tuesday to repeal the 1099 tax reporting requirements that have long been considered too onerous for small businesses, but had escaped correction this long because lawmakers couldn’t agree on a politically satisfactory way to remove them.

They finally went with a House proposal that pays for the uptick in cost -- about $19 billion -- by lifting restrictions on the government’s ability go after taxpayers that have been overpaid in health care tax credits. It’s a change that several Democrats initially railed against, but eventually came to adopt. All members of the Nevada delegation supported it.

But that happened the same day as Republicans took a bold strike at Medicare and Medicaid, the most far-reaching of all government health care initiatives, and together the biggest chunk of mandatory spending in the federal budget.

The proposal to convert Medicaid into a block grant program for the states, and Medicare into a privatized program subsidized by the federal government, is simultaneously being praised from the right for its meaty budget-cutting mettle, as it is being criticized from the left for what Democrats are calling its hypocrisy.

The Ryan budget is “the most comprehensive and most courageous budget reform proposal any of us have seen in our lifetimes,” New York Times conservative columnist David Brooks wrote. “It will become the 2012 Republican platform, no matter who is the nominee ... the current welfare state is simply unsustainable and anybody who is serious, on left or right, has to have a new vision of the social contract.”

Sounds kind of like what the French and Germans are going through. Except, Democrats say, there’s nothing unique about the Ryan proposal: it’s just Obama’s health care plan, turned inside out.

“It looks to us like they have kept the very savings in medicare that they railed against over the last couple months and years,” said Assistant Minority Leader Chris Van Hollen. “The health care reforms enacted in the Affordable Care Act ... they’re not repealing all of them. They’re keeping, as far as we can tell, the savings in Medicare. They don’t reform it, they de-form it. they take away the Medicare guarantee for seniors, say you’ve got to go into the private insurance market. And all the risk of increased costs in the health care system will be borne by the Medicare beneficiaries.”

There’s nearly six full months to go still until fiscal 2012 starts, so it’s a safe bet that competing numbers projecting government and cost savings will be flying for some time to come. But the final arbiter of Ryan’s proposal may not be the direction in which the budget pendulum ultimately swings by October 1st, but how voters respond to it on November 6th of next year.

We’re talking about a program that by and large, benefits seniors, who, by and large, are the most reliable, committed voting population in the country. They’re also a bloc that tends to swing more conservative than the average voter. And while Medicare isn’t uniform across the country’s entire senior population, it also doesn’t discriminate: everyone over the age of 65 is eligible, and most take advantage of it.

So it’s a risky political calculation for Republicans to target, en masse, what’s potentially the most reliable cohort of their voting base. Except they don’t: backers of Ryan’s proposal are quick to remind that the budget doesn’t actually affect anyone who is a senior today.

“The budget does not change Medicare for anyone 55 or older and protects those who are currently in the system. The reforms in this budget are about preserving the program for future generations by implementing cost-effective measures," said Stewart Bybee, Communications Director for Congressman Heller.

But that calculation depends on the presumption that seniors will be focused solely on their own selves, to the extent that they won’t care about what happens to the generation coming ten years or more down the pike. Medicare for many seniors, is sacrosanct -- just remember the letter to Obama that became famous back in 2009.

“I don't want government-run health care. I don't want socialized medicine,” a woman wrote to the President, Obama said. “And don't touch my Medicare."

So far, the Nevada delegation is split as might be expected on Ryan’s budget: the Republicans are for it, and the Democrats are against it.

Join the Discussion:

Check this out for a full explanation of our conversion to the LiveFyre commenting system and instructions on how to sign up for an account.

Full comments policy