1. "The budget deficit is overwhelmingly about Medicare. It’s overwhelmingly about the fact that most Americans will pay much less in Medicare taxes than they will get in Medicare benefits – even though people don’t always realize that. They think they pay for their Medicare, but the typical person does not come close to doing so. So neither party has a plan to get it into balance.

    "But both parties have a plan that — if you think about it – philosophically would make a difference, would reduce the long-term Medicare deficit. And so we don’t have to get too precise and say, ‘Well, neither of them has a plan that works and thus, neither one of them has a plan that is meaningful at all.’ They do each have meaningful plans.

    "The Democrats’ plan is to make much less of a change to Medicare than Republicans would. It is to say, through a variety of ways, we want to reduce the growth rate of Medicare spending. We want to say, if there is scientific evidence that suggests that this expensive new treatment doesn’t actually make you healthier, well, over the long term Medicare may not reimburse for that treatment, as much as it would for a treatment that there is scientific evidence. You could still get it, but you’d have to pay for it. It takes baby steps in that direction. Many health experts wish it would go farther, but when you think about the whole debate over death panels, you realize why this is tricky terrain. …

    "In a sense, they try to take Medicare and they try to say, we’re going to make it more efficient. We’re going to have it so the government is not so often paying for healthcare that doesn’t make people healthier. And the government needs to make those decisions because Medicare is a government program.

    "The [representatives] say, ‘No, no, no.’ The whole thing, to some extent, is broken and what we need to do is turn it over to the private market. And competition will take care of this problem. And so the government will give you a chunk of money. You can go out; you can buy your own plan. And by competing for your business, the plans will get rid of those inefficiencies in Medicare. The Republicans have backed off a little bit from some of that.

    "In the original Paul Ryan plan, you had to move to that if you were 55 and under – everyone 55 and older got to remain in Medicare. In the new plan, it’s sort of an option. But I don’t think there’s any doubt that philosophically that’s what the Republicans want to move more toward. And you can make an argument that it will make a big difference. There’s always some reason to doubt that it would because historically, the record of market competition working in health care is very mixed. It’s worked for things like laser surgery. It hasn’t worked so well for things like heart surgery or cancer care."

    David Leonhardt on how Democrats and Republicans differ on Medicare

  2. David Leonhardt


    2012 election

  1. Paul Ryan said the people are not better off. And Joe Biden said America is better off. I actually think you can make a really good argument that they’re both right. And here’s what that argument would look like. The country itself is better off. Four years ago, September 2008, we were just about to enter a horrific downturn. The collapse of Lehman Brothers set off the worst of it. If you look at something like world trade, stock prices, industrial production world-wide – an economist named Barry Eichengreen with colleagues have done some of this work – it is remarkable how similar 2008 looks like 1929 in terms of the speed of the declines, in almost any global economic indicator of import that you look at. In most of the ways, 2008 was a little bit worse than 1929. And yet, of course, we don’t have anything that looks like the Great Depression. As bad as the economy is, we don’t have unemployment at 20 percent. When you look at those measures, what you see is in 2009, the economy really stabilized. It’s remarkable to look at those lines continue to fall back in 20s and 30s, and sort of flatten out in 2008 and 2009. The Obama administration can claim a lot of credit for that. They broke the back of this, along with the [Federal] Reserve, and by the way, with an assist from the outgoing Bush administration, which was quite aggressive in its final months. And so is the country better off today or when it is was in the very early stages of this really frightening crisis? I don’t think there’s any question that we’re better off today as a country than we were then. …

    "But, there is also a very serious argument that a typical American household is worse off than it was four years ago and that’s because financial crises don’t do all their damage at once. They do it over many months and then there are long, slow disappointing, painful recoveries. And I think one of the fairest indictments of the Obama administration is that it has consistently underestimated the severity of this crisis. It didn’t in 2009, but since then it has. It thought the recovery would be better than it really was. And the same goes for the Federal Reserve. And so most of the reason why we’re not better off is just that’s the way financial crises work. But some portion of it is that the policy makers, The Fed and Obama administration looked on the bright side a little bit too often. And didn’t take every step they could have taken. And so when you look at something like household income, when you look at median wealth, when you look at the percentage of the population that’s working – on all of those measures we are lower than we were four years ago. And so I think it’s fair to say the typical American household isn’t better off, but the country is.

    — New York Times Washington bureau chief David Leonhardt on the question: “Are you better off now than you were four years ago?”

  2. David Leonhardt

    Are you better off now?

    Paul Ryan

    Joe Biden