Relevant and even prescient commentary on news, politics and the economy.

A New IOM Report Reveals Why Medicare Costs So Much (Hint–It’s Not Just the Prices)

by Maggie Mahar

A New IOM Report Reveals Why Medicare Costs So Much (Hint–It’s Not Just the Prices)

(reposted with authors permission)

George WBush is 67. Chances are Medicare paid for the stent operation that I describe in the post above. For years, medical researchers have been telling us that this procedure will provide no lasting benefit for a patient who fits Bush’s medical profile.   Nevertheless, in some hospitals, and in some parts of the country, stenting has become as commonplace as tonsillectomies were in the 1950s.

Location matters. Last month, a new report from the Institute of Medicine confirmed what Dartmouth’s researchers have been telling us for more than three decades: health care spending varies  across regions. More recently, as Dartmouth’s investigators have drilled down into othe data,, they have shown that even within a region, Medicare spends far more per beneficiary in some hospitals than in others.

In a recent Bloomberg column, former CBO director Peter Orszag notes that “Because this variation doesn’t appear to be reliably correlated with differences in quality, the value [that we are getting for our health care dollars] seems to be much higher in some settings than in others.” He asks the logical question: “What is causing this and what might we do about it?”

Rep Marsha Blackburn’s snow job. Explains how Social Security money flows

I was watching C span Washington Journal this morning.  Rep Marsha Blackburn was the guest.  I got to listen to her explanation of how the Social Security funds flow and just had to post the clip.   Copied from the transcript of the clip:

THEIRS MONEY THAT GOES TO MEDICARE AND SOCIAL SECURITY AND I THINK IT IS JUST IS SO INAPPROPRIATE THAT THE FEDERAL GOVERNMENT DOES NOT USE THAT AS A TRUST FUND BUT THEY MOVE IMMEDIATELY TO THE GENERAL FUND AND STACK UP IOU’S THAT ARE SITTING IN A CABINET IN WEST VIRGINIA.

What she says should not be allowed to stand and if C-span were half of what it used to be, she would not have had the following go uncorrected.  Thus I leave it to the Angry Bears to correct her here and thus document her ignorance of the subject. 

I have not watched this lady before.  I could not help but think she is just a more polished version of Sarah Palin. She is totally capable of pulling off what we used to call a “snow job” when writing their essay.

Carpe David Brooks. Before He Drives Me Crazy. [Freudian typo now corrected. 3:25 p.m.]

An exchange between reader nitu mishra and me in the Comments thread this morning to this AB post of mine from yesterday.

nitu mishra:

Here’s a good article on 2012 Q4 earnings outlook.

http://tinyurl.com/investing002

Me:

Ah. If only I could actually understand graphs, without having to stare at them for ten minutes or so first, Nitu. But I don’t have to understand the graph posted at that url to know that corporate earnings are TANKING.  I know that because I already read David Brooks’s column today, and he says that Obama should propose a cut in corporate tax rates, because corporations need to have money to use for INVESTMENTS.  And of course Brooks wouldn’t say that unless corporate profits* ARE tanking and corporations, well, just can’t afford to invest.  They need further tax breaks in order to have the money to do that!

Like Apple.

(And, pleeeeease: No one post that aggregate U.S. corporate profits are at all-time highs and that corporations are HOARDING their profits rather than using them to invest.  I know that. My comment is facetious.)

I’m back on my David-Brooks-formulaic-conflations watch today, because, well, he has another column in today’s Times.  And (surprise!) it’s another classic I’ve-found-the-secret-formula-for-phoning-in-NYT-columns column. So I can’t resist.

The formula, of course, as anyone who reads his columns even occasionally knows, is to summarize a new book he’s read about economic or social trends (or both!) and then use the last two or three paragraphs of the column to string together conclusions that are either non sequiturs to the information or ideas he’s just summarized from the book, or to state unexplained conclusions that are contrary to that information or those ideas and pretend that the information or ideas support those conclusions.

It’s easy.  And it’s a very nice gig.

Today’s offering is based on a book called “Innovation Economics.”  I’ve selected two excerpts from the column, that, I trust, together illustrate my point.  The first, from early in the column, is:

As Robert D. Atkinson and Stephen J. Ezell note in their book “Innovation Economics,” American firms are also lagging in their commitment to research and development. Between 1999 and 2006, for example, German firms increased research-and-development spending by 11 percent, Finnish firms by 28 percent and South Korean firms by 58 percent. During that same period, U.S. spending increased by a paltry 3 percent.

Increasingly, companies have to spend their money on retirees, not future growth. Last week, for example, Ford announced that it was spending $5 billion to shore up its pension program. That’s an amount nearly equal to Ford’s investments in factories, equipment and innovation.

And then the denouement:

The political debate, though, is largely oblivious to this mental shift. Republicans and Democrats are so busy arguing about the merits of government versus business that they are blind to the problem that afflicts them both.

In his State of the Union address Tuesday night, President Obama is apparently planning to give us yet another salvo in that left-right war, as he did in his second Inaugural Address. One of his aides, in a fit of hubris, told Politico that the president will be offering Republicans a golden bridge to ease their retreat.

But it would be great if Obama gave an imaginative speech that reframed things as present versus future.

If the president were to propose an agenda for the future, he’d double spending on the National Institutes of Health. He’d approve the Keystone XL pipeline. He’d cut corporate tax rates while adding a progressive consumption tax. He’d take money from Social Security and build Harlem Children’s Zone-type projects across the nation. He’d means test Medicare and use the money to revive state universities and pay down debt.

Would Americans buy that agenda? Maybe. Americans are neglecting the future, but I bet they’re still in love with it.

The title of the column is “Carpe Diem Nation.”  The first excerpt is noteworthy both for its statistics and for the fact that Brooks has built a career on trashing European economic policy and culture as anti-entrepreneurial.  The second excerpt would be notable for its vertigo inducement, were vertigo inducement not a regular part of the formula, column after column.  But it is, so it’s not notable.  

In between those two excerpts, Brooks apprises readers who aren’t regulars, and who therefore don’t know, that his real purpose is to argue for the dismembering of the social safety network for the elderly, because, well, we couldn’t possibly raise taxes to cover that social safety network, as they do in, say, Germany and Finland.**  Raising FICA taxes very slightly would take care of Social Security needs, but rather than do that, or to raise taxes on upper-income folks and on corporations to Clinton-era levels, it’s better to remove basic sustenance income from millions of elderly if we want to build Harlem Children’s Zone-type projects across the nation.  

This is true especially regarding corporate taxes, since record corporate profits and outright hoarding of those profits by corporations doesn’t mean that increasing their taxes by raising tax rates or by closing loopholes would be a better investment for the country than reducing corporate taxes even further. I mean, you never know when Apple might conclude that it finally has enough after-tax profits to start investing them in research and development.

Of course, seniors who rely entirely or mainly on Social Security benefits and Medicare aren’t known for their dedication to Apple MacBooks, iPhones and iPads, so there’s no real need to worry that a reduction in those seniors’ meager income would hurt the economy by depriving Apple of enough money to enable the company to invest.

So carpe diem to cut taxes on corporations while ending Medicare and Social Security.  Just like Germany and Finland. If it’s the future that you’re interested in.

—-
*The post originally said “corporate taxes ARE tanking….” That was a typo. Or maybe a Freudian slip.

**Sentence was corrected to correct two typos–and to make sense. 11:21 p.m.

The "Fiscal Cliff" and the Coming Retirement Crisis of the Middle Class

On January 1, Congress approved a tax and spending bill to avert the so-called “fiscal cliff” combination of tax hikes and spending cuts that would have created deflationary pressure on the United States (though Yglesias questioned the conventional wisdom of whether it would necessarily cause a recession). Let’s take a look at the deal in some detail, then proceed to the gruesome details of what will happen around the Ides of March.

From Think Progress, here are some of the more critical parts of the deal.

1) The Bush tax cuts expire on only about 0.7% of households, those earning more than $400,000 per year as an individual or $450,000 for a couple. This brings in $600 billion over 10 years. Since rich people don’t spend as much of their income as the poor and middle class do, this is less deflationary than a tax increase on the middle class, as I discussed in November.

2) With the expiration of the temporary 2% payroll tax cut, 77% of households will see their taxes go up. Indeed, every single income group will, on average, see their taxes increase, as shown below (via Matt Yglesias):

1357144024996

Since this hits the middle class more directly, the deflationary consequences are larger than they would be for an increase in taxes on the rich. On the other hand, this strengthens the long-run funding of Social Security, an issue I will return to shortly.

3) Unemployment insurance is extended for two million workers. This will get spent and have a definitive stimulative effect on the economy.

However, the second shoe of the fiscal cliff, the automatic cutbacks known as the “sequester” was simply postponed for two months, which is the same time that the Treasury Department will run out of creative ways to keep the country from exceeding the debt ceiling, which it hit on December 31.

Combining these two negotiations, the debt ceiling and the sequester, will be an extremely high-stakes battle where the middle class has a lot to lose. The big problem here is that some Tea Party Republicans really do want to use the debt ceiling to take the economy hostage and force cutbacks in Social Security, Medicare, and Medicaid. Despite the fact that Republicans lost the Presidency as well as both Senate and House seats (with a majority of the votes cast for the House going to Democrats), they see their gerrymandered House majority as giving them license to wreak havoc.

The consensus among most commentators (Krugman, Klein, and Yglesias, for example) is that the fiscal cliff deal will work out okay as long as the President does not cave in to the Republicans’ threats over the debt ceiling.  I agree as far as that goes. But, as Yglesias points out, there is nothing great about what Klein says is the most likely scenario, where the President gets $1 trillion in new tax revenue for $1 trillion in cuts over 10 years. That is still $2 trillion in austerity measures at a time when unemployment is barely below 8%!

The looming problem rarely mentioned, even in the context of the Republican campaign against Social Security, is that my children’s generation (Generation X, if you will) faces a retirement crisis that many of my generation will avoid, based on the end of pension plans. According to one Social Security Administration report, the percentage of private-sector workers with a traditional defined-benefit pension plan fell from 38% in 1980 to 20% in 2008. Over the same period, private-sector workers who only received defined contribution plans rose from 8% to 31%. Note that this means that 49% of private-sector workers are not covered by any pension plan at all. Moreover, while governments have more commonly provided defined-benefit plans than private employers have, they are under attack in many states.

Let’s do the math. With 49% of private workers having no pension, and another 31% having an on-average less generous defined contribution pension, how will seniors support themselves if Social Security is cut? Hint: It won’t be pretty.

Get ready for a bumpy March.

Cross-posted from Middle Class Political Economist.

There are no "per se" tax or spending caps: lame duck negotiations no place for Medicare/Medicaid cuts

 by Linda Beale

There are no “per se” tax or spending caps: lame duck negotiations no place for Medicare/Medicaid cuts

When George W. Bush got reelected with a minority of the popular vote and contested state counts, the GOP claimed a mandate to keep going with the fiscally irresponsible program of high military spending combined with tax cuts particularly advantageous for their wealthy and corporate-owning supporters.
When Barack Obama got reelected with a clear majority of the popular vote and a resounding majority in the electoral college, the GOP says Obama has no mandate because the GOP managed to retain the House though Democrats in the House got more votes than Republicans in the House.
Anybody notice the partisan inconsistency there?

What we do know is that a majority of Americans–even lots of those Republicans who voted for Romney–want this Congress to preserve Medicaid and Medicare.  There is a huge effort by some–like the Peterson Institute, the Simpson-Bowles comedy tour, and right-wing propaganda tanks–to cast Medicare as impossible to sustain because of the current trend in health care costs.  The argument goes this way:

  • health care costs in the US are rising
  • the population that is eligible for Medicare in the using is rising as baby boomers age
  • Medicare costs will therefore inevitably increase
  • even though Medicare costs are rising less rapidly than non-Medicare health care costs (because of the ability of the government to mandate certain cost controls), those increases will eventually require significantly higher government outlays
  • the US has unprecedented levels of debt and annual budget deficits
  • the US spends too much compared to its tax revenues (the tax take is several percentage points less of the GDP than the spending percentage)
  • therefore the US can’t afford to pay those increasing amounts for Medicare health care costs
  • therefore we should cut back on eligibilty for, and benefits from, Medicare.

But this argument has several fatal flaws that include the following:

  • debt is extraordinarily cheap right now
    • if you can borrow at very low rates, it is better to borrow now than later
    • if you can borrow at very low rates and there are important projects on which to spend the money, the borrowed money acts as a stimulant to the economy
    • if the economy is stimulated by the borrowed money, the GDP growth will likely support continued low interest rates and faster revenue growth that will repay the debt faster
  • deficit spending by the government is vital when there isn’t private spending
    • and if the economy grows, private spending will grow and deficit spending can pull back
  • spending priorities have to be determined: 
    • there is no per se rule that higher spending is necessarily bad (though the right-wing in this country presupposes that there is and based almost all policy prescriptions on that presupposition, because the right-wing ideologically wants to divert public spending to its private pocketbooks)
    • there is no arbitrary and fixed percentage of GDP that is the “right” amount to be spent by the government on government programs
    • we spend too little now on public infrastructure ( public transporation, national roadways, electrical grids, and sewage systems are badly deteriorated), basic research (we have cut back on funding for NIH and NSF, major drivers of advancements in scientific and medical knowledge), and major priorities like combatting global warming/ supporting renewable energy
    • we spend too much now on the military (the military-industrial complex constitutes about 60% of the federal government)
    • we should support continued spending on Medicaid and Medicare, because those programs fill a vital need and serve the population well–we should not reduce benefits but rather increase them, at least for those who rely on Medicare/Medicaid as their primary or only health care plan
  • We’ve already built in various cuts to the spending for Medicare and Medicaid (possibly too much) and the question of what the costs will be ten years down the road depend in part on what else we do along those lines and how those things work out. See Editorial, Health Care Entitlements, New York Times (Nov. 29, 2012); Yves Smith, Naked Capitalism.
  • tax policy should be based on fairness in the way we raise revenues and spending priroities in the amount of revenues we raise
  • An equation that says “X (health care costs) is increasing and Y (Medicare coverage of health care costs) is increasing (because the number of people needing the program that pays for health care costs is increasing) and Z (taxes for coverage of health care costs) is increasing” and then concludes “therefore we must reduce Y” is using false logic: 
    • to maintain a relative constant, there are more options than “reduce Y” since the country could:
      • reduce X (move to single payer, as every other advanced nation has done, and halve the cost of health care)
      • increase Z (increase the tax support for Medicare, because it is a high priority that a majority of the citizens of our democracy support)

What we have to do is get away from the kind of thinking that seems to permeate so much of the discussion in Congress and in the media–that there are pre-set limits to how much we should borrow, how much we should spend, or how much we should raise in tax revenues.

The deficit hawks want us to think that the countnry will be just another Greece if we don’t rein in spending and debt and keep taxes low.  Traditionally our spending has ranged around 21% of GDP, but there is nothing magical about that number–it could rise to 24% or 26% without harm.  And we are not Greece, because we remain a powerful economy, one that can print our own money and one that commands interest from the global economy, so our debt (mostly caused by the Bush tax cuts combined with the Bush wars, and the Reaganomics deregulatory mania) is not an unbearable yoke around our necks.  We should be discussing the real needs of the country for infrastructure and provision of public goods and then figuring out how to pay for them with a combination of taxes and debt.

cross posted with ataxingmatter

After selling the election

In a previous post Fiscal cliff and the frenzy  I pointed to the rush of reporting the day after the election. Some of these articles should be in the op-ed section instead of reporting.

Lori Montgomery

“Avoiding hard decisions could have grave consequences, analysts say…”

        … 

Few expect Washington to replicate the scope of the Bowles-Simpson plan. Though it is widely praised, its $4 trillion in 10-year savings includes major changes to Social Security opposed by liberals and an aggressive new tax code that would generate far more revenue than most conservatives could stomach.

        … 

About half the new savings would come from reversing part of the massive tax cuts that, along with the collapse of tax collections during the recent recession, are a major cause of current budget problems. The rest would come from lower spending, including on Social Security and Medicare, forecast to be the biggest drivers of future borrowing.

Zachary Goldfarb

Much of the public dispute over the fiscal cliff has centered on the president’s demand that taxes rise for the wealthy. But entitlements are an essential element of the discussion because they are the main drivers of the nation’s borrowing problem over the years to come.

from The Root

After four years of sheer obstructionism — behavior that was called out during the presidential campaign season — most Americans are pointedly aware of who is willing to further wreck the nation’s economy and who would like to rescue it.

Fifty-three percent of the nation believes that if a fiscal agreement isn’t reached by New Year’s Eve, Republicans in Congress are the ones to blame, reports a new Washington Post-Pew Research Center poll. It also reports that only 38 percent believe that the president and the Republican Congress will reach a deal.

If those pessimists are right, then in an effort to assure a long-term deficit reduction, a series of mandatory and draconian spending cuts will jump off in less than seven weeks, coupled with the expiration of a slew of tax cuts.

Farmers, Medicare Recipients, and Sons of Multimillionaires, Some of Whom Won’t Take Responsibility for Their Own Lives – [UPDATED]

This summer’s widespread drought has been extremely hard on Midwestern and plains-states crop farmers, and many of them are chafing at the thought of having to take responsibility for their own lives if the Farm Bill doesn’t make it through Congress before the upcoming recess.

They had panicked earlier in the summer when Congress was dallying in passing an emergency relief bill, but were rescued from having to take responsibility for their own lives when the Republican-controlled House agreed at the last minute before Congress’s August recess to allow the farmers—including some who won’t be paying income tax for this year unless those federal subsidies increase their incomes enough—to mooch off the likes of Mitt Romney and his son Tagg, whom Romney convinced to take responsibility for himself

Which Tagg did, by borrowing a reported (if I recall correctly) $10 million from his parents to start a (very) private equity firm whose investors apparently all, or almost all, were people who’d made their fortunes through investments with Bain Capital. 

Tagg is a role model for young people just starting out today who want to take responsibility for themselves.  His father suggested last winter that other young people should emulate the son: “Start a business.  Borrow money from your parents, if you have to,” Romney told a group of them.  Or something like that.

In that same speech, he advised young people to “get that education.”  Presumably, by having their parents pay their tuition and expenses.  Like Mitt Romney himself did.  And like all his kids did.

No silver spoon for the Romneys, though.  No sir. Just personal responsibility. Unlike all those farmers in Kansas, Nebraska and Indiana who are part of Obama’s base.

Then, of course, there the Medicare recipients who refuse to take responsibility for their lives by paying their healthcare costs, or at least the part of their healthcare costs that exceed the amounts they’d paid into the fund over the years. People who think they’re entitled to healthcare.  And, probably, to you-name-it.

—–

UPDATE: A commenter on another blog pointed out that Israelis, whose healthcare system Romney praised during his July overseas rollout, are similar to Obama supporters in that they think they’re entitled to healthcare. 

For that matter, so are Poles, who’s free-enterprise culture Romney praised during that same overseas trip.

And, now that I think about it, so do the Australians, Austrians, Germans, Japanese, Dutch, Taiwanese, and the citizens of quite a few other countries that are known for their people’s feelings of victimhood and socialist freeloading. 

SECOND UPDATE:I’m copying here the three comments posted to this post:

Elliot MacLeod-Michael Sep 18, 2012 1:44:00 PM

I sure hope people like Boeing don’t catch wind of this, or any other massive company type people who do not pay taxes.

little john Sep 18, 2012 2:12:00 PM

This blog told me earlier that the Farm Bill was welfare for Agribusiness. Now it’s just for “regular” farmers in Kansas, Nebraska and Indiana? Hmmm.

Beverly Mann Sep 18, 2012 3:23:00 PM  

No, john, my post doesn’t say that the Farm Bill is just for regular farmers. It’s also for agribusinesses, who, as Elliot points out, are people too. And some of them may not pay taxes, and the rest pay taxes at, I guess, about the rate that Romney did for 2010.

Presumably, the ones who pay no taxes will vote for Obama in the hope of avoiding taking personal (they’re people, after all) responsibility for themselves.

So sorry; I couldn’t resist.

Omigod

(Dan here…Lifted from Robert’s thoughts)

Robert writes:

Omigod Sept 4 2012 really is opposites day.  Ezra Klein made an incorrect claim of fact about health care financing.  He wrote:

But I’m not going to make that argument. I’m on-record saying that trust-fund accounting is by and large a ridiculous way to look at the federal government’s finances, but both parties do it, and so Ryan isn’t committing any foul here. And within the trust-fund accounting rules, Obama is using his Medicare cuts to pay for the Affordable Care Act and Ryan is using his Medicare cuts to finance the Medicare program in the future.

My amazed comment follows.

I agree that trust fund accounting is absurd, but your trust fund accounting is totally wrong.  The balance of the Medicare plan A trust fund would be identical under the ACA and the Ryan budget.  There is just no difference at all.  The ACA did not take any money out of the Medicare trust fund to pay for anything.  That’s why it extended the forecast time till the fund is empty by 8 years.

The ACA spending increases are, by trust fund accounting (which I agree is nonsense) separate from the Medicare spending cuts (and the Medicare tax increases).  The effect on the deficit is the sum.  The Medicaid expansion and the subsidies for insurance bought on exchanges are not at all funded by any money which would otherwise be in the Medicare plan A trust fund.

Amazingly uber wonk Ezra Klein is just wrong on a health care financing fact (a meaningless one I agree but you are just wrong).

The Elephants are Still Thirsty

by Run 75411

The Elephants are Still Thirsty

In my earlier post on Carrying Water for Elephants I explained how the $716 billion in planned reductions to Medicare was calculated, who it impacted, and from where it originated.

The $716 billion is far larger than the initial $449 billion first reported. In 2010, the CBO arrived at an estimate of savings of ~$449 billion starting from 2012 onwards and covered 6- 7 years from when the bill takes full effect in 2014 to 2019. The second estimate of savings was the result of John Boehner’s request for a review of the costs and gains realized from the repeal the ACA in its entirety. The second review covered the period from 2014 to 2022 and resulted in the $716 billion. “Medicare Cuts: What is the Fight About?” Brookings Institute

Above the explanation of how the $716 billion calculated; I presented Ezra Klein’s pie chart explaining where the reductions were made. Not one of the reductions comes from reductions in Medicare benefits to recipients which as I also explained is denied the PPACA. In last night’s Republican Convention Paul Ryan again claimed the reductions to providers are actually cuts in benefits to Medicare recipients and the reductions are being used to fund the PPACA. Neither statement is true; but then, Paul Ryan is a Republican VP candidate who hopes to confuse the voters with supposition and conjecture. Paul should be made to explain what he will do with the reductions achieved from similar reductions he has proposed for Medicare . . . maybe more tax breaks for the 1 percenters???

There is no amount of water Paul Ryan or Mitt Romney can carry to quench the thirst of this elephant of misrepresentation.

Oh, Mr. Ryan, Do Get Wonky On Us. Please. (I.e., thank you, Brit Hume and Matt Miller.)

In poker a “tell” is the physical giveaway or tic that lets you know someone is lying about his or her hand. In politics it’s the mode of evasion a politician chooses to sidestep a truth he or she doesn’t want to admit or to avoid saying something against self-interest. In his debut interview with Fox News’ Brit Hume Tuesday, Rep. Paul Ryan’s “tells” were audacious and revealing. They suggest an opening Democrats would be wise to pursue.

Ryan (R-Wis.) tried to cloak himself in his supposedly charming “wonky-ness” to sidestep two simple questions from Hume: When does Mitt Romney’s budget reach balance, and when does Ryan’s own budget plan do the same? Ryan pirouetted because Hume’s queries threatened to expose his famed “fiscal conservatism” as a fraud.

It’s worth parsing Ryan’s tactics in this exchange because it shows the brand of disingenuousness we’re dealing with. So let’s go to the videotape. Have a look at the relevant two-minute portion of the clip (excerpted on this CNN video) and then we’ll dissect it.

Okay, you’re back. Hume started with a simple question: “The budget plan that you’re now supporting would get to balance when?”

Now, for context, recall that in the last era of epic budget smackdowns, 1995 and 1996, Newt Gingrich would have had an equally simple answer: in seven years. President Bill Clinton’s failure to embrace the goal of a balanced budget at all was a major political liability that Clinton finally (and shrewdly) erased when he came out with his own 10-year plan in mid-1995. (It’s worth underscoring that a 10-year path to balance was viewed then as the outer limit of credibility — pledging to end the red ink any further than a decade out didn’t pass the laugh test.)

Since Ryan knows that Romney’s bare sketch of a plan never reaches balance, he stumbles momentarily before trying to move the conversation to his comfortable talking points about Romney’s goal of reducing spending to historic norms as a share of gross domestic product.

But Hume grows quietly impatient. He practically cuts Ryan off.

“I get that,” Hume says. “But what about balance?”

You can see Ryan flinch. He doesn’t know, he says. Why not? “I don’t want to get wonky on you,” he says, recovering, “because we haven’t run the numbers on that specific plan.” But that’s not “getting wonky” at all. As common sense (and the Gingrich/Clinton approach) suggests, there’s nothing arcane about this subject. You decide on a sensible path to balance as a goal and come up with policies that achieve it. All this means is that Romney hasn’t done what a fiscally conservative leader would do. Trying to evade this as a matter of not “getting wonky” is Ryan’s tell. He’s betting Hume is too dumb, uninterested or short on time to press the point.

Recognizing Paul Ryan’s ‘tell’when he is trying to avoid something, Matt Miller, Washington Post, today’s edition

Wow.  Okay.  That’s a much longer excerpt from someone else’s piece than I like to use, unbroken by my own commentary.  And it doesn’t even include the real coup de grace of that column, the best I’ve read in a really long time.  The column goes on recite further details of that interview:  

“Your own budget . . . when does that contemplate reaching balance?” Hume asks.

There’s no exit. Not until the 2030s, Ryan finally admits, looking uncomfortable — but then he quickly adds, making a face, that’s only under the Congressional Budget Office’s scoring rules, implying that they’re silly constraints every Fox News viewer would agree are ridiculous (instead of sensible rules meant to credit politicians only for policy proposals that are real). Ryan adds that “we believe” if we get the economy growing, “it would balance in 10 years.” But that’s supply-side faith-based budgeting again — exactly what we ran an empirical test on in the 1980s. (And the truth is, if Ryan’s big tax cuts were properly accounted for, his plan’s real date of balance would push well beyond 2040).

And finally that promised coup de grace:

Why am I harping on this? Because it’s impossible to overstate how central the unjustified label of “fiscal conservative” is to the Ryan brand and the GOP’s strategy. As Clinton understood in the 1990s, “fiscal responsibility” is a values issue important to the voters who decide modern presidential elections.

The point: Democrats can’t afford to let Ryan/Romney’s phony image as superior fiscal stewards survive. And Hume’s interview shows how swiftly this charade can be exposed if Democrats and the press zero in on simple questions like Hume’s. If the press is primed to cover this more intelligently, such queries will also expose the big Republican lie — the idea that you can balance the budget as the baby boomers age without taxes rising.

Let me be clear. The most important issue facing the country isn’t when we’re going to balance the budget. It’s how to get growth and jobs reignited in the near term and how to renew the country’s promise and competitiveness after that (an agenda in which long-term budget sanity is just the ante). But if Democrats spend all their energy on Medicare — and don’t knock out the GOP ticket’s undeserved reputation for fiscal responsibility — they’ll find themselves in unexpected peril as the race heads to the fall.

In a lengthypost I wrote on Wednesday I expressed my own fear of the danger to Obama and the other Democrats of an all-Medicare-all-the-time campaign focus, because it removes the emphasis on the dramatic income tax reductions for the wealthy and therefore on the radical reduction of tax revenue—which, among other things, surely would require a substantial reduction in Medicare benefits to current and imminent beneficiaries, despite Romney/Ryan’s protestations to the contrary. Here’s how I ended that Wednesday post:

A lot of eyebrows were raised on Sunday when Ryan, sitting next to Romney in an interview, told Bob Schieffer that he wants to end the tax breaks that apply only to the wealthy.  That’s nice, but of no effect.  A seminal part of his tax-and-budget plan, passed this year by the House, is the elimination of all income taxes on capital gains and dividends.  And although this would mean that many very wealthy people will pay no income taxes or estate taxes, and many other very wealthy people would pay income taxes at a single-digit rate, the elimination of these taxes would apply as well to the non-wealthy who have a capital gain or receive stock dividends, however small.  And so—voila!—Ryan’s statement, made with such earnestness, does not apply to the issue of taxes on capital gains and dividends.  Nor, for that matter, to estate taxes, which his plan entirely eliminates; some non-wealthy people leave small estates, after all.  And semantics is the name of their game, the objective of which is the enabling of ever more vast accumulations of wealth, utterly unfettered by tax obligations.  Pure and simple.

My big fear about the all-Medicare-all-the-time campaign that began last weekend with Romney’s Ryan announcement is that it allows Romney and Ryan to claim the mantle of straight talkers about what they warn is a Medicare-caused fiscal calamity that awaits.  They have yet to explain why, if they fear such a calamity, they propose to reduce federal revenue by trillions of dollars, through their tax-elimination-on-the-wealthy plan.  And when they stress, as they do again and again, that their destroy-Medicare-in-order-to-save-it plan will not end the current program for its current or relatively-imminent recipients (those who are 55 or older), maybe they’ll deign to reveal what programs will be eliminated in order to pay for Medicare for current recipients and baby boomers andand—the trillions-of-dollars tax cuts for the wealthy.

My suggestion: Hurricane disaster relief for the southern Atlantic and Gulf Coast states, which will vote for this ticket en force, and crop insurance and drought disaster relief for the plains states, which will vote for them and their budget plan in almost as large percentages. 

In 2005, Ryan now-famously advised his audience when he addressed an Ayn Rand fan club that they should make no mistake: current politics is a clash between “individualism” and “collectivism.”  And indeed it is.

Now, let’s ensure that the public knows the specifics.  

After all, for all the indignant denials Romney has made about Harry Reid’s allegation that Romney paid no income taxes for a period of at least 10 consecutive years, Ryan’s plan—the plan being the one that Romney adopted all the way back last winter, during the primary season; the drafter being the person whom Romney has chosen to be a heartbeat away from the actual presidency has made —would enable Romney to openly pay no taxes on most of his income for the next ten years and beyond.

And about Medicare anyway: Isn’t it a collectivist program?

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UPDATE: Turns out, I’m very late to this party.  How could this not have gotten a lot of media attention earlier?