Krugman Exposes Ryan

Published on Friday, August 31, 2012 by The New York Times

Romney-Ryan: The Medicare Killers

by Paul Krugman

Paul Ryan’s speech Wednesday night may have accomplished one good thing: It finally may have dispelled the myth that he is a Serious, Honest Conservative. Indeed, Mr. Ryan’s brazen dishonesty left even his critics breathless.
Some of his fibs were trivial but telling, like his suggestion that President Obama is responsible for a closed auto plant in his hometown, even though the plant closed before Mr. Obama took office. Others were infuriating, like his sanctimonious declaration that “the truest measure of any society is how it treats those who cannot defend or care for themselves.” This from a man proposing savage cuts in Medicaid, which would cause tens of millions of vulnerable Americans to lose health coverage.
And Mr. Ryan — who has proposed $4.3 trillion in tax cuts over the next decade, versus only about $1.7 trillion in specific spending cuts — is still posing as a deficit hawk.
But Mr. Ryan’s big lie — and, yes, it deserves that designation — was his claim that “a Romney-Ryan administration will protect and strengthen Medicare.” Actually, it would kill the program.
Before I get there, let me just mention that Mr. Ryan has now gone all-in on the party line that the president’s plan to trim Medicare expenses by around $700 billion over the next decade — savings achieved by paying less to insurance companies and hospitals, not by reducing benefits — is a terrible, terrible thing. Yet, just a few days ago, Mr. Ryan was still touting his own budget plan, which included those very same savings.
But back to the big lie. The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.
Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs.
Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies.
Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs.
I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs.
So Vouchercare would mean higher costs and lower benefits for seniors. Over time, the Republican plan wouldn’t just end Medicare as we know it, it would kill the thing Medicare is supposed to provide: universal access to essential care. Seniors who couldn’t afford to top up their vouchers with a lot of additional money would just be out of luck.
Still, the G.O.P. promises to maintain Medicare as we know it for those currently over 55. Should everyone born before 1957 feel safe? Again, no.
For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees.
Beyond that, the promise of unchanged benefits for Americans of a certain age just isn’t credible. Think about the political dynamics that would arise once someone born in 1956 still received full Medicare while someone born in 1959 couldn’t afford decent coverage. Do you really think that would be a stable situation? For sure, it would unleash political warfare between the cohorts — and the odds are high that older cohorts would soon find their alleged guarantees snatched away.
The question now is whether voters will understand what’s really going on (which depends to a large extent on whether the news media do their jobs). Mr. Ryan and his party are betting that they can bluster their way through this, pretending that they are the real defenders of Medicare even as they work to kill it. Will they get away with it?

© 2012 The New York Times

Paul Krugman is professor of Economics and International Affairs at Princeton University and a regular columnist for The New York Times. Krugman was the 2008 recipient of the Nobel Prize in Economics. He is the author of numerous books, including The Conscience of A Liberal, The Return of Depression Economics, and his most recent, End This Depression Now!.

Not out of Spite.

Sigmund Freud (Photo credit: mansionwb)

Deluded Individualism

By FIRMIN DEBRABANDER

There is a curious passage early in Freud's "Ego and the Id" where he remarks that the id behaves "as if" it were unconscious. The phrase is puzzling, but the meaning is clear: the id is the secret driver of our desires, the desires that animate our conscious life, but the ego does not recognize it as such. The ego - what we take to be our conscious, autonomous self - is ignorant to the agency of the id, and sees itself in the driver seat instead. Freud offers the following metaphor: the ego is like a man on horseback, struggling to contain the powerful beast beneath; to the extent that the ego succeeds in guiding this beast, it's only by "transforming the id's will into action as if it were its own."
By Freud's account, conscious autonomy is a charade. "We are lived," as he puts it, and yet we don't see it as such. Indeed, Freud suggests that to be human is to rebel against that vision - the truth. We tend to see ourselves as self-determining, self-conscious agents in all that we decide and do, and we cling to that image. But why? Why do we resist the truth? Why do we wish - strain, strive, against the grain of reality - to be autonomous individuals, and see ourselves as such?
Perhaps Freud is too cynical regarding conscious autonomy, but he is right to question our presumption to it. He is right to suggest that we typically - wrongly - ignore the extent to which we are determined by unknown forces, and overestimate our self-control. The path to happiness for Freud, or some semblance of it in his stormy account of the psyche, involves accepting our basic condition. But why do we presume individual agency in the first place? Why do we insist on it stubbornly, irrationally, often recklessly?

I was reminded of Freud's paradox by a poignant article in The Times a few months back, which described a Republican leaning district in Minnesota, and its constituents' conflicted desire to be self-reliant ("Even Critics of the Safety Net Increasingly Depend on It," Feb. 11). The article cited a study from Dartmouth political science professor Dean Lacy, which revealed that, though Republicans call for deep cuts to the safety net, their districts rely more on government support than their Democratic counterparts.
In Chisago County, Minn., The Times's reporters spoke with residents who supported the Tea Party and its proposed cuts to federal spending, even while they admitted they could not get by without government support. Tea Party aficionados, and many on the extreme right of the Republican party for that matter, are typically characterized as self-sufficient middle class folk, angry about sustaining the idle poor with their tax dollars. Chisago County revealed a different aspect of this anger: economically struggling Americans professing a robust individualism and self-determination, frustrated with their failures to achieve that ideal.
Why the stubborn insistence on self-determination, in spite of the facts? One might say there is something profoundly American in this. It's our fierce individualism shining through. Residents of Chisago County are clinging to notions of past self-reliance before the recession, before the welfare state. It's admirable in a way. Alternately, it evokes the delusional autonomy of Freud's poor ego.
These people, like many across the nation, rely on government assistance, but pretend they don't. They even resent the government for their reliance. If they looked closely though, they'd see that we are all thoroughly saturated with government assistance in this country: farm subsidies that lower food prices for us all, mortgage interest deductions that disproportionately favor the rich, federal mortgage guarantees that keep interest rates low, a bloated Department of Defense that sustains entire sectors of the economy and puts hundreds of thousands of people to work. We can hardly fathom the depth of our dependence on government, and pretend we are bold individualists instead.
As we are in an election year, the persistence of this delusion has manifested itself politically, particularly as a foundation in the Republican Party ideology - from Ron Paul's insistence during the primaries that the government shouldn't intervene to help the uninsured even when they are deathly ill, to Rick Santorum's maligning of public schools, to Mitt Romney's selection of Paul Ryan as a running mate. There is no doubt that radical individualism will remain a central selling point of their campaign. Ryan's signature work, his proposal for the federal budget, calls for drastic cuts to Medicaid, Medicare, Pell grants and job training programs, among others. To no surprise, as The New Yorker revealed in a recent profile of Ryan, the home district that supports him is boosted by considerable government largesse.
Of course the professed individualists have an easy time cutting services for the poor. But this is misguided. There are many counties across the nation that, like Chisago County, might feel insulated from the trials of the destitute. Perhaps this is because they are able to ignore the poverty in their midst, or because they are rather homogeneous and geographically removed from concentrations of poverty, like urban ghettos. But the fate of the middle class counties and urban ghettos is entwined. When the poor are left to rot in their misery, the misery does not stay contained. It harms us all. The crime radiates, the misery offends, it debases the whole. Individuals, much less communities, cannot be insulated from it.
Thanks to a decades-long safety net, we have forgotten the trials of living without it. This is why, the historian Tony Judt argued, it's easy for some to speak fondly of a world without government: we can't fully imagine or recall what it's like. We can't really appreciate the horrors Upton Sinclair witnessed in the Chicago slaughterhouses before regulation, or the burden of living without Social Security and Medicare to look forward to. Thus, we can entertain nostalgia for a time when everyone pulled his own weight, bore his own risk, and was the master of his destiny. That time was a myth. But the notion of self-reliance is also a fallacy.
Spinoza greatly influenced Freud, and he adds a compelling insight we would do well to reckon with. Spinoza also questioned the human pretense to autonomy. Men believe themselves free, he said, merely because they are conscious of their volitions and appetites, but they are wholly determined. In fact, Spinoza claimed - to the horror of his contemporaries -that we are all just modes of one substance, "God or Nature" he called it, which is really the same thing. Individual actions are no such thing at all; they are expressions of another entity altogether, which acts through us unwittingly. To be human, according to Spinoza, is to be party to a confounding existential illusion - that human individuals are independent agents - which exacts a heavy emotional and political toll on us. It is the source of anxiety, envy, anger - all the passions that torment our psyche - and the violence that ensues. If we should come to see our nature as it truly is, if we should see that no "individuals" properly speaking exist at all, Spinoza maintained, it would greatly benefit humankind.
There is no such thing as a discrete individual, Spinoza points out. This is a fiction. The boundaries of 'me' are fluid and blurred. We are all profoundly linked in countless ways we can hardly perceive. My decisions, choices, actions are inspired and motivated by others to no small extent. The passions, Spinoza argued, derive from seeing people as autonomous individuals responsible for all the objectionable actions that issue from them. Understanding the interrelated nature of everyone and everything is the key to diminishing the passions and the havoc they wreak.
In this, Spinoza and President Obama seem to concur: we're all in this together. We are not the sole authors of our destiny, each of us; our destinies are entangled - messily, unpredictably. Our cultural demands of individualism are too extreme. They are constitutionally irrational, Spinoza and Freud tell us, and their potential consequences are disastrous. Thanks to our safety net, we live in a society that affirms the dependence and interdependence of all. To that extent, it affirms a basic truth of our nature. We forsake it at our own peril.

Firmin DeBrabander is an associate professor of philosophy at the Maryland Institute College of Art, Baltimore and the author of "Spinoza and the Stoics."

Local Bias kicks off fundraising.

Local Bias is excited to begin a sixth season in September and is asking for viewer support to help pay the crew and myself. While Local Bias is a labor of love, it is also labor deserving of financial support. To that end, I have created a kick starter campaign which is linked to here:http://www.kickstarter.com/projects/1643783729/season-six-of-local-bias.

Please watch the video and share it, even if you are unable to contribute. I'll post names of supporters here and on facebook after the campaign is over.