Bobo has lost his mind. In “The Policy Verdict I” he babbles that on Medicare reform, Republicans have the upper hand. Mr. Nocera, in “Buying the Election?”, says campaign financing has gotten out of hand, and our democracy is paying the price. No shit, Sherlock? When did it dawn on you? Mr. Bruni asks “At Long Last, Dignity?” He says an 80-year-old gay man wishes for marriage, even if it’s too late. Here’s Bobo’s lunacy:
In Thursday night’s debate, Vice President Joe Biden will almost certainly go after Representative Paul Ryan’s Medicare plan. And why shouldn’t he? It’s unpopular. But I’d like to make a case for that plan. It’s the best thing the Romney-Ryan campaign has going for it.
First, let’s define the problem. Today, Medicare costs about $550 billion. By 2020, according to the Congressional Budget Office, it will cost more than $1 trillion, sucking money away from every other government program.
According to the Urban Institute, the average couple in 2010 had paid $109,000 in Medicare taxes during their working years but would be able to receive about $343,000 in benefits. A chunk of that $234,000 gap will be paid for by their grandkids. That should weigh on the conscience of every American over 55. You’re supposed to help your grandkids, not take from them.
Basically, there are two ways to reduce Medicare inflation, through the political system or through a market system. Obamacare tries the former. The current budget projections are so bad because almost no one outside the employ of the president believes this approach will reduce Medicare costs. Obama’s primary cost-control instrument is an independent board of experts that Mitt Romney mentioned often in last week’s debate. It’s supposed to lower payment levels.
There are problems. It’s hard for a few people in Washington to centrally rejigger something that complex. Second, the board is not really out of political control. Congress has already restricted its power and has devised gimmicky ways to overrule an unpopular decision. (All decisions to restrict benefits are unpopular.)
The history of Medicare is strewed with efforts to control costs by controlling prices. The results are terrible. Providers just increase the number of services, redefine the classification of services or find other ways to get their money back. A study by the Congressional Budget Office found that, between 1997 and 2005, Medicare payments for individual treatments fell by 5 percent, but the total spent on these services skyrocketed by 35 percent. Doctors made up in volume what they lost in reimbursement levels.
The second approach is to replace the fee-for-service system with more normal market incentives. Give recipients a choice among insurance options and have providers compete to offer comprehensive coverage like today’s Medicare.
This idea has been floating around for a while, and it used to be popular in parts of the Democratic Party until the party swung left. Senator John Breaux, a Democrat, co-led a commission that promoted this idea in 1997. Bill Clinton floated a “managed competition” plan for Medicare late in his presidency. Democrat Alice Rivlin and Republican Pete Domenici have co-authored a premium support plan for the Bipartisan Policy Center.
Paul Ryan wrote his own version a few years ago and has come up with a more moderate version with Senator Ron Wyden, a Democrat. Whenever you hear a Democrat say that Romney and Ryan would end Medicare or cost seniors $6,000, that is a misleading reference to the original Ryan plan, not anything on offer today. Today’s Romney plan would not shift costs to seniors.
Would a market-based approach reduce costs? There are some reasons to think so. A study published in the Journal of the American Medical Association found that if Ryan-Wyden had been in place between 2006 and 2009, costs might have come down by around 9 percent with no reduction in benefits. Under a demonstration project in Denver in the 1990s, private plans bid 25 percent to 38 percent less than government-determined payment rates.
The Medicare drug benefit began in 2006 with a voucher approach. Costs have been about 30 percent below early estimates. A RAND Corporation study of consumer-directed high deductible plans found that when families had an incentive to monitor costs, they spent about 14 percent less.
Do these and other studies prove that market-based approaches would work? Absolutely not. In each case, the situation is complicated. Voucher plans may save money, but perhaps by shedding the sickest customers.
There are serious health economists who scoff at market-based strategies. Others just don’t know. The leader of the Congressional Budget Office, Doug Elmendorf, candidly admitted at a Congressional hearing that his agency doesn’t know how behavior would change under this sort of competition.
My bottom line is this: The status quo is cataclysmic. The national debt problem is a Medicare problem. The Democrats’ price-control approach has little chance of working.
The Romney-Ryan approach might work. If it doesn’t, the federal budget would suffer but seniors wouldn’t. Today’s seniors would be left untouched anyway, and tomorrow’s would have the option of private plans or traditional Medicare. At worst, if the market approach flopped, we’d be back to where we started.
If we don’t get Medicare right, there’s no money for anything else. On this particular policy issue, the Republicans have the edge.
If the Republican “plan” (some hard numbers would be nice) is so effing popular and such a grand idea why do they keep lying about it? Here’s Mr. Nocera:
Do you remember that moment in the first Austin Powers movie when Dr. Evil, back in action after being cryogenically frozen for 30 years, gets his hands on a nuclear warhead? “If you want it back,” he snarls to a group of world leaders who have gathered in a secret United Nations bunker, “you will have to pay me” — here he pauses for dramatic effect — “one million dollars!” The assembled leaders burst into laughter because it was such a pathetically small sum.
Campaign finance these days reminds me a lot of that scene. I lived for a few years in Washington, right around the time that Congress, aroused by the Watergate scandal, was reforming the country’s campaign finance laws. It instituted a system for presidential elections that combined small contributions from individuals ($1,000 or less), public financing from the taxpayers and a cap on how much the candidates could spend. In the Gerald Ford-Jimmy Carter year of 1976, the two candidates were allowed to spend — can we pause here for dramatic effect? — around $35 million each.
Fast forward 36 years, to last weekend’s news that the Obama campaign had raised $181 million in just one month, September. Not all that long ago, the ability to partake of public financing was a sign that you had arrived as a serious candidate; today no candidate in his right mind would want to be so constrained.
Four years ago, Obama became the first presidential candidate since campaign reform was instituted to opt out of public financing for the general election. He raised $750 million. John McCain, who accepted public financing, was only able to directly spend the $84 million or so he was allotted under the system. (Although the Republican Party raised millions more.) This election season, Mitt Romney and President Obama could end up spending more than $1 billion each. They seem to spend more time fund-raising than pressing the flesh with voters. According to Brendan Doherty, a political science professor at the United States Naval Academy, Obama has held six fund-raisers in a single day. Twice.
And that doesn’t even account for what’s truly different about this election: the rise of the “super PACs” and 501(c)4s, which are essentially a form of campaign money-laundering, allowing wealthy people to contribute millions toward supposedly “independent” spending on campaign advertising, polling and other expensive campaign goodies. Sheldon Adelson, the casino mogul, whose main political interest appears to be Israel, has pumped $10 million into Restore Our Future, the biggest Republican super PAC. Although individual contributions to a particular candidate remains severely restricted — no more than $5,000 — the amount someone can pour into a super PAC is limitless. The means by which the country finances its campaigns is utterly broken.
In a recent cover story in The Atlantic, James Bennet, the editor, traces how that happened. He focuses on a man named Jim Bopp Jr., a lawyer from Terre Haute, Ind., who has largely devoted his life to freeing the nation of campaign spending limits. To him — and, indeed, to the majority of the current Supreme Court, in the Citizens United case — limits on political spending are a violation of the First Amendment.
What is astonishing is the way Bopp makes unlimited spending seem actually democratic. “Most people don’t even know who their congressman is,” Bopp tells Bennet. If there were more spending on campaigns, voters would be more educated about the candidates. The Supreme Court majority, meanwhile, has essentially said that, by definition, campaign spending that is independent of the candidate cannot be corrupting.
But, of course, what we are learning in the real world is that super PACs and 501(c)4s are hardly independent. Karl Rove, who absolutely knows what the Romney campaign needs at any given moment, runs the most important of the Republican super PACs. Rahm Emanuel, the mayor of Chicago and Obama’s first chief of staff, is helping to raise money for a Democratic super PAC.
What we also know in the real world is that unlimited spending will not serve to enlighten voters. It will deaden them to political argument — as is happening in just about every swing state, where the ads are running with such frequency that people are tuning them out. Finally, we know from hard experience that the money that comes into politics has the potential to corrupt.
In Congress we see it every day. A congressman gets on an important committee, begins to raise money from the companies that care about the committee’s issues — and, suddenly, the congressman is writing legislation the company wants.
What feels different now is that the sums are so large, and that it has the potential to influence not just Congressional and Senate candidates but the presidential candidates as well. If Romney wins, will he really be willing to take a position on Israel that is different from Adelson’s? One suspects not.
“This can’t be good for Democracy,” Bennet told me in an e-mail. It’s not.
Again, no shit. What gave it away? Here’s Mr. Bruni, who’s in Cape Neddick, Maine:
If you live for 80 years, Chuck Bennett told me, you see things you never imagined. Crazy, fantastical stuff.
A man on the moon. “Amazing,” he said.
The Soviet Union’s disintegration. “Also amazing.”
And on Nov. 6, if the polls are right and his hope is fulfilled, the people of Maine may pass a referendum for same-sex marriage, which no state has adopted by popular vote before.
“That’s equally amazing to me,” he said. Ten minutes later, he circled back to say it again. “I would like to reiterate how amazing it is.”
Bennett was born in 1932 and grew up in Brooklyn without anything but slurs and clinical terms to describe his attraction to other men. In the late 1950s, he was forced out of the Navy for being gay.
He never found a long-term romantic partner, thwarted in part by a disapproving society with no obvious role models for him, and he bought his dream house on the ocean here 15 years ago with two close friends, because he didn’t want to grow old alone and didn’t expect to meet anyone special, not so late in the game.
“You know that old saying, Born 50 years too soon?” he asked me. “I think I do feel something of that.”
Maine is one of four states with same-sex marriage on the ballot on Election Day, a crucial moment for advocates and opponents alike. The referendums are the first and best tests of popular sentiment since President Obama’s history-making statement of support in May. (For more on this, visit my blog.)
In Minnesota, the vote is on an amendment to the state Constitution to ban same-sex marriage. But in Maine, Maryland and Washington, the vote is to permit it, and thus to join the six states where it’s already legal, thanks to legislatures or courts.
Advocates are most optimistic about Maine, and I traveled here last weekend for a sense of what victory would mean to someone who’d known and braved a much different world. I found my way to Bennett, a courteous man with a soulful gaze and a precise way of speaking that reflects his long career in academia, first as a college English professor, then as a dean.
He recalled that during his teenage years, his only assurances that there were other people like him were newspaper stories about men arrested on Fire Island for “obscene” or “depraved” behavior.
For a while he dated women, but couldn’t summon any real passion for them. He wasn’t sure where that left him. Clearly, he wouldn’t marry. But what about a relationship like that with a man?
In his late 30s, he had one, and wanted it to go on forever. It lasted five years. Nothing like it ever came along again.
He felt the need to be secretive about his sexuality and kept work colleagues at a distance. His parents died without knowing he was gay.
Starting in the mid-1980s, he marveled at the proliferation of gay characters in movies and on TV. He later joined efforts to end the ban on gays in the military, giving money to the cause.
But when gay advocates started talking about marriage, he thought it nuts, partly because they were buying into such a flawed institution. But also, he said, “The likelihood of winning was so, so far-fetched.”
One of his housemates, David Newman, 71, who is also gay, still has trouble understanding the way “I do” and gold bands became such an ardent, defining quest. He spent a lifetime trying, out of painful necessity, not to be tormented by the straight world’s norms, which excluded him.
“How can somebody like me, who has made a significant investment in inventing an alternative world, come around to accept gay marriage?” he asked, clarifying that he supports the referendum. It’s just unsettling to him, this challenge to what he thought he was supposed to believe about such conventions.
For Bennett, the marriage focus of the Maine referendum is almost beside the real point, which is validation.
“I see it as something of profound significance,” he said. “Whether anyone winds up getting married in Maine, I don’t care. I care that they can get married.” That right means that gay people are equal to straight people. It recognizes their dignity. His dignity.
I asked him if the absence of such recognition during most of his life made him bitter.
“I was fortunate,” he said, explaining that his family wasn’t especially religious and his nature isn’t self-punishing, so he never felt that being gay was some abomination. But it was certainly a limitation. A cause for hiding, or at least holding essential parts of himself in reserve.
“I’m inclined to look back not in anger, as John Osborne once said, but with some degree of sadness,” he said. “Everyone could have been happier. Everyone could have been more fulfilled if they hadn’t been burdened with this prejudice.”