When is a Cut not a Cut? Framing and Medicare
Scott Lemieux points to the confusion over “cutting” Medicare, arguing that not all cuts are created equal.
There’s nothing wrong with Medicare cuts per se; indeed, spending less per capita on Medicare should be a progressive goal. It’s a question of what these cuts mean. Evidently, cutting payments to the rentiers Republicans have sought to reward through Medicare Advantage is an unequivocally good thing. And reductions in payments to hospitals that come because there are fewer uninsured patients that hospitals have to treat are also a good thing. And this is what the Medicare cuts Obama supported come from. The Medicare cuts Ryan supports, conversely, come from requiring people to pay much more out of pocket for the same things, preventing them from getting insurance that will get the same things covered, or denying them the ability to get insurance at all.
I agree on the substance, but I think we need to rethink our terminology. Talk of ‘good cuts’ is counterproductive. You can’t use the same word to denote taking benefits away from people that you use for delivering the exact same benefits for a better price. Those who oppose social insurance but want to shift as much public money into corporate hands as possible (that is, proponents of the Predator State) have an obvious interest in conflating the two. Those who want to protect Social Security and Medicare need to be a lot clearer about the difference.
Personally, I think “cuts” implies “benefits cuts” to most people, so I’d use it that way – always including the word benefits. Talk of saving money shouldn’t be referred to as a cut – and should always mention that it’s delivering the same benefits more cheaply. You should also always mention that Medicare is already providing health care more efficiently than the corporate insurance sector, misleadingly called the private sector. Talk of Social Security cuts (which as Scott notes, are different, in that it’s always about a cut in benefits), in any form, should make one a social leper. In essence, if you don’t want something to have a chance of happening, then you don’t want it to be floated without a massive freakout. The reaction to such suggestions is how people know the boundaries of the possible. But ambiguity makes that more difficult.
Clarity is important both for getting the public engaged on this issue, where they are far more progressive than official Washington. It’s also important for ensuring accountability for those who present themselves as our allies.
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