And this should also be clear: None of these cuts/savings affect any basic benefits, meaning that hospital care, doctor visits, lab tests, and outpatient services will be covered as they are now. When the cuts to Medicare Advantage plans are fully phased in, by the end of the decade, some plans may not be able to offer extra benefits—like vision care or chiropractic visits—which have attracted seniors in recent years, but it’s still too early to predict what will happen. Will seniors be hurt by that part of the cuts? Actuaries who design these policies tell me that’s unlikely in many parts of the country, where there are well over 100 plans to choose from.
What about the $716 billion versus $500 billion? The Congressional Budget Office updated the numbers because they may be looking at a different timeline now, explained Tricia Neuman, a senior vice president of the Kaiser Family Foundation. “Because Medicare spending increases each year, the effects of the savings provisions [in the ACA] increase each year.”
The old spin
The administration portrays these cuts in the projected budget as “savings” to the program because provider and insurance reimbursements won’t grow as fast as they otherwise might. Who uses which word depends on where spinners sit on the Great Ideological Divide.
Today the GOP likes the word “cuts” because it sounds oh so scarier to old people. The administration prefers “savings” because slowing down the rate of reimbursement to providers and insurers does save money for the program and frees up money for other purposes (like healthcare insurance subsidies).
But there is some interesting background to these word choices. In the mid 1990s, during another drive to privatize Medicare led by the conservative Heritage Foundation, it was the GOP who policed the media, making sure they did not use the word “cut” to describe changes they were promoting. As I reported in my book Slanting the Story: The Forces That Shape the News, Haley Barbour, then GOP National Chairman and now governor of Mississippi, vowed to raise “unshirted hell” with the news media whenever they used the word “cut.” As I wrote, “Barbour called news anchormen and correspondents and held breakfasts and lunches with reporters “educating” them on the difference between cuts and slowing Medicare’s growth.”
It wasn’t long before news anchors and reporters began using the different words. On the CBS Evening News correspondent Linda Douglas told viewers a Republican bill would double monthly premiums, create incentives to use managed care, and limit doctor and hospital fees—“all adding up to a savings of $270 billion in the growth of Medicare spending.”
So, in the mid-90s, Republicans wanted cuts in the growth of Medicare to be labeled “savings.” Now, Obama prefers that word, and the Republicans call them “cuts.”
The press coverage now
So far, in this round of privatization talk, some in the press have pushed back against spin. Sunday on Meet the Press David Gregory noted the $716 billion were “not benefit cuts. Indeed, Ryan made those same cuts in his own budget.”
Gregory asked one of his guests, Virginia Gov. Bob McDonnell, a Republican, if he thought that kind of talk was “over the top by the Republican ticket.”McDonnell didn’t answer the question and instead bridged to his talking points—“we have serious, hard talk and real solutions from the Romney-Ryan ticket. We’re in trouble in the country. We’ve got to make changes.”
On CNN, Soledad O’Brien pressed former New Hampshire Gov. John Sununu so hard he became visibly agitated. Sununu charged that “Obama gutted Medicare by taking $717 billion out of it. The Romney plan does not do that.” O’Brien responded:
“I understand that this is a Republican talking point because I’ve heard it repeated over and over again. These numbers have been debunked, as you know by the Congressional Budget Office. It cuts a reduction in the expected rate of growth, which, you know, not cutting budgets to the elderly. Benefits will be improved.”
Sununu shot back: “Soledad, stop this! All you’re doing is mimicking the stuff that comes out of the White House and gets repeated on the Democratic blog boards out there.”