10-13-2011, 01:31 PM
rjmacs wrote:
[quote=Ted King]
[quote=rjmacs]
I'm afraid that the Democratic Party's approach to Medicare isn't a whole lot more rational than this.
Could you elaborate?
Preemptive request: please don't reply to my comments below with "the Republicans did that too," or, "the Republican position was worse" - that is not a logical defense, it's a political defense. My comments below are about the Democratic Party, per Ted's request.
So far, the party has been similarly unwilling to insist on either fiscal responsibility or outcomes-oriented reimbursement re: Medicare. Overwhelming support for Medicare Part D (the drug benefit) with no funding source or insistence on price negotiation as a condition of passage was just ridiculous. Year after year of accounting that is completely dependent on cutting reimbursement to providers, accompanied by year after year of deferring those cuts out of political cowardice. During the healthcare reform debate, there was a total failure of Democratic leadership to insist on outcomes-oriented reforms or comprehensive, team-based care.
The issue of Medicare's future is saturated on all sides of the debate by political cowardice. The reality is that the system needs to change, eliminate its fee-for-service structure, and become much more involved in managing patient care if it is to survive as a public program. The alternative is to privatize. These are deeply unpopular and politically difficult ideas, discursively at odds with popular American notions of individualism, entitlement, and rights (which themselves are full of irony and contradiction, but that's not the present point).
I don't disagree with the facts you are presenting, but I don't agree with the characterization of that being "not a whole lot more rational" than the positions put forth by the Republican candidates in the debate. I say that because it seems to me that what you have described that has happened with Democrats and health care is that they are stymied by the politics of the situation. Is it a logical contradiction to take what they can get toward more health care for those who wouldn't otherwise have it even if the political process keeps them from adequately addressing things that you mentioned? I think that is different from advocating ideas that are diametrically opposed, as is what I think the Republicans are doing. Republicans bashed Democrats in the 2010 election cycle for voting for reductions in Medicare benefits which helped them take over the House and then what did they do - they passed Paul Ryan's bill that would very drastically reduce benefits. The Republican candidates for president just seem to advocate one side or the other of this contradiction - whichever is expedient at the moment - without acknowledging the contradiction. That's the reality distortion field.