Robert Samuelson of the Washington Post is my least favorite kind of pundit. Ideological hacks come in a number of different flavors. Some, like George Will and Charles Krauthammer, are unabashedly ideological-- they play for Team Republican and they know it. Others, like Rush Limbaugh and Glenn Beck, are rodeo clowns-- they say things to get a rise out of people, and their fans claim that whatever racist, sexist, or otherwise insulting trope they're trotting out is what everyone is thinking, and the brave Limbaugh is the only one saying it.
But Robert Samuelson is a different breed-- he's the "reasonable" ideologue. He likes to talk about being committed to "fair", and "unbiased" reporting, and faults others for "twisting" the rhetoric or facts to match their political preferences. He accuses the "liberal" mainstream media of doing it most, this time in a column about Medicare reform. Here's the crux of his claim (not in order, but it gets at the key arguments:
But many Democrats despise vouchers, which (they say) would “privatize Medicare” and “end Medicare.” The language is self-serving demagoguery intended to terrify seniors. Unfortunately, some in the media sometimes sloppily adopt these attack phrases as acceptable descriptions.
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These descriptions aren’t acceptable, because they don’t reflect reality. The fact that some voucher advocates also use “privatize” doesn’t change matters. Consider.
Vouchers would not “end Medicare.” Fundamentally, Medicare promises health-care coverage to most Americans 65 and over. We call this an “entitlement.” The entitlement wouldn’t end. The federal government would still pay for coverage. In this basic sense, Medicare vouchers don’t threaten the program.
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But similar changes can occur — and already have — under the present system. If the government cuts reimbursement rates for some services, those services may become less available. In 1997, that’s precisely what happened with home health care services. The American Medical Association has repeatedly warned that if Medicare reimbursement rates are held down, fewer doctors will see Medicare patients. Similarly, premiums for wealthier recipients have already been raised for doctors’ services and drug coverage.
Vouchers wouldn’t “privatize Medicare.”The reason is simple: Medicare has always been “privatized.” Most doctors who receive Medicare reimbursement aren’t government doctors. Similarly, most hospitals are private, whether for-profit or not-for-profit. Drug and medical-device companies are private. Under the Medicare Advantage program, insurance companies already offer competing plans for about 25 percent of recipients. They offer “Medigap” insurance (plans that cover what Medicare doesn’t) to another 18 percent of recipients.
Samuelson's claim is that, because a voucher program would involve some government support to help seniors buy health insurance, that doing so wouldn't "end" Medicare. He suggests that talking about "privatizing" Medicare is misleading because Medicare is already privatized, in the sense that Medicare doesn't employ medical practitioners. His first claim is enormously disingenuous. His second is either patently dishonest, or reflects deep stupidity.
To begin with, it helps to understand what Medicare is. Simply put, it's a government-run health insurance provider for senior citizens. That means that, once you're eligible, government provides you with health insurance that allows you to have your treatment paid for by Medicare. One simple way to think about it is that's Blue Cross/Blue Shield for the elderly. Now, it doesn't have to cover everything-- you can decide that Medicare should cover only certain procedures, or should have a certain deductible, or something along those lines. In practice, those kinds of changes happen all the time (and Samuelson describes them, dishonestly, as similar to a voucher scheme). Those kinds of changes, if draconian enough, could be fairly said to gut Medicare. But so long as a government-run insurance plan remained in place, it would still be Medicare.
A voucher scheme, as contemplated by the right, gets rid of that health insurance program. Instead, it provides seniors with a block of money to go out into the private insurance market and buy insurance. Samuelson and other hacks on the right call that "Medicare". But it's Medicare in the same way that the government dissolving the US Army and instead paying private contractors to wage war on its behalf wouldn't "destroy" the US Army. Sure, there would still be an institution providing defense services, but that doesn't mean that it would be the US Army. Plain and simple, saying that vouchers destroy Medicare is nothing more than calling a spade a spade. Now, you can argue that a voucher program would do a better job of delivering health care to seniors, or that it would save money (the second claim is perhaps, in a vague sense, true; if you cut services enough, you could cut costs. Literally all of the evidence refutes the first claim). But that doesn't mean that a voucher program is the same thing as Medicare; it's a scheme to destroy Medicare and replace it with a voucher system.
The second claim Samuelson makes is, if it's possible, even worse than the first. Samuelson says that a voucher scheme wouldn't "privatize" Medicare because... Medicare is already private. Now, if Samuelson is serious about that claim, he's stupid. I think, more likely, he thinks his readers are stupid. Medicare is NOT privatized because Medicare isn't a hospital or a drug provider or any other provider of medical services. Medicare is an insurer-- it's the entity that pays for medical treatment, not the one that provides it. Imagine for a moment that the government gave you an option to buy homeowners insurance (call it GovInsCo). It would pay all of the costs of repairing your home if it was destroyed in a natural disaster. In essence, you'd submit your receipts for home repair to GovInsCo, and it would cover up to a certain amount in repairs. Would you call that a "private" program just because the repair company you hired to fix your house would be privately owned? I doubt even Samuelson would be audacious enough to make that claim, but he persists with making the claim about medicine.
What Samuelson does, in short, is get worked up over those who point out that a voucher scheme replacing Medicare would, in fact, "end" Medicare, since no government-run insurance plan for the elderly would exist. And handing seniors money to buy private insurance in its place would, in fact, be a "privatization" of Medicare, as it would take seniors out of a government-administered health insurance program and instead hand them vouchers to buy private insurance. In short, just because Samuelson recognizes that people overwhelmingly like Medicare, and don't like the idea of privatizing it, he insists that a plan to do just that is... something else.
It's an approach that is, at its root, profoundly dishonest.
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