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VP Debate: The Constrained Discussion on Social Insurance

I think Dave Weigel highlights the right moment in last night’s Vice Presidential debate, on the subject of Medicare. Paul Ryan is most closely associated with that policy, and Biden was clearly briefed that Ryan would try to bamboozle his way through the question. So Biden cut off the ring and never let one lie go unanswered. This was the part of the debate Republicans must have hated the most, because it included the most interruptions, preventing the unadulterated bullshit to emerge without challenge.

REP. RYAN: Here’s the problem. They got caught with their hands in the cookie jar turning Medicare into a piggy bank for “Obamacare”. Their own actuary from the administration came to Congress and said one out of six hospitals and nursing homes are going to go out of business as a result of this.

VICE PRESIDENT BIDEN: That’s not what they said.

REP. RYAN: Seven point four million seniors are projected to lose the current Medicare Advantage coverage they have. That’s a $3,200 benefit cut.

VICE PRESIDENT BIDEN: That didn’t happen.

REP. RYAN: What we’re saying —

VICE PRESIDENT BIDEN: More people signed up.

REP. RYAN: These are from your own actuaries.

VICE PRESIDENT BIDEN: More — more — more people signed up for Medicare Advantage after the change.

REP. RYAN: What — what they’re —

VICE PRESIDENT BIDEN: No — nobody is getting shut down.

That’s just an example (and it happens to be true; Obamacare lowered the corporate subsidy to private Medicare Advantage plans, and as a result, Medicare Advantage did not die out, it thrived). Check Weigel for the whole thing.

But the myth that Biden didn’t confront sprung from the very premise of the question.

“Both Medicare and Social Security are going broke and taking a larger share of the budget in the process,” said Martha Raddatz, marring an otherwise good moderating performance. Social Security has nothing to do with the federal budget. It has a dedicated funding stream from the payroll tax, and is fully funded for the next two decades, which is more than you can say about pretty much any other government program. A good portion of Medicare comes from its hospital insurance tax, another dedicated funding stream. That Medicare is taking a larger share of the federal budget is an artifact of higher health spending in the United States generally, and Medicare is the least important driver of that. In fact, the antidote for higher health spending is more Medicare, a single payer program that can bargain down these higher costs.

Biden did a passable job confronting Ryan’s lies on Medicare. He correctly noted that restoring the $716 billion in “cuts,” which are actually savings to the payouts to private interests from Medicare, would cause the Medicare trust fund to go insolvent in 2016, within a Romney first term, rather than 2024. He failed to follow up on this, and add that the only way the Romney campaign has identified to deal with that is by cutting benefits. Biden called the Ryan plan for Medicare a voucher, and he correctly said that the only way it would save money for the government is through cost-shifting onto seniors. He listed one good source of savings on the table for Medicare: to allow it to bargain for prescription drug prices, savings hundreds of billions of dollars over the next decade. When Ryan tried to claim that he had a Democratic partner in Ron Wyden on his premium support plan, Biden interrupted, “And he said he does no longer support you on that.” When Ryan name-checked Alice Rivlin, the former Clinton budget director and architect of premium support, Biden added, “(She) disavows it.”

But he didn’t challenge this premise, this idea that these vital programs are “going broke,” and that the role of government is just to hang onto them rather than design them in a more adequate way to increase security for older Americans. We need a Social Security system that increases benefits to those who need it. We need a Medicare program that covers really everyone, but certainly more people, to increase its bargaining power. But Biden, inside the contours of the question, and determined to maintain the wiggle room the President clearly wants, could only say that he opposed a voucher system for Medicare and privatization for Social Security. I agree, but that’s not the only answer.

Ryan was exposed on Medicare and Social Security (though I’m not sure he committed the ticket to privatization, as TPM suggests). Ryan’s malarkey was called out. But the overall debate on social insurance was terribly constrained.

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David Dayen

David Dayen