The Art of the Entitlement Deal

President Barack Obama pointed the finger of blame at Republicans yesterday, as incredulous Americans witnessed three fingers pointing right back at him for historically inept leadership on the debt, spending more than the cumulative total since our nation’s founding 235 years ago this July 4th.
Still, Republicans must recognize reality.
Everyone knows — “entitlements” are the federal government’s budget-busting cost-drivers.
Even so, the loss of Jack Kemp’s old seat in Buffalo, New York, where House Budget Committee Chair Paul Ryan’s (R-WI) Medicare plan loomed large, was a big warning to Republicans: Don’t get out front on Medicare.
Donald Trump went so far as to call it a “death wish” — a sentiment MSNBC’s Lawrence O’Donnell recently echoed on The Last Word, gleefully intoning: “It has the power to destroy Republican candidates.”
O’Donnell and “The Donald” are both right.
Oh, it’s charming that Ryan is so intent on setting Medicare on a stable fiscal trajectory — like by-the-book French police officer Nestor Patou, played by Jack Lemmon in Irma la Douce (1963), who tries to eliminate prostitution in Paris’ red light district.
The pols who prey on seniors, telling them Medicare as they know it will end, while pocketing big liberal and corrupting PAC money, should be the ones suffering.  Instead, like Patou, Ryan gets the ax — by proxy in NY-26, his boss’ old district.
But there’s a subtler means to moral ends.
In Irma la Douce, when Patou, now jobless, goes to a bar to drink away his sorrows, he is befriended by Irma, played by Shirley MacLaine, and beats up and replaces her pimp, whereupon he dresses up as “Lord X,” pretending he wants her services, but only pays her to talk and play cards.
So what’s Republicans’ Lord X path to redemption?
The subtler, more effective, immediate approach to fiscal sanity vis-à-vis entitlements is to coax the Obama administration into playing its proper role in working to eliminate waste, fraud, and abuse, to save billions and extend Medicare’s solvency well past its 2024 projected bankruptcy.
Seniors are no dummies. They know when they get a back brace that’s a piece of junk that Medicare bills $951 for (Home Depot sells a quality brace for about $25), telling concerned senior, “Don’t worry, it’s not your money!,” as a loved one recently experienced, the system is broken and corrupt.
Ferreting out fraud, waste, and abuse, is, of course, but a down-payment on longer-term sustainability — the reality of which will tee up a new opportunity to re-conceptualize how to give beneficiaries a greater ownership stake, which is the best way to keep down costs.
But that opportunity will come only after we get past the August 2 debt ceiling crisis because, just as Republicans won’t budge on taxes, Democrats won’t budge on Medicare cuts.
At least, that’s the expectation — unless Republicans are smart and don’t take the bait like in 1995/96 when President Bill Clinton played them like a fiddle during that far more benign budget stalemate.
It’s the same bait Democrats always offer; then Republicans end up losing come Election Day. And, while you may have the best policy vis-à-vis entitlement reform — or the seeds of it, you can’t set policy if you lose elections.
You can take it to the nearly bankrupt entitlement “lock box” that Democrats will refuse to budge on sacred promises made to seniors, as recent comments by House Minority Leader Nancy Pelosi (D-CA), Senate Majority Leader Harry Reid (D-NM), and Senate Majority Whip Dick Durbin (D-IL) illustrate. And if you think about it, unencumbered by conscience concerning who is going to pay the tab for unsustainable Medicare promises, why would they forfeit the electoral political gold their demagoguery delivers?
Minority Leader Pelosi is, in fact, gambling such demagoguery will win her back the House speakership. “Our three most important issues: Medicare, Medicare and Medicare,” she recently told Washington Post’s Karen Tumulty.
So instead of insisting on the whole loaf, Republicans should be Reaganesque and accept a mutually agreed partial loaf on Medicare reform and “revenue enhancements” — provided these “enhancements” don’t limit job creation.
Then, after the immediate crisis passes, the GOP should look to “Medicaid transformation,” also contained in Ryan’s budget, as the better path to long-term entitlement reform.
This much-overlooked proposal provides a template for achieving across-the-board health care savings, by putting the patient — not government or insurance bureaucrats — in the driver’s seat and emphasizing good health, which reduces costs. That this plan also treats Medicaid recipients with real dignity for the first time in their lives by affording them first-class, instead of third-rate, health care is political gold that would make Kemp proud.
Additionally, its $1 trillion in program savings (averaging $20 billion per state) and $300 million in administrative saving is, well, huge!
Time will tell if Republicans, ignoring the Blamer-in-Chief’s tactic, will instead practice the “art of the deal.”