The ACP Advocate Blog
by Bob Doherty
Tuesday, September 1, 2009
Why are fiscal conservatives opposed to Medicare cuts?
Anyone looking for ideological consistency and clarity of thinking should stay away from Washington. It is no secret that liberals and conservatives alike take positions in conflict with their usual governing philosophy when it suits their political interests. Still, there are times when the bending of philosophical underpinnings is so pronounced it makes you have to stand up and take notice.
Fiscal conservatives are supposed to be all about reducing federal spending on social programs, while liberals are supposed to be passionate about defending such expenditures. Except, that is, when they don't.
Case in point: the broad opposition from so-called fiscal conservatives to just about every measure in pending health care reform bills that hold the promise of reducing federal spending.
Writing in the Washington Post, Michael Steele, the chairman of the Republican National Committee, proposes a "Medicare Patient Bill of Rights" in which he expresses opposition to Medicare savings, "First, we need to protect Medicare and not cut it in the name of 'health-insurance reform' " - and specifically expresses opposition to the $500 billion in Medicare "cuts" being considered by Congress. (Take the entire $500 billion off the table, though, as Mr. Steele suggests, and health care reform will drive an even bigger hole in the federal deficit.)
He wants to "prohibit government from getting between seniors and their doctors" and the creation of "government boards that would decide what treatments would or would not be funded" and opposes comparative effectiveness research because it could "actually lead to government boards rationing treatments based on age. For example, if there are going to be only so many heart surgeries in a given year, the Democrats figure government will get more bang for its buck if more young and middle-aged people get them."
(Even though the pending bills do not give the federal government the authority to deny coverage based on cost or age, nor does it create government boards to decide which treatments will be funded.)
Mr. Steele also opposes having the government fund discussions between physicians and patients on end-of-life care, and pledges to protect the Tri-Care for military families from cuts.
All of this may make for good politics, since the latest polling suggests that seniors are the most concerned about the impact of health reform legislation on their care. The RNC is now running an anti-reform ad targeted at seniors.
Mr. Steele's proposal has received the predictable criticism from liberal quarters but also from Robert Costa writing in the conservative National Review, who suggests that Mr. Steele's position is a "capitulation to the Medicare crowd."
It isn't only Republican politicians that have ruled out Medicare cuts; "Blue Dog" Democrats also are complaining about many of the same Medicare cuts even as they pledge to "bend the curve" on health spending. And, ironically, it is the liberals who are saying that cuts in Medicare are needed to fund the broader health reform and that the government needs tools, like comparative effectiveness research, to bring down overall health care spending.
The problem is that even though promises to protect Medicare may be good politics, they are at odds with the reality that the program is not sustainable. If the GOP regains power, it will have to deal with the governing consequences of running as the protectors of Medicare - knowing that spending on the program will have to be trimmed, no matter who is in charge.
As Simon Johnson and James Kwak write in today's Washington Post, "if you are for fiscal discipline, you should be for health-care reform. If our government cannot produce some kind of reform, that will only reinforce the perception that our political system is incapable of resolving our largest, most difficult problem -- and that is what will make investors think twice about investing in America."
Today's question: What do you think about fiscally conservative politicians who are opposed to cutting Medicare's costs? And about liberals who support such cuts to fund broader health reform expansions?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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