American

But a lot of it is simply due to the fact that health care costs are rising faster than the economy is growing. Revenues simply cannot keep up.



It’s basic math – we cannot solve our fiscal or economic challenges unless we get health care costs under control.

The budget passed by the House last month takes credible steps to controlling health care costs.

To an alarming degree, the budget debate has degenerated into a game of green-eyeshade arithmetic, with many in Washington – including the President – demanding that we trade ephemeral spending restraints for large, permanent tax increases.



This sets up a debate in which we are really just arguing over who to hurt and how best to manage the decline of our nation. It is a framework that accepts ever-higher taxes and bureaucratically rationed health care as givens.



I call it the “shared scarcity” mentality. The missing ingredient is economic growth.

Maybe John Boehner can hold another vote in the House on ending Medicare and armtwist the four Republicans who voted against it last time to vote for it this time. Since after they did it the last time, it has worked out so well for the Republicans. You see, after President Obama took Paul Ryan to the cleaners for his Path to Poverty (aka Road to Ruin) "budget" including his plan to end Medicare and forcing seniors to go buy health insurance in the open market - since, you know, insurance companies are dying to insure seniors - by paying $6,000 extra. After all, Ryan had a justified cause to do this:After the Republicans took that vote and were creamed by their constituents (thanks in no small part to a job well done by President Obama and Congressional Democrats on messaging), Paul Ryan has responded with the natural response of the Right wing when they get themselves into a hole: dig some more . Yesterday, Ryan gave a speech to the Economic Club of Chicago, trying out a brand new lipstick on his end-Medicare pig: he called the speech "Shared Scarcity vs. Renewed Prosperity." Yes, Paul Ryan is very much against shared scarcity, especially if you share the scarcity with the super rich. And his renewed prosperity means brand new $200,000 tax breaks for millionaires and billionaires while the seniors get shared poverty. You know, thePaul Ryan way.I find it rather amusing that Paul Ryan derides President Obama's sensible budget proposals - cut spending wherever possible and make those who have done the best over even the worst economic crisis in memory pay their fair share - "shared scarcity." After all, isn't it the Republicans that constantly scream about how scarce our resources are and how, therefore, we cannot afford any number of public services at the core of any civil society?But I digress. House budget czar Ryan defined the problem rather innocently - although I suspect not having all those animated graphs in front on the screen stole some of his thunder:Yes. Which is why Paul Ryan was hell bent in opposition to the Affordable Care Act, which begins to bend the health care cost curve the right way. I assume this is also why Paul Ryan threw a fit over the fact that in the ACA, insane taxpayer subsidies to private Medicare (Medicare Advantage) plans were wound down. The Paul Ryan logic is thus: we must control health care costs; private companies do the best job with controlling cost; therefore, we the taxpayerssubsidize private health insurers withthan Medicare spends to cover the same exact things. Make sense? Me neither.But wait, there's more. Private companies are so efficient that we must give them more money for Medicare advantage. And the same private companies, who already cost more than Medicare, will then take the seniors Paul Ryan kicks off Medicare by giving them a voucher that will be $6,000 short, and all shall be well. Phew!Here's what Ryan wants you to believe his budget does:Actually, it takes credible steps to pass the cost onto seniors. $6,000 per senior. The Ryan Path to Poverty takes credible steps to directly transfer $6,000 each from 33 seniors right into the pocket of the average millionaire in this country.It gets rich. Really rich.The bureaucrats referred to by Ryan are the members of the Medicare Independent Payment Advisory Board, which would have the authority to make cuts in provider pay if cost benchmarks are not met,See, Paul Ryan thinks Medicare is "bureaucratically rationed" health care. Which is why seniors hate it. Of course, $6,000 extra per senior is not rationing. And of course, insurance company bureaucrats wouldthink of interfering with your health care.And nooo, we canthink of returning the income tax rates for the top 2% of income earners to the Clinton era. Because you see, that would be a large permanent tax increase. Besides, why would you want to make them pay a fairer share when they are the job creators! We all know how many jobs they have created in the last 10 years the tax cuts were in effect!Oh, and Paul Ryan knows all about economic growth. That is why he proudly voted against the American Recovery Act, which, at the end of last year, raised economic growth by as much as 3.2 percentage points than would have happened otherwise, and raised employment by as much as 3.6 million people. Ryan knows so much about economic growth that he voted against a small business tax cut and loan guarantees bill that was supported by both labor and the Chamber of Commerce just last year. Not to mention the health care reform law itself included tax breaks for small businesses, as well incentives for health professionals and providers. The guy who has voted against every pro-growth piece of legislation and for every budget busting tax giveaway and war is supposed to now be the go-to guy for lectures on economic growth. Give me a break.Czar Ryan of course couches his drive to end Medicare and turn it into a voucher program into the language of "strengthening" it. Yes, I suppose he strengthens Medicare in the same way one burns down a village in order to save it. Though he did not mention his specific plan in this speech and pretended that Medicare as a publicly managed system is a horrible horrible thing, he could not contain what he really wanted to do. No one was being fooled. He was telling the audience that we need mega tax giveaways for millionaires and billionaires so much that we can no longer afford to take care of the elderly.Newt Gingrich! You know, when Newt Gingrich calls your plan radical for being too far right, you have gone over the edge. Newt Gingrich defines the far right edge of American politics, and even he thinks Ryan's got a couple of screws loose.But bark as he might, I suspect that Czar Ryan knows that he's lost his bite. He's not going to be able to destroy Medicare and turn it into a subsidy program for the private insurance companies while throwing seniors to the wolves. How do we know that? We know that from the hue and cry of Republican House freshmen who are now begging President Obama to stop being mean and telling people about their vote to end Medicare. President Obama and Democrats have rightly held the Republicans accountable and made their life difficult. I doubt even a total failure of a Speaker like John Boehner would make that same mistake twice.