Is President Clinton capable of telling the truth?

Reuters

Former President Bill Clinton addresses delegates during the second session of the Democratic National Convention in Charlotte, North Carolina, September 5, 2012.

President Clinton delivers a very entertaining speech. But truth-telling does not come easily to a man who a decade ago asked to resign from the U.S. Supreme Court Bar rather than face a threatened suspension over lying to a federal grand jury. Most of Mr. Clinton's "stem-winding" speech (Factcheck.org's characterization) lies outside my area of expertise. And I won't bother repeating the two health-related claims that even Factcheck.org was willing to characterize as "overselling ‘Obamacare'" and ‘other exaggerations.'

Instead, I would like to focus on a stunning string of a half-dozen half-truths and bogus conclusions about Medicare recounted in less than two-and-a-half minutes-a rate of mendacity that perhaps shouldn't surprise us coming from a man that former Senator Bob Kerrey (D, Nebraska) characterized as an "unusually good liar."  Here's what Bill Clinton said verbatim (fabrications in italics).[1]

"Now, there were two other attacks on the president in Tampa I think deserve an answer. First, both Governor Romney and Congressman Ryan attacked the president for allegedly "robbing Medicare" of $716 billion. That's the same attack they leveled against the Congress in 2010, and they got a lot of votes on it. But it's not true."

Readers can judge for themselves based on what follows, but I regard the preceding statement as an unambiguously erroneous conclusion.

"Look, here's what really happened. You be the judge. Here's what really happened. There were no cuts to benefits at all, none."

This is half-truth #1-roughly analogous to quibbling over what the meaning of "is" is.

Imagine that you had an auto insurance policy and that your carrier announced that it would be gradually cutting the amounts paid to repair shops by roughly 50 percent. Admittedly, this would not happen instantaneously; it would take years for these payment cuts to take effect a little bit at a time. But eventually your policy would be paying 70 percent less than other policies do for the identical service.

Of course, so long as you are able to find a participating repair shop, this change would not affect you. Indeed, you would save money on the 20 percent of each bill you had to pay, since it would be based on the lower payment rate. But would any reasonable person expect to still be able to find a participating repair shop as easily as before? No, the reality is that owners of policies like yours would become second-class citizens that some shops would refuse to serve at all and other shops would serve only if they were willing to waste a lot of time standing in line.

This is exactly how we can expect the brutal cuts in Medicare provider payments to play out.

We already know how hard it is for Medicaid recipients to find a doctor willing to take them. (As I explained last week, only 53 percent of physicians are willing to accept all or most new Medicaid patients). Yet under the Affordable Care Act (ACA), the Medicare actuary projects that the program will be paying physicians less than Medicaid, eventually paying less than half of Medicaid rates! [2]

Moreover, the cuts to Part A providers (hospitals, home health agencies etc.) are so deep that the Medicare actuary projects 15 percent will be unprofitable by 2019, gradually increasing to 40 percent by 2050. Mr. Clinton is far too smart a man to believe that such devastating cuts will not create crippling problems of access to Medicare providers.[3] Indeed, were private health insurers imposing such draconian cuts, President Clinton would be the first in line to vilify them for their greed and heartlessness. Make no mistake about it: the assertion that the health care law did not cut Medicare benefits is a very carefully crafted deception.

"What the president did was to save money by taking the recommendations of a commission of professionals to cut unwarranted subsidies to providers and insurance companies that were not making people healthier and were not necessary to get the providers to provide the service."

This is half-truth #2. Mr. Clinton evidently is referring to the $156 billion in payment cuts to Medicare Advantage plans. However, such cuts constitute less than one quarter of the $716 billion in Medicare spending cuts required by ACA between 2013-2022.[4] Moreover, the claim that these subsidies were unnecessary to get providers to provide the service is belied by the Medicare actuary's projection that these cuts will result in more than 7 million Medicare recipients in private Medicare Advantage plans being forced back onto traditional Medicare, cutting enrollment in such plans by about half. Does Mr. Clinton know something the Medicare actuary does not?

"And instead of raiding Medicare, he used the savings to close the donut hole in the Medicare drug program."

This is half-truth #3. Ignore the fact that closing the donut hole actually is a spectacularly bad idea. Let's take Mr. Clinton's claim at face value. Closing the donut hole offsets only 3.2 percent of the $716 billion being slashed from Medicare.[5] Which is to say that 97 percent of the Medicare cuts are NOT being used to help seniors but, instead, are being diverted to finance a brand new entitlement (exactly the charge leveled by Paul Ryan). So it might be more accurate to say that Mr. Clinton was only 3 percent truthful in this statement.

"And - you all got to listen carefully to this. This is really important - and to add eight years to the life of the Medicare trust fund so it is solvent until 2024."

This is half-truth #4. As the Medicare actuary and CBO director both have explained repeatedly over the past two years, we can EITHER use the $716 billion in Medicare savings to extend the life of Medicare OR we can use it to help offset the huge cost of the new entitlement created by ACA. But we cannot spend the same dollars twice. To claim otherwise is a flat-out lie. More importantly, if one wishes to assume that the $716 billion in Medicare cuts actually is being used to extend the life of Medicare, then President Obama's assurance that he would not sign a health bill that would add a dime to the deficit was a flagrant falsehood. Properly scored,ACA will add $340 billion to the deficit over the next 10 years.

In short, readers can either choose to believe that President Obama told the truth in making his pledge (because he raided $716 billion from Medicare to help offset the cost of this new entitlement) or to instead believe that President Clinton has told the truth that the life of the Medicare trust fund has been extended (in which case, ACA creates a huge shortfall in financing that eventually will have to be made up through borrowing or higher taxes). Both claims cannot be true.

"So President Obama and the Democrats didn't weaken Medicare. They strengthened Medicare."

By now, any impartial reader can see why I would view this as another unambiguously erroneous conclusion.

"Now, when Congressman Ryan looked into that TV camera and attacked President Obama's Medicare savings as, quote, "the biggest, coldest power play," I didn't know whether to laugh or cry... because that $716 billion is exactly to the dollar the same amount of Medicare savings that he has in his own budget!"

As Ronald Reagan might say, "there you go again" with half-truth #5. Yes, the dollar amount of Medicare savings is identical. But the way Paul Ryan achieves those savings is completely different. Under ACA, the lion's share of savings come in the form of top-down price controls that will have predictable severe adverse consequences on access to care for today's and tomorrow's Medicare beneficiaries. Under the Ryan plan, the savings come from fierce competition among health plans-the very same competition that has successfully squeezed 30 percent savings out of Medicare Part D premiums even while preserving widespread access.

With more than 1,000 plans nationwide, is anyone complaining that seniors lack access to prescription drug plans?  Medicare Part D provides real-world proof that competition and consumer choice can lower costs without hurting access-a very sharp contrast to the inevitable access problems that will face Medicare patients if the ACA is fully implemented as written. More importantly, the Ryan plan actually does use every penny of those savings to shore up Medicare rather than divert them to pay for something else.

"You got to give one thing: It takes some brass to attack a guy for doing what you did."

With all due respect, Mr. Clinton, it takes some brass to stand up on national TV, spew such a barrage of half-truths, and expect the public to believe them.

Footnotes

[1] For those who prefer to hear these words directly, see 30:36.

[2] The figure shown is slide 12, found here.

[3] Anyone who believes otherwise should read the Medicare actuary's compilation of quotes from prominent health economists and experts (p. 9), some of whom, such as David Cutler, at Harvard, and Peter Orszag, were formal advisors to President Obama or members of his administration!

[4] The Medicare Advantage cuts originally were projected to save $170 billion. The $156 billion is based on CBO's latest estimates for the 2013-2022 period (Table 2).

[5] Projected savings from closing the donut hole were $2.2 billion  in 2011, rising to $8.8 billion by 2020, for an average savings of $5.5 billion a year; thus, over 10 years, total savings would be $55 billion. But $32 billion of this cost was to be financed through discounts provided by pharmaceutical manufacturers, with the balance paid through federal subsidies. Thus, at most, the share bankrolled by Uncle Sam-$23 billion-offsets only 3.2% of the $716 billion in Medicare cuts projected under ACA.

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