Thursday, August 23, 2012

The Definitive Guide to the Medicare Debate

Paul Ryan may have finally figured out a way to sell his Medicare plan. He got help from his mom. This past Saturday, Ryan made a campaign visit toThe Villages, a sprawling retirement community in central Florida. And he brought along his mother, who cherishes her Medicare as much as every other retiree in America. “Medicare was there for my family, for my grandma, when we needed it," Ryan told the crowd. “And Medicare is there for my mom when she needs it now, and we have to keep that guarantee.”
Of course, it’s entirely possible that Ryan’s proposal could end the Medicare guarantee—that, if implemented, some seniors might not be able to get comprehensive insurance. But that’s pretty much the way the Medicare debate in this campaign has unfolded.
Ryan and Mitt Romney have called for the most profound, radical changes in the program’s history. But rather than clarifying the differences between their position on Medicare and President Obama’s, they’ve done their best to obscure them. They’ve accused Obama of “raiding” Medicare when Ryan’s own budget calls for reducing the program’s funding by the same amount of money. They have insisted they won’t do anything to affect current retirees, even though they have pledged to repeal the Affordable Care Act, which bolsters Medicare’s drug coverage and makes preventative care available without out-of-pocket expenses. 
Romney and Ryan have also been less specific than you might have heard. That’s particularly true for Romney, whose “proposal” consists of a fact sheet, plus a few speeches, statements, and op-eds. This allows them to escape responsibility for the inevitable trade-offs that their vision, like every effort to reform Medicare, would require. And it gives them a political advantage over President Obama, who must defend reforms of Medicare in the Affordable Care Act and his latest budget—right down to the last legislative clause and dollar figure.
Yes, I keep reading that Romney and Ryan have been “brave” and “serious” about Medicare, while Obama has ducked hard choices. I would say it's the other way around.
The public deserves a better debate than this. Medicare occupies a special place in the American welfare state. In the U.S., the purpose of most government programs is merely to offer assistance. You can’t afford food or housing? OK, here’s some money to help you pay for your grocery bills or cover the rent. Medicare is much more than that: It’s a promise that, upon reaching 65, you will be able to get medical care without risking financial ruin. That makes it more like Social Security, which guarantees a pension to everybody in retirement, or public schools, which guarantee an education for all children. 
At the same time, Medicare really does place a big strain on the federal budget. And it’s going to place an even bigger strain in the future. If current trends continue, the government will eventually confront a set of unpleasant options if it wants to keep the program’s promise to seniors: It will have to raise taxes, cut spending elsewhere, or cope with even higher deficits. Very few Americans would want that.
Figuring out how to get out from under Medicare’s financial burden, while still protecting seniors, represents a genuine challenge. Obama has in mind one way to deal with it, Romney and Ryan another. What follows is an effort to explain the basics of those two approaches, extrapolating as best I can from what Romney and Ryan have said they intend to do. And since you might not want tto read the whole thing, I’ve summarized the essential points in a chart at the bottom of the item.
By the way, I’ve submitted questions to the Romney-Ryan campaign, trying nail down some of the most important details. If I get answers, I’ll let you know.
1. How do the plans control Medicare spending? It’s easy to forget, but presidents were "cutting" Medicare long before Obama and Romney came along. Ronald Reagan, George H.W. Bush, and Bill Clinton all presided over reductions in what Medicare paid providers—that is, doctors, hospitals, and suppliers of medical goods.
The Affordable Care Act adopts the same approach. But rather than simply reducing payments across the board, it also targets areas where evidence suggests that Medicare is overpaying for services and introduces incentives designed to promote better quality care. So, for example, it pays less to the insurers providing Medicare Advantage coverage, because studies have shown the government has been paying them too much. And it penalizes hospitals with high rates of inpatient infection, giving hospitals a powerful reason to be more careful with their patients. 
The Affordable Care Act also creates a board of experts, appointed by the president, to make recommendations on further cuts whenever the overall cost of Medicare grows faster than a pre-set spending target. The law explicitly prohibits the commission, theIndependent Payment Advisory Board (IPAB), from reducing coverage, raising premiums, or making other changes that directly affect beneficiaries. This is a really important distinction, for reasons we’ll discuss shortly.
The conservative approach to controlling costs focuses on competition. If more individual seniors were actively shopping for insurance options, the thinking goes, seniors would become more cost-conscious and insurers would compete for their business—by promising lower prices, better services, or some combination of the two. 
To make this possible, Romney and Ryan have called for replacing the existing Medicare program with a voucher scheme, or what's known among policy wonks as “premium support.” Starting a decade from now, new retirees would no longer enroll, by default, in the government-run Medicare plan. Instead, seniors would be entitled to a voucher or payment, which they could then apply towards the cost of a private insurance policy or the traditional Medicare plan. (The original Ryan budget did not include a traditional Medicare option. The new one does and Romney has said his plan would, too.)
The value of the voucher would be equal to the second-cheapest plan in each marketplace, which might (or might not) be the traditional Medicare plan. Romney and Ryan have said all private plans would have to provide coverage as good as what traditional Medicare provides, although they have not indicated whether they are prepared to endorse the steps necessary to make that promise a reality.
Generally speaking, which approach is preferable? Conservatives say that traditional Medicare has not controlled costs sufficiently, given that the program’s financial future remains so daunting. And without government meddling so much in the market, they say, private plans would be free to bid down premiums—making insurance more available to everybody. They also warn that the more traditional approach to controlling cost, ratcheting down what Medicare pays providers, could cause doctors and hospitals to see fewer patients. Something along those lines has happened to Medicaid: The program pays physicians so little that many won't take new Medicaid patients. 
But doctors and hospitals could react the same way if private plans pay them less. And the evidence that competition can reduce Medicare costs more quickly, or with fewer repercussions, is thin at best. Among other things, Medicare has enormous economies of scale, including very low overhead. Current projections suggest that, as a result of the Affordable Care Act's changes, the cost of Medicare will grow more slowly than the cost of private insurance on a per capita basis for the next decade. If the law's payment reforms induce the health care industry to deliver care more efficiently—and there are early, though very limited, signs that might be happening—the savings should be even larger than the official projections suggest. 
Turning Medicare into a more wide-open marketplace also asks a lot of seniors, many of whom may not be up for it. As my colleague Tim Noah pointed out last week, nearly 30 percent of all seniors have cognitive impairment, making them easy targets for exploitation and fraud. And even seniors without cognitive impairment may not have an easy time navigating the private insurance marketplace: Studies of the Medicare drug benefit, which already has a similar competition scheme, suggest that seniors have generally not chosen the plans that best match their needs
One final note: Romney and Ryan say that their proposals would preserve traditional Medicare as an option for anybody who wants it. But, aPeter Orszag wrote last week, private plans frequently save money by seeking out the healthiest customers, who cost less to insure. This creates potential for “adverse selection”—leaving Medicare with less healthy beneficiaries, driving up its costs, and leaving it less attractive to younger, healthier seniors. If that happened, Medicare could "wither on the vine," as Newt Gingrich famously put it during the 1990s.
By the way, these two versions of cost control, government administration and competition, are not mutually exclusive. As a matter of fact, the existing Medicare program already has some competition: Today, seniors have the option of enrolling in “Medicare Advantage” plans that offer at least the same package of benefits, and usually some extras. Government manages that competition aggressively—too aggressively, according to conservatives. But without that oversight, the competition could go awry, in ways that could leave the poorest and sickest seniors without the protection they need.
2. How quickly do the plans cut spending? Let’s talk about that $716 billion that the Affordable Care Act takes out of Medicare spending in the first ten years. More important, let’s put that figure in context. Seven-hundred and sixteen billion dollars is a lot of money. And it’s supposed to be! A major goal of the Affordable Care Act is to ease the strain Medicare will put on the federal budget. But, relatively speaking, the Affordable Care Act’s cuts are smaller than the cuts that were in the Balanced Budget Act of 1997, which Clinton signed and which a Republican Congress enacted.
Romney, Ryan, and their allies have made this cut the main focus of their attacks, accusing Obama of “raiding” Medicare. It’s difficult to overstate the hypocrisy of this attack. Both of Ryan’s budget proposals called for cutting the exact same amount from Medicare. Romney has pledged to undo those cuts, but if you examine his overall budget framework—in particular, his promise to cap non-defense federal spending at 16 percent of gross domestic product—doing so would be virtually impossible, at least without even more implausible cuts elsewhere. Ryan has since said he, too, supports undoing those Medicare cuts. But that doesn’t fit his budget particularly well, either.
(If you want to assume that Romney and Ryan are serious about putting the $716 billion back into Medicare, whatever the consequences for the rest of their budgets, that raises a whole new set of problems. Jackie Calmes of the New York Times explained why on Tuesday.)
But let’s put that issue aside and focus on what would happen after the first ten years. In the competition schemes conservatives that favor, program costs would rise at a fixed rate. That means the voucher's value would increase according to a predetermined formula, and in the original Ryan budget that formula would have resulted in dramatic funding cuts. By 2030, according the Congressional Budget Office, the skimpy voucher would have left the typical senior individually responsible for about two-thirds of his or her medical bills.
The new Ryan budget envisions a much less severe cut: Under that budget, the voucher would increase at the same rate as gross domestic product, plus half a percentage point. CBO has not revised its estimate of how that would affect individual seniors, but the growth rate is the same as the target Obama proposed setting with his latest budget (which calls for reducing costs slightly more aggressive than the Affordable Care Act originally did). 
Romney has not said, specifically, how fast the voucher would grow under his scheme. And, again, it’s safe to assume this is a deliberate dodge. If he came up with a growth rate, forecasters would crunch the numbers and come up with projections of what it would mean to individual seniors. But one thing we know is that Romney’s spending cap leaves even less room for domestic spending than Ryan’s budget. That makes it quite likely that Romney’s plan, if taken at face value, would entail a more severe spending cut than Ryan’s or Obama’s.
3. On whom do the plans place the most risk? This is probably the most important issue in the entire debate. And it’s really an argument over what kind of guarantee Medicare offers.
The Affordable Care Act alters the way Medicare pays for services. But it does not undermine the basic guarantee to seniors—that, upon retirement, every American will get a comprehensive set of insurance benefits. The Republican voucher schemes wouldn't make that guarantee. Their guarantee would be to the government and, by extension, to the taxpayers: It'd be a guarantee that the program’s cost will not exceed a pre-determined amount. 
Maybe the easiest way to think about this is to imagine what would happen if either set of proposals failed to control health care costs as their architects hope. In other words, let’s assume that the cost of medical care for the elderly keeps going up, beyond the target that both Obama and Ryan have endorsed (GDP plus a half a percentage point).
Under Obama’s proposal, the IPAB would make recommendations for reducing the program’s spending. It would probably do so by reducing what Medicare pays providers of care. But, again, the law prohibits IPAB from cutting benefits and does not require IPAB to reduce spending by enough to meet the spending target. As a result, the program could end up a little growing more quickly than the spending target. That would force the government to accommodate that higher cost—by raising taxes, cutting spending somewhere else, or tolerating higher deficits.
The Romney and Ryan proposals are a lot less specific about what happens if spending exceeds the growth rate. And the latest Ryan proposals, including not just his budget but the policy paper he wrote with Senator Ron Wyden, would give Congress an opportunity to alter the program’s payments, apparently in a similar way that IPAB could. But the Ryan budget does not protect benefits explicitly. Romney has not made such a guarantee, either, despite what you may have heard. Without such a guarantee, seniors might have to make up the difference between the value of the voucher and what it costs to buy a decent insurance policy.
Patricia Neuman, senior vice president of the Kaiser Family Foundation and director of the program on Medicare policy, summarizes it this way:
While both sides set targets to constrain the growth in Medicare spending, they do so in very different ways, with important implications for beneficiaries. Under the health reform law, the IPAB is explicitly prohibited from making changes that would increase premiums or cut benefits for seniors. No similar restrictions are included in the Ryan proposals.
So under Obama’s proposals and the Affordable Care Act, providers and the public as a whole bears the risk of higher costs, as they always have with Medicare. Under the Romney and Ryan proposals—again, based on what we know about them—individual seniors could end up bearing the risk.
Which approach you prefer is a matter of philosophy and values. But they represent very different commitments.
4. What else would the plans (and the men behind them) do to the health care system? We’ve been talking a lot about Medicare and very little about Medicaid. That’s a mistake. The changes to Medicaid that Romney and Ryan have endorsed are actually more drastic than what they have in mind for Medicare. And those cuts to Medicaid would end up affecting seniors on Medicare, both directly and indirectly.
Romney and Ryan say Obama “raided” Medicare to pay for Obamacare because, in effect, the money that's coming out of Medicare will help finance the Affordable Care Act. But that money still helps seniors. A small portion improves Medicare benefits directly, by giving seniors more help with prescription drugs and providing free preventative care. The rest helps to stabilize the health care industry, so that it can tolerate and adapt to the law’s Medicare cuts without reducing services and causing shortages. That infusion of money from Medicaid and private insurance tax credits is the reason that the major health care providers (doctors, hospitals, drug makers) went along with the Affordable Care Act in the first place.
Both of Ryan’s budgets call for massive cuts to Medicaid. Romney’s tight spending cap would require cuts as severe, and possibly more severe, than the ones in Ryan’s proposals. Independent analyses, including one from researchers at the Urban Institute and the Kaiser Family Foundation, suggest that between 14 and 27 million people on Medicaid could lose their coverage—above and beyond the 17 million who would lose coverage because both Romney and Ryan would repeal the Affordable Care Act. Dumping between 14 and 27 million uninsured people on the health care system would have a devastating impact on doctors and hospitals, forcing them to dispense a lot more charity care and affecting their ability to provide care for everybody else.
The researchers from that Urban-Kaiser study made one key assumption: That, confronted with insufficient funding, states would react entirely by reducing services or eligibility for the non-elderly. But most of the money that Medicaid spends goes to the disabled and the elderly. A huge chunk of that goes to nursing home care. States would almost surely make some cuts to their services, too. In that sense, cuts to Medicaid would almost surely hurt seniors directly, and not just indirectly.
Those cuts, if enacted, would produce real budget savings. It’s one reason that, on paper, the Ryan and Romney would appear to save the government a lot more money on health care than the Affordable Care Act will. But the cuts would have dramatic, devastating effects—on seniors, among others. 
My Bottom Line: Transforming Medicare into a voucher scheme is not a crazy idea. Smart conservative economists like Joe Antos and Gail Wilensky believe it’s the best way forward. They make a reasonable case and there are versions of premium support that many liberals (including this writer) could support, particularly if it were part of a bigger compromise on health care and spending. But the plans that Antos and Wilensky envision would include careful regulations and protections that, so far, Romney and Ryan have not endorsed. And they couldn't possibly work in a world where the Affordable Care Act came off the books and Medicaid, as we know it, ceased to exist.
One of the best arguments against the Romney-Ryan approach appeared a few months ago in the New England Journal of MedicineIn that article, economists Henry Aaron and Austin Frakt concluded:
although it’s true that Medicare is a key driver of long-term federal spending, we don’t believe that recently proposed premium-support reforms are the solution. They lack safeguards for beneficiaries. They threaten to shift costs to the elderly and disabled and force them to shop for coverage in a confusing insurance market.
Aaron was an early supporter of premium support back in the 1990s, when the idea first appeared on the national agenda. If he’s changed his mind about the idea, at least in the current political context, that tells you something. 
Author’s Note: Blog items don’t usually include bibliographies, but I want to mention a few sources that were particularly helpful—starting with a Kaiser Family Foundation side-by-side comparison of voucher plans and a Center on Budget and Policy Priorities analysis of the Romney budget proposal. I also learned (as I always do) from experts at both institutions, as well as writing by Aaron Carroll and Sarah Kliff, plus ongoing Medicare coverage in Health Affairs and the New England Journal of Medicine.
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The Real Reason Rick Warren Cancelled His Candidate Forum: His Increasing Irrelevance

Well, this is embarrassing. Last month, evangelical pastor and best-selling author Rick Warrenannounced that he was going to hold a forum at Saddleback Church with the presidential candidates. Warren hosted a similar event in 2008 with John McCain and Barack Obama, at which he interviewed each of the men separately in front of a large audience. The forum was covered by all the major media outlets, and Warren basked in his self-appointed role as America’s leading religious figure.
Yesterday, Warren declared that he was cancelling this year’s candidate forum because the presidential campaign had become too uncivil. It was a ridiculous excuse and a transparent attempt to save face. In reality, there was no event to cancel. 
The first sign that Warren has misjudged his influence should have been the fact that he never had a firm date for his forum. In the July conference call with reporters to announce his plans, Warren said that he still needed to finalize an exact date but was looking at the week of August 20. He also noted that while he had held favorable conversations with both campaigns, neither candidate had yet agreed to attend. By comparison, Warren only unveiled plans for the 2008 forum after weeks of intense negotiations with both sides and after getting commitments from both campaigns to participate. He also announced the scheduled date for the event.
Despite Warren’s efforts to make it seem as if he was selflessly cancelling an appearance with both presidential candidates in order to avoid contributing to a toxic political climate, the evidence strongly suggests that there wasn’t any Saddleback forum this time to cancel. The Associated Press reported this morning that neither campaign was planning on attending any event at Saddleback. Saddleback’s own events calendar does not list any candidate forum. (And lest you think a listing was removed when the forum was “cancelled,” the calendar does note that the cross-training fitness class originally scheduled for today has been cancelled.) 
According to a Fox News blog, “Romney campaign officials say the campaign had not accepted the invitation nor put it on any schedule. At the time the proposed Warren forum was first publicized, the Romney camp said it was not planning to attend.” There is also no evidence that the church held a public lottery for tickets to the forum, as Warren originally said in July. 
I have no doubt that somebody in Warren’s camp had a conversation with staff in the Obama and Romney campaigns at some point. But in the absence of an agreement, he appears to have simply broadcast his plans for a repeat performance of the 2008 event and expected that the candidates would come to him. It must have been quite the ego blow, then, to learn that Romney and Obama had reached an agreement to talk about matters of faith and religion in another forum—separate interviews with a little-known church quarterly, Cathedral Age, which is the official publication of the Washington National Cathedral. The interviews were made public yesterday, just hours before Warren pulled the plug on his own event.
The decision makes sense for both candidates. Romney has made clear that he wants to talk about his faith on his own terms, which the print interview allowed him to do. And Obama had a multitude of reasons to be wary of Warren, as I explained last month.
But if anyone in the Obama camp was feeling torn about skipping another Saddleback event, they have only to read Warren's comments to the Orange County Register yesterday to put their minds at ease. After rolling out the excuse that he couldn’t possibly hold a civility forum with such uncivil candidates, Warren explained that he would instead host a forum on religious freedom in September. That might ordinarily seem like a worthy, non-partisan endeavor. But “religious freedom” has unfortunately become this year’s “family values”—a phrase that is now code for “socially conservative issue.”
When asked by the OC Register reporter what he thought the candidates’ views on religious freedom were, Warren made it even more clear that he considers the issue from a partisan perspective. “President Obama’s policies clearly show what he values, and I have told him that I adamantly disagree with those particular policies,” said Warren. “I have not talked about this issue with Governor Romney, but I would imagine that as a Mormon he’d obviously understand the importance of protecting all religions against persecution and ensuring people’s rights to practice their conscience without government intervention.”
Got that? Without talking to Romney—or apparently investigating his positions on religious freedom at all—Warren can safely say he’s pretty sure they’d be on the same page. He hasn’t talked to Obama either, but judging the president by one policy, he can say that Obama doesn’t value religious freedom. Of course, I’m just assuming that the policy Warren refers to is the contraception mandate—he never specifies. Maybe he disagrees instead with Obama’s policy of letting faith-based organizations discriminate in their hiring when they use government funds. Or the Justice Department’s involvement in getting a court decision that declared the National Day of Prayer unconstitutional overturned.
For the past few years, Warren has scoffed at the idea that he has any real involvement in politics. With this latest episode, the California pastor has also proven that he is not a leader. A real leader doesn't respond to incivility in politics (the horror!) by throwing up his hands and cancelling a forum that he himself described as “a place where people of goodwill can seriously disagree on significant issues without being disagreeable or resorting to personal attack and name-calling.” And if that wasn’t the real reason he was cancelling the event, a real leader would swallow his pride and tell the truth.


Decision comes after cyclist angrily declares 'enough is enough' and doesn't fight PED charges

Lance Armstrong won the last of his seven Tour de France titles in 2005.
U.S. Anti-Doping Agency chief executive Travis Tygart says the agency will ban Lance Armstrong from cycling for life and strip him of his seven Tour de France titles for doping.
Armstrong on Thursday night dropped any further challenges to USADA's allegations that he took performance-enhancing drugs to win cycling's premier event from 1999-2005.
Armstrong says USADA doesn't have the authority to vacate his Tour titles. However, Tygart told The Associated Press that USADA can do it.
Tygart called the Armstrong case a "heartbreaking" example of a win-at-all costs approach to sports.

  U.S. Anti-Doping Agency chief executive Travis Tygart says the agency will ban Lance Armstrong from cycling for life and strip him of his seven Tour de France titles for doping.

What Romney Wants You to Forget

Mitt Romney and Paul Ryan were among the first Republicans to condemn Todd Akin, the GOP Senate candidate in Missouri who over the weekend suggested women’s bodies naturally thwart pregnancy in cases of “legitimate rape.” Maybe Romney and Ryan were anticipating the political backlash and maybe they were genuinely appalled at what Akin said. I really don’t know. I’m willing to give them the benefit of the doubt—and to give them credit for reacting so quickly.
But the official campaign statement included a telling postscript: “a Romney-Ryan administration would not oppose abortion in instances of rape.” The clarification was necessary because Ryan has opposed such exceptions in the past. AsNewsweek’s Michelle Goldberg and Salon’s Alex Seitz-Wald have pointed out, Ryan's record on abortion is extremely conservative, even by Republican standards. He has a perfect 100 rating from the National Right to Life Committee. And he’s lived up to that rating by, among other things, co-sponsoring a bill that declared “personhood” begins at fertilization—a legal standard that, if ever applied, could outlaw not just abortion but also in vitro fertilization, intrauterine devices, and some oral contraceptives. Akin was one of the other co-sponsors.
Ryan also co-sponsored (with Akin, again) a bill that would have modified the existing ban on federal funding of abortion. Presently, the law allows federal funds to support abortions in case of rape and incest. The bill would have narrowed the exceptions to cases of “forcible rape” and, for incest, cases involving minors. The legal implications of the proposed standard were unclear. But, as Nick Baumann of Mother Jones explained at the time, abortion rights advocates feared (reasonably) that victims raped while under the influence of drugs or alcohol, victims with diminished mental capacity, and victims of date rape might not be eligible if the new definition ever took effect. (For more background, see Ian Millhiser of ThinkProgress.) The bill was so controversial that House Republicans withdrew that language.
Romney would like us to ignore this part of Ryan’s record, just as he’d like us to ignore Ryan’s advocacy of immediate cuts to Medicare and his crusade to privatize Social Security. Under different circumstances, Romney might have a point.
A presidential candidate’s record is obviously more important than his or her running mate’s. And Romney has said consistently (I think) that he supports the rape and incest exceptions, while promising that Social Security is off limits for budget cuts and vowing, however implausibly, to undo the Medicare cuts that Ryan has supported.
But a vice presidential nominee’s history matters, too, particularly when we’re talking about recent history. The two abortion proposals and the budget with the Medicare budgets are all from 2011. Yes, that’s last year. Ryan’s advocacy of Social Security dates back farther, to the Bush Administration. But in politics that’s not exactly an eternity. These positions tell us about Ryan’s values and priorities—that he is no friend of Medicare and Social Security, that he would prohibit victims of rape and incest from getting abortions if he could. And that, in turn, tells us something about Romney.
Romney keeps insisting that he chose the man, not the agenda, when he asked Ryan to join him on the ticket. But during the primaries Romney was very clearly praising the man and the agenda, holding Ryan up as an intellectual leader for the Republican Party and famously condemning a rival, Newt Gingrich, who had the temerity to suggest that Ryan’s ideas were too politically toxic to gain wide acceptance. Romney had in mind Ryan’s economic agenda, but he was also trying to please the GOP’s conservative base. And nothing he’s done since that time suggests he’d stop wooing them as president.
And let’s not forget that, if Romney wins, Ryan will be one heartbeat away from the presidency. You shouldn’t choose a president by focusing exclusively on the vice presidential nominee. But you also shouldn’t choose a president by pretending the vice presidential nominee doesn’t exist. That means considering the nominee’s record—which, in this case, includes positions on abortion that the majority of Americans could not stomach.

How Romney, Ryan, and the Republicans Fell in Love With a Big Government Program

We’ve spent a lot of time arguing about Medicare this week: What each of the presidential candidates is proposing and what it would mean for seniors. But sometimes, with all of the gobbledygook about benefit guarantees and growth rates, it’s easy to lose sight of what each side of the debate really wants. And that’s the real issue. Who believes in Medicare and who doesn’t? Who thinks that government should guarantee that all seniors have a defined set of benefits and who does not?
Steve Benen, who has spent plenty of time arguing the finer points of policy this week, takes a moment to answer those question.  Forgive the long quote, but I think he captures the debate particularly well:
What is Medicare? It’s a massive, government-run system of socialized medicine. It’s wildly popular, very successful, and one of the pillars of modern Democratic governance. This government-run system of socialized medicine was created by Democrats against the opposition of conservative Republicans, and it’s Democrats who’ve fought to protect it for more than a half-century.
Or to summarize, the left loves Medicare and always has; the right hates Medicare and always has. For liberals, the system is a celebrated ideal; for conservatives it’s an unconstitutional, big-government outrage in desperate need of privatization.
In 2012, once we get past all of the talking points and attack ads, we’re left with this: Romney/Ryan wants you to believe they’re the liberals. No, seriously. Think about what the Republican presidential ticket, Fox News, Krauthammer, Donald Trump, and the Republican National Committee have been saying all week: those mean, rascally Democrats cut our beloved Medicare and voters should be outraged.
In other words, the argument pushed by the most right-wing major-party ticket in a generation is that Barack Obama is a left-wing socialist who wants government-run socialized medicine and that Barack Obama is a far-right brute who wants to undermine government-run socialized medicine.
Greg Sargent makes a similar observation this morning: That the Romney-Ryan agenda is “about obfuscating the actual policy differences between the two candidates over the program.”
I’d quibble with Benen’s use of the term “socialized medicine.” Medicare is actually “socialized insurance.” Socialized medicine implies that the government has taken ownership of the providers of medical care, by running hospitals and turning the professionals, like doctors, into government employees. You see that in some countries abroad: The United Kingdom has a version of this. And here in the United States, the Veterans Administration operates on that principle. But Medicare is government-run insurance, not government-run medicine.
Otherwise, he and Sargent have it absolutely right. And it’s not hard to see why supporters of Romney and Ryan have adopted this strategy. A frontal assault on Medicare would be true to Republican principles of governing. But it’d also alienate older, white voters that have become the Republican base. By attacking Obama's relatively mild reforms of Medicare, even as they propose far more radical changes, Romney and Ryan can tap into white, working class resentment and the sense—particularly among the elderly—that Obama is stealing from them.
It’s not a particularly honest or noble way to run a campaign. Time will tell whether it’s effective.

Statement issued Thursday night by seven-time Tour de

France winner Lance Armstrong:


"There comes a point in every man's life when he has to say, "Enough is enough." For me, that time is now. I have been dealing with claims that I cheated and had an unfair advantage in winning my seven Tours since 1999. Over the past three years, I have been subjected to a two-year federal criminal investigation followed by Travis Tygart's unconstitutional witch hunt. The toll this has taken on my family, and my work for our foundation and on me leads me to where I am today - finished with this nonsense.
I had hoped that a federal court would stop USADA's charade. Although the court was sympathetic to my concerns and recognized the many improprieties and deficiencies in USADA's motives, its conduct, and its process, the court ultimately decided that it could not intervene.
If I thought for one moment that by participating in USADA's process, I could confront these allegations in a fair setting and - once and for all - put these charges to rest, I would jump at the chance. But I refuse to participate in a process that is so one-sided and unfair. Regardless of what Travis Tygart says, there is zero physical evidence to support his outlandish and heinous claims. The only physical evidence here is the hundreds of controls I have passed with flying colors. I made myself available around the clock and around the world. In-competition. Out of competition. Blood. Urine. Whatever they asked for I provided. What is the point of all this testing if, in the end, USADA will not stand by it?
From the beginning, however, this investigation has not been about learning the truth or cleaning up cycling, but about punishing me at all costs. I am a retired cyclist, yet USADA has lodged charges over 17 years old despite its own 8-year limitation. As respected organizations such as UCI and USA Cycling have made clear, USADA lacks jurisdiction even to bring these charges. The international bodies governing cycling have ordered USADA to stop, have given notice that no one should participate in USADA's improper proceedings, and have made it clear the pronouncements by USADA that it has banned people for life or stripped them of their accomplishments are made without authority. And as many others, including USADA's own arbitrators, have found, there is nothing even remotely fair about its process. USADA has broken the law, turned its back on its own rules, and stiff-armed those who have tried to persuade USADA to honor its obligations. At every turn, USADA has played the role of a bully, threatening everyone in its way and challenging the good faith of anyone who questions its motives or its methods, all at U.S. taxpayers' expense. For the last two months, USADA has endlessly repeated the mantra that there should be a single set of rules, applicable to all, but they have arrogantly refused to practice what they preach. On top of all that, USADA has allegedly made deals with other riders that circumvent their own rules as long as they said I cheated. Many of those riders continue to race today.
The bottom line is I played by the rules that were put in place by the UCI, WADA and USADA when I raced. The idea that athletes can be convicted today without positive A and B samples, under the same rules and procedures that apply to athletes with positive tests, perverts the system and creates a process where any begrudged ex-teammate can open a USADA case out of spite or for personal gain or a cheating cyclist can cut a sweetheart deal for themselves. It's an unfair approach, applied selectively, in opposition to all the rules. It's just not right.
USADA cannot assert control of a professional international sport and attempt to strip my seven Tour de France titles. I know who won those seven Tours, my teammates know who won those seven Tours, and everyone I competed against knows who won those seven Tours. We all raced together. For three weeks over the same roads, the same mountains, and against all the weather and elements that we had to confront. There were no shortcuts, there was no special treatment. The same courses, the same rules. The toughest event in the world where the strongest man wins. Nobody can ever change that. Especially not Travis Tygart.
Today I turn the page. I will no longer address this issue, regardless of the circumstances. I will commit myself to the work I began before ever winning a single Tour de France title: serving people and families affected by cancer, especially those in underserved communities. This October, my Foundation will celebrate 15 years of service to cancer survivors and the milestone of raising nearly $500 million. We have a lot of work to do and I'm looking forward to an end to this pointless distraction. I have a responsibility to all those who have stepped forward to devote their time and energy to the cancer cause. I will not stop fighting for that mission. Going forward, I am going to devote myself to raising my five beautiful (and energetic) kids, fighting cancer, and attempting to be the fittest 40-year old on the planet."

The Networks Are Skipping Ann Romney's Convention Speech—And That's a Good Thing

That is just rude.  What did I say, the Republican men and the main stream media just want to dismiss the notion of a woman, speaking. And this is the presumptive candidate's wife.  Who's next....
Next Monday night at 10:30 pm, Ann Romney is slotted to speak at the Republican National Convention. It is, I suppose, her official presentation to political society, and an important moment in the election season narrative-construction of the Romneys-as-couple. She will tell some heartwarming anecdotes about their marriage, express her admiration for his measure as a man, and talk about how only he can fix the mess the country’s in. Unsurprisingly, the television networks are not convinced that’s going to make for very compelling television.They’re airing only limited coverage of the conventions, and so instead of Mrs. Romney, those who tune into CBS, NBC, or ABC will have their option of “Hawaii Five-O,” “Grimm,”or “Castle,” all variations on the crime procedural. Perhaps if Mrs. Romney came outfitted in a Sherlock Holmes cap they’d carry her speech?
RNC organizers are, of course, upset, and considering moving Mrs. Romney’s time slot. But even that won’t guarantee she’ll show up on viewers’ televisions, if CBS’s Scott Pelley is to be believed. “We also want to cut away when it’s just the scripted, sort of — and I’m searching for a better word than propaganda — but cut away when the convention isn’t providing much information to the audience,” he told the Times. (Do modern conventionsever provide information to the audience?) It seems we’d rather watch third-rate summer reruns than one of the few important political events of the year. All-in-all, it looks like a sad moment for the American experiment, right?
Not at all. Mrs. Romney, if her husband were elected, wouldn’t have any official role in shaping policy. Why does she need to have an official tryout on the national stage as spousal accessory? There is perhaps no clearer signpost of the way that presidential elections have become as much pageant as policy debate than the spousal convention speech. The networks aren’t eroding our civic pride so much as restoring it. This isn’t a monarchy.  This is a democracy. And the people just want to watch "Hawaii Five-Oh."

Astronomy Picture of the Day

Discover the cosmos! Each day a different image or photograph of our fascinating universe is featured, along with a brief explanation written by a professional astronomer.
2012 July 10 

Happy People Dancing on Planet Earth 
Video Credit: Matt Harding & Melissa Nixon; Music: Trip the Light
xplanation: What are these humans doing? Dancing. Many humans on Earth exhibit periods of happiness, and one method of displaying happiness is dancing. Happiness and dancing transcend political boundaries and occur in practically every human society. Above, Matt Harding traveled through many nations on Earth, planned on dancing, and filmed the result. The above video, the latest in a series of similar videos, is perhaps a dramatic example that humans from all over planet Earth feel a common bond as part of a single speciesHappiness is frequently contagious -- few people are able to watch the above video without smiling.

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Authors & editors: Robert Nemiroff (MTU) & Jerry Bonnell (UMCP)

NASA Official: Phillip Newman Specific rights apply.

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