Hero of the Day: Naftali Ben-David

No, he’s not a Mossad agent, just a reporter for the Wall Street Journal, and he wrote one of the most important lines in contemporary American journalism.  Concerning Paul Ryan’s House Republican budget proposal, Ben-David observes:

The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills.

That’s exactly right.  Not “revamp” Medicare, or “streamline” Medicare, or “reform” Medicare, or the perhaps the worst: “Democrats say it would end Medicare.”  Ryan’s plan would end Medicare.  This is not opinion.  It is fact.  Republicans might want to defend this, or back off from it, or change the subject.  But they must acknowledge it.  Facts are stubborn things.

Now, it’s up to the Democrats to keep saying it.  “The Republicans — who want to end Medicare — want to shut down the government.”  “The candidates of the Republican Party, which wants to end Medicare, have not said whether or not they, like Congressional Republicans, want to end Medicare.”  Or even: “Congressional Republicans, who want to end Medicare, have not come up with a coherent response to the Libyan war.”  Every Republican candidate must be asked, “Like the Republican Party in the House, do you want to end Medicare?”

On this day, and in this part of this article at least, opinion is not divided about the shape of the earth.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

10 thoughts on “Hero of the Day: Naftali Ben-David”

  1. “The plan would essentially end Medicare … as a program that directly pays those bills.”

    Spinning so furiously in a post about telling the truth — ironic.

  2. Maybe the evidence is in regarding the Republicans working to redistribute wealth upward at the expense of Middle and Working Class Americans. Seems so to me! Look at the proposed budgets of the 12 newly elected Republican governors as merely one set of empirical indicators!

  3. Bruce,
    The following 3 points are, I believe, incontrovertable:
    1) The plan would change Medicare from being a system that pays for medical care into being a system that subsidizes the acquisition of private health insurance.
    2) Medicare is cheaper than private health insurance, and the subsidies available to current users of Medicare will be insufficient to buy equivalent health insurance. Either they’d have to spend more of their own money, or they’ll have to purchase inferior care – if such is even available.
    3) The subsidies that under Ryan’s plan would replace Medicare are set to increase in value at a rate far below the rate of medical inflation. Thus, every year they will cover even less of the expense of health insurance than they did the year before.

    So: the current nature of Medicare absolutely ends. It is to be replaced with something inferior, and even that is designed to erode and eventually evaporate over time. Claiming this plan would “essentially end Medicare” is wrong how exactly?

  4. Bruce Ross probably just thinks he will never get old and sick. And he may be right about the latter. Could be right about the former, too. Hope he has so much life insurance that his children won’t need their survivors’ benefits from Social Security, because it would turn them into raving socialists if they took them.

  5. “Now, it’s up to the Democrats to keep saying it.”

    Yeah, we’ll see.

    I’ve long argued against forming a third party to the left of the Dems, because of our first-past-the-post voting system. The best way to go, it would seem, would be to move the party away from the plutocratic trend it’s been on.

    Recently, though, it seems like the party is pretty much totally beyond redemption. One could try to analyze this endlessly: is it lack of a spine? Corruption (thoughts of future lobbying deals)? Stupidity? At the end of the day, it doesn’t matter.

  6. KLG wrote, “Bruce Ross probably just thinks he will never get old and sick.”

    It’s not only about the fortunes of the elderly. It’s also about economic rents, and the fact that health insurance companies contribute essentially nothing to production.

  7. This plan doesn’t end Medicare in the same way that being cut up into steaks doesn’t end the cow.

  8. The one thing that is certain is that Medicare as you knew it is over. It is unsustainable. The only question is what to put in its place.

    Already, Medicare in my personal experience (with my parents) provides a lousy experience for both provider and patient. The providers are being reimbursed insufficiently, and this is reflected in their manner and approach to Medicare patients. Even so, and despite ever higher funding (since there is no limit to the wage base), the program is tipping into the negative currently, with much worse deficits in the offing as baby boomers age. And that’s without covering long term care expenses!

    There is not much I know (nor does anyone else) about the Ryan plan yet (since it doesn’t get released until later this morning) so I’ll reserve judgment as to whether it’s the best answer. It gets points for its courage in facing into the real budget challenge (entitlements). Presumably, private insurers would have to take on all comers, which means it is not really insurance at all, but gate keeping and bill paying. So Warren can relax about that.

    One of the reasons Medicare was doomed to failure is the widespread expectation (driving reality) that medical inflation would exceed general inflation, and it certainly has. Technology and malpractice insurance costs have had a lot to do with that, but so has consumer indifference to costs because of third party payment. Ryan is trying to get at that. Obviously, medical inflation can not continue without limit in a sustainable system.

    Meanwhile, there is a serious and growing shortage of nurses, GP’s and doctors for certain specialties. You guys think a single (governnment) payor system can work but your heads are in the sand. Even where you claim such systems “work,” they are sucking 60% or more of GDP. This is a very hard problem, too hard to mastermind from a college campus or think tank, and one which could use a whole lot more free market medicine. The Ryan plan may not be where we end up but it’s the first time anyone is talking about reality, because of the obvious political risk. That conversation needs to be had.

  9. Even where you claim such systems “work,” they are sucking 60% or more of GDP

    You’re just a wee bit off. An order of magnitude, or so. Nothing between friends.

    (that is, you’re an order of magnitude high. In case you were wondering. Which the absurdity of your number suggests to me wasn’t quite impossible).

    Here in the US, we actually spend more on government provision of health care, per capita, than does Britain – and Britain covers the whole country for that amount, and achieves outcomes just as good as ours. The thing is, we spend just as much on private healthcare as we do on government-funded healthcare. The critical fact is that we are actually managing to pay twice as much as Britain on healthcare, per GDP. And that’s after New Labour vastly increased spending on the NHS.

    Now, single-provider (like Britain) or single-payer (like most of the rest of the rich world) isn’t a panacea. Medical inflation in Britain and elsewhere is similar to medical inflation in the US, from a much lower starting point. Medical inflation will have to be addressed. But the Brits have bought themselves a couple of decades before they’re in a position as bad as ours, and at least in theory they’re in a much stronger position to recognize and to implement reforms. Here in the US, where health care is treated as a profit center, we are used to health insurers taking a huge proportion of the premiums for administration (read: denial of claims) and profits, and still behaving in such a way that individually purchased health insurance is almost completely unreliable in most states (the ACA will address this issue, of course), and we see awful profit-gouging abuses of the system as profiled in Atul Gawande’s excellent article comparing the use of Medicare funds in two demographically similar Texas cities.

    And in particular, it’s worth noting that Ryan is an utter fraud. His purportedly serious, realistic changes don’t even kick in for ten years, and then rather than proposing any mechanism to achieve cost savings he simply makes health insurance much harder to afford and then ever increasingly unaffordable. There are provisions in his plan to help the poorest seniors, but the political brilliance of Social Security and Medicare has always been that they’re not need-based relief of the poor – because in our society we’re often content to let the poor suffer, if not always quite content to let them starve. Ryan would turn Medicare into Welfare; can you predict the eventual effect of that transformation, especially given that Ryan is already proposing to cut $100 billion a year out of the Government program that is supposed to pay for health care for the poor, the already chronically underfunded Medicaid? And by underfunding seniors’ health insurance, he is effectively proposing a massive tax increase on seniors – truly massive, not inconceivably in the 100% range – for elderly seniors living on moderate incomes. Think that will happen, do you?

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