"I'm a Very Serious Person™, and I want to ameliorate the crushing debt threatening our children. Entitlements are the biggest threat, so we need to get rid of Obamacare and instead implement Simpson-Bowles.""Please note that any dialogue remotely resembling the above qualifies you for the pundit trash heap. It means you have no idea what you are talking about, and likely have no interest in remedying it. Then again, that's a generic pundit job description, isn't it?
But, still... there are are issues on the table about the fiscal cliff and entitlements, so let's take a walk down Memory Lane with Alan Simpson and Erskine Bowles' commission.
In December of 2010, the blue ribbon debt reduction commission (aka National Commission on Fiscal Responsibility and Reform) chaired by Simpson and Bowles, couldn't get enough votes from commissioners (they needed 14 and got 11) and therefore never issued an official report (for example, Dick Durbin and Tom Coburn voted for it, Paul Ryan and 7 others voted against it.)
The funny thing is, though, when you look to see what the report actually said about health care costs, they whiffed on their moment of truth. The commission report said almost nothing except "let's see what Obamacare does, and if that's not enough to enact savings, we can and should do something else (more on that in a moment.) But don't take my word for it, let's look at their exact language (page 41):
Commission members, and virtually all budget experts, agree that the rapid growth of federal health care spending is the primary driver of long-term deficits. Some Commission members believe that the reforms enacted as part of ACA will “bend the curve” of health spending and control long-term cost growth. Other Commission members believe that the coverage expansions in the bill will fuel more rapid spending growth and that the Medicare savings are not sustainable. The Commission as a whole does not take a position on which view is correct, but we agree that Congress and the President must be vigilant in keeping health care spending under control and should take further actions if the growth in spending continues at current rates.Get that? "Some say" Obamacare will work to cut costs, "some say" it won't. We don't know. But we should wait and see on whether it does.
It's for that reason that Paul Krugman, writing about Simpson-Bowles, concludes:
It offers nothing on Medicare that isn’t already in the Affordable Care Act.This is no surprise. Back in August 2011, I wrote two posts about Medicare. In Medicare: Why is it on the table? we discuss the demographic time bomb pushing costs up (the number of Medicare recipients nearly doubles by 2035). In Medicare: What can we do about it?, we review savings for Medicare built into ACA:
Actual S-B Position 1:
• Simpson-Bowles recommends finding out whether ACA helps to control costs before implementing anything else to cut Medicare and Medicaid. If you support Simpson-Bowles, you support waiting on discussing Medicare and Medicaid cuts.
I'll bet you didn't know that, and I am certain the pundits didn't, either. But when Republicans have a fit about Obama taking a hard line on this in fiscal cliff discussions, just remember that Republicans Tom Coburn, Judd Gregg and Mike Crapo—all who voted for the report—and other Very Serious People™ in Washington, including Alice Rivlin and Simpson and Bowles themselves, agree with Obama's position.
But wait, there's more below the fold...
Federal health care spending represents our single largest fiscal challenge over the long-run. As the baby boomers retire and overall health care costs continue to grow faster than the economy, federal health spending threatens to balloon. Under its extended-baseline scenario, CBO projects that federal health care spending for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the health insurance exchange subsidies will grow from nearly 6 percent of GDP in 2010 to about 10 percent in 2035, and continue to grow thereafter.Much of the rising cost is from demographics, but some simply the increasing cost of health care per person. Given these two factors, if ACA/Obamacare doesn't reduce cost enough, what should the Federal government do? The suggestion from the commission is a laundry list of options, mostly incompatible, seemingly designed by a committee:
We recommend requiring both the President and Congress to make recommendations whenever average cost growth has exceeded GDP plus 1 percent over the prior five years. To the extent health costs are projected to grow significantly faster than that pace, we recommend the consideration of structural reforms to the health care system. Commissioners have suggested various policy options, including: moving to a premium support system for Medicare; giving CMS authority to be a more active purchaser of health care services using coverage and reimbursement policy to encourage higher value services; expanding and strengthening the Independent Payment Advisory Board (IPAB) to allow it to make recommendations for cost-sharing and benefit design and to look beyond Medicare; adjusting the federal-state responsibility for Medicaid, such as block grants for acute or longterm care; establishing a robust public option in the health care exchanges; raising the Medicare retirement age; and moving toward some type of all-payer system.Did you get that?
Actual S-B Position 2:
• If Obamacare fails to rein in costs, consider single payer. If you support Simpson-Bowles, you take single payer seriously.
Actual S-B Position 3:
• If Obamacare fails to rein in costs, consider a robust public option. If you support Simpson-Bowles, you take Medicare for All seriously.
Sure, there are other suggestions (I noted they were incompatible) such as vouchers and privitization, and there are even good ideas like allowing CMS more purchasing leeway (e.g., importing drugs form Canada) along with the bad ones (raising Medicare age, cutting back Medicaid support with the block grant dodge) but the hard fact is that Simpson-Bowles endorses consideration of single payer and a public option.
It is perfectly appropriate, therefore, for public option or "Medicare for all" advocates to say "let's do a public option, as suggested by Simpson-Bowles" or "let's consider Medicare for all, as recommended by Simpson-Bowles".
You'd be right, and unlike the pundits, you've actually read Simpson-Bowles.
Oh, and one more thing. Do note that Simpson-Bowles suggests "expanding and strengthening the Independent Payment Advisory Board (IPAB) to allow it to make recommendations for cost-sharing and benefit design and to look beyond Medicare" as a cost control. By advocatingevidence-based medicine for all of health care and not just Medicare, it's an effective way to bring down cost per beneficiary as well as cost per patient overall (don't worry about intrusiveness. Anything that affects Medicare this much is already adopted by the entire health system currently.)
Contemplating the 2012 election that can already be seen looming on the distant horizon, the President's advisors were no doubt hoping that the "death panel" debate was… well… dead. But Obama himself inadvertently resurrected it when, in response to Republican budget proposals, he claimed that Medicare costs will be kept under control by the Independent Payment Advisory Board (IPAB). Obamacare opponents have been screaming about this committee since it was first added to the "reform" bill. And, since that time, anyone with the temerity to call it by its proper name -- death panel -- has been vilified by the Democrats and the "news" media. Nonetheless, that's precisely what IPAB will be. Its sole purpose is to cut funding for some health care services seniors now take for granted. And those cuts will kill people.Actual S-B Position 4:
• Simpson-Bowles endorses death panels. If you support Simpson-Bowles, you support death panels.
If you don't support death panels, you must not be a Very Serious Person™.