Medicaid cuts versus slower growth!


The New York Times tries to explain:
Is human life a vale of tears? A mere entertainment arranged by the gods?

We ask for a very good reason. In this morning's hard-copy editions, the New York Times tried to explain the endless debate about those "Medicaid cuts."

The key word there is "tried."

Do journalists at our biggest news organs have any skills at all? You'd think the answer would have to be "yes."

The gods who rule this vale of tears may have a better idea.

The analysis piece to which we refer was written by Alan Rappeport—and no, he isn't a kid.

He graduated from Emory in 2001. One year later, he got a master's degree from the Columbia School of Journalism.

In 2006, he got a master's degree in economic history from the London School of Economics. After spending five years at the Financial Times, he started at the New York Times in April 2014.

Rappeport has a gauzy resume. He didn't have the slightest idea how to settle the endless dispute he'd been asked to resolve.

The scribe had been asked to settle a question. The basic question was this:

Does the Senate GOP health care bill involve cuts in the Medicaid program, as Democrats say? Or are Republicans simply slowing the rate at which the program will grow?

It's stunningly easy to explain this matter. Unless you work for the New York Times, in which case it can't be done.

Before we look at Rappeport's piece, let's settle this tiresome question. As a courtesy, we'll start with the rather silly but technically accurate claim the Republicans have been making. From there, we'll move to the Democrats.

When Republicans say there are no cuts, this is what they mean: They mean that total spending in the Medicaid program would continue to rise from its current level under their proposal.

(We can't swear that that is true. But that is what they claim and that is what they mean.)

X number of years from now, the federal government would be spending more dollars on Medicaid than it is spending this year. That's what the Republicans mean when they say they aren't imposing a "cut."

When Democrats say there very large cuts, this is what they mean: Among other things, they mean that spending won't rise quickly enough to keep up with inflation, or even to come close. More dollars will be spent as compared to this year, but those dollars will pay for fewer services.

In the case pf the GOP plan, it seems that those dollars will pay for far fewer services. But it isn't entirely easy to get clear on such facts, given the staggering lack of skill within our upper-end press corps.

Does the GOP plan involve Medicaid cuts? Or are they simply slowing the rate of growth? Rappeport was asked to untangle this endless conundrum. This is the way he began:
RAPPEPORT (6/28/17): Republicans, under fire for proposing health care legislation that would reduce Medicaid funding by hundreds of billions of dollars, have embraced an old argument that taking money from a program is not a “cut.”

At first glance, the new pitch to make their strategy more palatable seems at odds with the numbers. The Congressional Budget Office said on Monday that the “Better Care Reconciliation Act” would reduce Medicaid spending by $772 billion over a decade. By 2026, Medicaid enrollment would drop by 16 percent among people under the age of 65.

So, are there cuts or not?
Sigh. Right in his opening sentence, Rappeport has assumed the answer to his question. Republicans would say they aren't "taking money from [the Medicaid] program." Right from the start, Rappeport treats it as a given that they actually are.

Republicans would say they aren't "taking money from [the Medicaid] program?" Absolutely! They would say that they're spending more money, in future years, than was spent in the program this year!

On that basis, they would say that their proposal adds money to the Medicaid program. They'd also say, with obvious justice, they aren't "embracing" the claim that Rappeport puts in their mouths.

In his second paragraph, Rappeport again blows past the basic Republican claim, silly though it may be. Did the CBO really say that the Republican proposal "would reduce Medicaid spending by $772 billion over a decade?"

Sad! Rappeport provide no quotation of any such CBO statement. He also provides no link to any such CBO statement. But if the CBO made some such statement, they would have been comparing the amount of spending the Republicans propose to the amount of future spending which would occur under current law.

Should a person refer to some such proposal as a "cut," a "reduction?" We're sorry, but that's a semantic question to which there's no ultimate answer.

How should a journalist deal with a semantic dispute of this type? He should simply explain the facts of the case! Here goes:

Under the GOP plan, spending would rise by a small amount as compared to this year. But it wouldn't come close to keeping up with the rate of inflation, thereby causing significant cuts in nationwide Medicaid services.

Dollar spending would rise by a small amount. The number of Medicaid recipients would have to be substantially cut. Those are the basic facts of the case. How hard was that to explain?

For the nation's upper-end journalists, this amazingly elementary matter is much too hard to explain. It isn't just Rappeport who gets tangled today. On the next page in the hard-copy Times, Margot Sanger-Katz (Yale 2002, CSJ 2003)bungles the very same question:
SANGER-KATZ (6/28/17): Contrary to statements by Kellyanne Conway and other Trump advisers that the bill contains no overall cuts to Medicaid, the budget office offered a chart highlighting the spending reductions for the program. It says explicitly that “states would not have substantial additional flexibility” under the bill’s Medicaid reforms, a typical selling point for a plan that would push more fiscal risk to state governments. It says that a waiver program for state insurance regulations would increase the deficit and would not reduce the uninsured rate in every state. In addition, the analysts wrote, “waivers would probably cause market instability in some areas.”
Sad. Sanger-Katz doesn't link to the chart to which she refers, nor does she actually quote any statement by the CBO. That said, the "spending reductions" to which she refers will qualify as "reductions" only if she compares future spending under the GOP plan to future spending which would occur under current law. In the end, she is simply adopting the semantic framework preferred by one of these sides.

Unless you're an upper-end journalist, it isn't hard to explain the basic facts of this case. Year by year, spending will rise by a small amount under the GOP bill. But because those small increases won't come close to keeping up with inflation, major cuts in Medicaid services will be required.

Spending will rise a small amount. There will be large cuts in Medicaid services. It's amazingly easy to state those facts. They leave the semantic confusion behind.

A journalist should know how to do that. But over the years, we've come to see that our journalists have almost no skills.

They know how to stick to a story-line; that tends to be where the skill set ends. Perhaps the gods find this amusing.

We know of no way to tell.

Meanwhile, for extra credit: Emory, Yale, CSJ, LSE? What are they teaching these kids?


  1. "Perhaps the gods find this amusing.

    We know of no way to tell."

    Simple, just ask Comey the God.

  2. "Year by year, spending will rise by a small amount under the GOP bill. But because those small increases won't come close to keeping up with inflation, major cuts in Medicaid services will be required."

    All they have to say is that since nominal spending increases will not keep up with inflation, the REAL value of that spending will fall; to put it another way--the purchasing power of those funds will be less with each passing year... so you will be able to buy less services over time--it is a REAL cut in Medicaid spending.

  3. Somerby, the GOP bill is absolutely going to kill Medicaid- yes, maybe not today, but this bill is a fucking hellish disaster for millions of Americans whose health care is tenuous. It's a disgrace, and your hairsplitting over a journalist's phrasing is confetti. Kiss my ass, Bob. Sounds like you want the Trump bill, just to annoy those liberals you seem to hate. Whenya ever going to cover the monstrous lies of Fox News, Bob? Oh yeah, you're too cowardly.

  4. It isn't just a matter of keeping up with inflation. It is a matter of keeping up with the number of people who need medicaid. No one has discussed this.

  5. Wasn't it Gingrich who started the nonsense about an inadequate increase not being a cut? We're giving you $1.00 to buy a hamburger. Tomorrow when the price is $1.10 we're going to give you a $1.05.

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