Paul Krugman wakes up this morning, mourning the death of Politifact. He has good cause! In announcing its 2011 "Lie Of The Year," the truth-squadding agency has settled on something that isn't so much a "lie" as it is "100 percent true on its face," and the selection seems to have been made because it doesn't seem to understand some very basic things about Medicare's defined health benefits.
As Politifact sees it, the "lie of the year" is the phrase, "Republicans voted to end Medicare." Okay. What is "Medicare?" Medicare is a single-payer health care system that primarily benefits seniors aged 65 and up, but it also covers younger Americans who have certain disabilities or who require kidney dialysis for any type of end-stage renal disease. It helps to cover the following things: hospital care, doctors' visits, outpatient care, prescription drugs and some preventative services. It's a defined health care benefit provided by the federal government.
On April 15, 2011, the House of Representatives, on a strictly party-line vote, voted to enact a budget plan that included a Medicare reform written by Rep. Paul Ryan (R-Wis.). As we reported at the time:
It calls for transforming Medicare from a program in which the government directly pays medical bills into a voucher-like system that subsidizes purchases of private insurance plans. People 55 and over would remain in the current system, but younger workers would receive subsidies that would steadily lose value over time.
Now, the GOP prefers the term "premium support" for voucher because "voucher" carries a negative connotation. So let's just be clear about this! Under Ryan's plan, instead of Medicare recipients receiving Medicare, they would receive money, which they could then spend on health care. The problem with Ryan's plan at the time is that his "premium support" -- i.e., the amount of money he'd hand to those who once received Medicare -- was not tied to health care costs, but rather, the rate of inflation. As Kevin Drum pointed out at the time, the idea of "premium support" is something that plenty of liberals could embrace -- provided that word "support" mean something.
Paul Ryan's Medicare plan has attracted nothing but scorn from liberals. Its basic problem is simple: it provides vouchers to Medicare beneficiaries to buy private coverage -- which is basically OK -- but it mandates that the value of the voucher will grow only at the rate of inflation. However, the cost of healthcare is almost certain to grow much faster than that over the coming years, which means that a couple of decades from now seniors would receive vouchers that paid for only a fraction of their coverage. They'd have to pay the balance out of their own pockets, and that payment would rise inexorably.
Now, Ryan says that competition between providers would bring down prices, so seniors would come out OK, but he doesn't seem to be willing to put his money where his mouth is. Despite his free-market convictions, his plan sets the value of the voucher by administrative fiat. Not only is this not a market-based solution, but it's a non-market solution we've been experimenting with for years in the form of Medicare Advantage, which allows private plans to compete with traditional Medicare coverage. So far, it's worked miserably: MA plans cost more than traditional Medicare, require higher government subsidies, and don't seem to have spurred any kind of innovation or productivity gains.
So, Ryan's plan may have well called it "premium let down." If the amount of money you get from the government to replace your previously-defined health benefit grows less and less valuable over time, it shifts the cost onto seniors. And the one thing Medicare is designed to do is keep health care costs from mounting on people who are least able to work. Ryan's "plan" for saving money through "Medicare reform" was to, quite literally, stop paying for it altogether.
Now Ryan is back, with Sen. Ron Wyden (D-Ore.), with a new plan that still has significant flaws, but now makes the concession that tying the premium support to the inflation rate was wrong. Their new plan -- which is all theoretical and will not be written as a piece of legislation now (or, most likely, ever) -- pegs the amount of the premium support to health care costs.
This is a significant improvement, in this area. But guess what? It's still a proposal to end Medicare. Any proposal that ends Medicare, ends Medicare! One need not object to the proposal to end Medicare to say, "This will end Medicare." If Paul Ryan negotiates a deal with a newly-discovered island nation of unicorns whereby the unicorns agree to provide seniors with immortality, that is still a set of circumstances by which Medicare is ended.
What's kind of amazing is that in writing up his "Lie of the Year" post, Bill Adair admits enough in his very first paragraph to be able to say that the "Republicans voted to end Medicare":
Republicans muscled a budget through the House of Representatives in April that they said would take an important step toward reducing the federal deficit. Introduced by U.S. Rep. Paul Ryan of Wisconsin, the plan kept Medicare intact for people 55 or older, but dramatically changed the program for everyone else by privatizing it and providing government subsidies.
Oh, you say that the program has "dramatically changed" for people who are not currently 55 or older, in that "the program" would no longer be "the program," but, in fact, be a totally different program based on a totally different idea? Okay then! That new idea ends Medicare, full stop.
I honestly don't know what's so hard about understanding this. The point is, when you provide a thing, and then you stop providing that thing, you've ended the provision of that thing, even if you provide a completely different thing.
What Politifact seems to object to is various Democrats using various, starkly different ways of describing the meaning of the verb "to end."
With a few small tweaks to their attack lines, Democrats could have been factually correct, said Norman Ornstein, a resident scholar at the American Enterprise Institute, a conservative think tank. "I actually think there is no need to cut out the qualifiers and exaggerate," he said.
At times, Democrats and liberal groups were careful to characterize the Republican plan more accurately. Another claim in the ad from the Agenda Project said the plan would "privatize" Medicare, which received a Mostly True rating from PolitiFact. President Barack Obama was also more precise with his words, saying the Medicare proposal "would voucherize the program and you potentially have senior citizens paying $6,000 more.
So, you know, go form an organization called WordTweaker and commit yourself to advocating for the most civil sounding adjectives, if that's what you want to do! But let's recall, Politifact, that your lie of the year is "Republicans voted to end Medicare." And end it, they did vote to do! Now, if the Democrats had said, "Republicans take Medicare out behind the Cannon Office Building and horsewhip it," that's a different story. But you've decided -- incorrectly -- that the most vanilla way of the describing what happened is a deception.
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And "privatizing" Medicare ends Medicare, as Medicare is a public entitlement program. (As a thought exercise for the folks at Politifact, why not stop buying gas for your car? You'll notice that at some point, your car will stop going forward without you pushing it. You did not "end your car." You've just made it less useful by no longer "funding" it with petrol.)
Politifact goes on:
They ignored the fact that the Ryan plan would not affect people currently in Medicare -- or even the people 55 to 65 who would join the program in the next 10 years.
Ha! No one in the world ignored that! That's the way you make ending an entitlement politically palatable -- you tell the people who are currently receiving the entitlement or about to receive the entitlement that it won't affect them. That way, the AARP doesn't, you know, SUMMON THE FORCES OF DARKNESS to vote you out of office. It's actually like Politifact just showed up in Washington yesterday!
They used harsh terms such as "end" and "kill" when the program would still exist, although in a privatized system.
But it wouldn't exist in a privatized system as imagined by Paul Ryan! In the Paul Ryan plan, the premium support is not tied to health care cost. Healthcare costs go up, the premium support fails to keep up, and the result is altogether unrecognizeable from Medicare.
They used pictures and video of elderly people who clearly were too old to be affected by the Ryan plan. The DCCC video that aired four days after the vote featured an elderly man who had to take a job as a stripper to pay his medical bills.
Fair enough! A political party exaggerated in a political ad, my God, let's all just start tearing our garters into smithereens! Of course, perhaps the ad makers hoped to convey that their description was a glimpse of the fate that would befall future seniors. I will retract this if I find out that Paul Ryan's budget plan also provided the means by which time stops passing.)
The truth is, Politifact has been so inconsistent in covering this matter this year, that it's pretty clear they really haven't figured this stuff out. Take this entry from April 22, 2011. In it, they take on Rep. David Cicilline's (D-R.I.) statement that, "We just fought a Republican budget that ends Medicare as we know it." That statement is precisely what Politifact calls the "lie of the year." But on one entry, they are of multiple minds on the matter. The entry begins with a graphic that indicates the claim is "mostly false."
But what's this doing there?
Under the Republican plan, developed because the GOP and other critics regard the costs of the current program as unsustainable, Medicare would continue in its present form for people who already receive it. In addition, those 55 or older would be covered by the program once they hit their 65th birthday. So even 12 years from now, part of today's Medicare would remain in place until every recipient covered under the existing rules has died.
The claim would be true for younger people, because the version of Medicare they would see when they retire would be very different. For example, they would have to buy health plans from private insurance companies, with financial assistance and regulation from the government -- akin in some ways to President Obama's health-care plan that so many Republicans object to. In addition, the eligibility age would gradually rise to 67.
Let me put a very fine point on this:
And here's the concluding sentence of this piece that began with a graphic saying it was "mostly false": "We rate his statement Barely True."
So there you have it. This year's "Lie Of The Year" is something that's actually "barely true." My advice to Politifact is to take a deep breath, start over, and try to actually learn some basic things -- like, what the words "end" and "we" mean when you hear the phrase "end Medicare as we know it."