BUSH TO PROPOSE VAST COST SAVINGS IN MEDICARE PLANThe key word in that page-one headline is savings. (Inside the paper, on page A8, the jump headline used the same term: Bush to Propose Vast Cost Savings From Medicare in His 2007 Budget.) In this headline, as in Robert Pears opening paragraphs, Bush proposes something which sounds good—savings. And he isnt proposing something unpleasant; he isnt proposing vast cuts. (Were transcribing the headlines in our hard-copy Times, not the ones which appear on-line.)
Why did the Times say savings, not cuts? We cant read minds, but this usage tracks to an RNC effort during the Medicare debate of the mid-1990s. At that time, the RNC badgered reporters about their use of the traditional but unpleasant term cuts. Medicare cuts sounds like something unpleasant—but Medicare savings sounds like something youd want. For that reason, Republicans insisted that the press corps should stop saying cuts. In that headline, we see their achievement.
(In vast detail, with on-the-record interviews, David Maraniss and Michael Weisskopf described this massive RNC campaign in a brilliant chapter of their 1996 book, Tell Newt to Shut Up.)
But should the Times have said cuts in its headline? Everyone knows the Republican argument: Under Bushs proposal, Medicare spending would continue to grow, so there arent any cuts! But uh-oh! By that logic, there arent any savings either! (If Bushs proposal would let spending grow, in what sense are there any savings?) In fact, to compute Bushs savings, you compare the spending he has proposed with the spending projected under current law. But if you make that same comparison, you also come up with vast cuts in that same projected spending! In other words, the two terms are interchangeable in this discussion; theyre two different names for the very same thing. Duh! To the extent that Bush is proposing vast savings, he is also proposing vast cuts.
In this discussion, cuts and savings name the same thing. The size of the savings is the size of the cuts. But in that Times headline, we see what the RNC achieved in its aggressive, mid-90s campaign. When Reagan made proposals like this, headlines said that hed proposed cuts. Today, though, Bush proposes vast savings.
ACCEPTING THE NEW WORD ORDER: Once the RNC brought down the hammer, cowering journalists tried to comply with their demands for a new word order. In three separate articles, we described the comical ways reporters struggled to avoid the word cuts in 1995 and 1996 (see THE DAILY HOWLER, 8/20/99). And we described a key part of that Maraniss chapter. Right up through the mid-1990s, both major parties had always said cuts when describing proposals like Bushs. Democrats had always called such programs cuts—but Republicans had always used that term too. In a comical part of the Maraniss chapter, the authors describe the way Republican leaders trained themselves not to use the outlawed word—the word they were all inclined to use. As noted, the books reporting was based on frank, open interviews with these GOP leaders.
In 1995, those pols campaigned against the word cuts; today, Pear skips the term almost totally. Here is the opening of his report, in which he explains the Bush proposal:
PEAR (2/4/06): In his budget next week, President Bush will propose substantial savings in Medicare, stepping up his efforts to rein in the growing costs of social insurance programs, administration officials and health care lobbyists said Friday.In this rendering, Bush isnt trying to cut the Medicare program—he is trying to rein in, curb and reduce growing costs. He is trying to limit the growth of domestic programs—which implies that the programs will continue to grow. Under the RNC language regime, reporters are only allowed to say cuts as part of this permitted expression: cut the projected growth in spending. If recent history is any guide, this will lead many readers to a false conclusion. It will lead them to think that Medicare services will increase under Bushs plan.
For the first time since taking office five years ago, they said, Mr. Bush will try to reduce projected Medicare payments to hospitals and other health care providers by billions of dollars over the next five years. In addition, they said, Mr. Bush intends to seek further increases in Medicare premiums for high-income people, beyond those already scheduled to take effect next year.
Despite the failure of his plan to overhaul Social Security last year, Mr. Bush has signaled that he intends to curb rapid increases in federal spending linked to the aging of the population. ''The retirement of the baby boom generation will put unprecedented strains on the federal government,'' Mr. Bush said in his State of the Union address on Tuesday.
Administration officials, Congressional aides and lobbyists said the president was contemplating a package of proposals that would cut the projected growth in Medicare spending by $30 billion to $35 billion in the next five years. That represents less than 1.5 percent of total Medicare spending in those years. But whether Congress has the appetite to trim popular benefit programs in an election year is unclear.
The House passed another deficit-reduction bill this week by just two votes, underscoring the qualms among moderate Republicans about how far to go in limiting the growth of domestic programs at a time when the administration continues to push tax cuts.
Mr. Bush plans to send his budget for next year to Congress on Monday. Many of his proposals follow recommendations from the Medicare Payment Advisory Commission, an independent federal panel.
But would that conclusion be warranted? After adjusting for inflation and for rising health costs, would Medicare services grow at the spending level Bush has proposed? Or would Bushs proposal result in cuts to Medicares actual services? Youd think that would be a seminal question—but Pear doesnt discuss it until paragraphs 9 and 10, when an advocate is allowed to claim—rather obliquely—that Medicare services would have to be cut under the terms of Bushs proposal:
PEAR (continuing directly): At a meeting last month, the panel said hospitals did not have to be fully compensated for the increased costs of the goods and services they used. These costs are expected to rise 3.4 percent in the fiscal year 2007. But the panel said that hospitals could get along with a smaller increase, 2.95 percent, if they became more efficient.Would the current level of Medicare services have to be cut under Bushs proposal? Would future recipients get fewer services than their counterparts get today? Youd think that would be a basic question. But fancy-pants journalists have excellent health care, and may not care much about such matters. At any rate, Pear buries this question quite neatly. In our hard-copy paper, we had to turn inside, to page A8, before Pollack was quoted raising this question—rather obliquely, as we have noted. Out on page one, readers heard about two pleasing things—vast savings and growth in the program. On page one, Bush was just trying to limit the growth of this domestic program.
Jack Ashby, a research director at the commission, said, ''We expect the recommendation to have no effect on hospitals' ability to furnish care to Medicare beneficiaries.''
But Richard J. Pollack, executive vice president of the American Hospital Association, said the cutback could damage the quality of hospital care. Already, he said, two-thirds of hospitals lose money serving Medicare patients.
''At the same time cuts are being proposed,'' Mr. Pollack said, ''demands on hospitals are increasing. We are taking care of a rising number of uninsured, we are investing in new technology to increase patient safety and to move toward electronic medical records, and we are preparing for emergencies, including the threat of pandemic disease.
Under the traditional language regime of both parties, Reagan wouldnt have gotten this treatment; Reagans headline would have said cuts. But working those referees really worked. In the Times, Bush is not proposing cuts. Hes proposing a finer thing—savings.
TELL MARANISS TO SHUT UP: For our money, Gene Lyons Fools for Scandal was the most important political book of the 1990s. (For that reason, career liberals know they must never discuss it.) Right behind it, wed place that chapter on the Medicare battle from the Maraniss/Weisskopf book. But alas! As is the nature of life on our planet, it too disappeared down a well. Journalists seemed disinclined to describe the way they bowed to Republican pressure.
STEPHANOPOULOS GETS IT RIGHT: Savings—or cuts? On yesterdays This Week, George Stephanopoulos deftly challenged this brainless bit of logic:
STEPHANOPOULOS (2/5/06): George [Will] is about to come out for the cuts right here.Thats such an old debate, Stephanopoulos said. And we might add—such an amazingly stupid one! But why does that dim-witted logic still linger? Because the entire press corps knuckled under when the GOP came to power in 1995. Newt told the press corps to stop saying cuts—and the brave boys and girls knuckled under.
COKIE ROBERTS: And I think that you're gonna—this is politically very hard to sell.
WILL: I'd love to come out for cuts but there are no cuts involved. What they're talking about slowing the rate of growth.
STEPHANOPOULOS: Oh, but it's a cut in services. That's such an old debate.
WILL: Then what is left to say if we actually cut them? What word do we use then?
STEPHANOPOULOS: Well, it's a cut to the person who's receiving the service.
Under Bushs proposal, Medicare spending would grow (unadjusted for inflation)—but services would be cut. Its very easy to state the distinction (although it seems that Will is still baffled). But for several years, in the mid-90s, your press corps politely agreed not to do it. On Saturday, an echo of that pitiful conduct sat atop page one of the Times.
Special report—There's something about Maury!
PART 1—NO BUSHEL OF WHEAT LEFT BEHIND: To this day, one is struck by the sheer absurdity of the programs logic. In last Thursdays Washington Post, Jay Mathews penned a detailed, page-one report about Maury Elementary School—a low-income school in Alexandria, Virginia which has struggled to satisfy basic provisions of the No Child Left Behind act. In the spring of 2004, Maury recorded low scores on Virginias Standards of Learning tests—so low that the school was tagged as needing improvement under terms of No Child Left Behind. In 2005, Maurys scores did improve (or seem to improve—more to come later). But early in his front-page report, Mathews gave a thumbnail of NCLB—and we were struck once again, as we always are, by the sheer, unvarnished, complete absurdity of the programs basic logic:
MATHEWS (2/1/06): No school in the Washington area has felt more severely the weight of the 2002 law [NCLB] that not only tracks how well children do on state testing but also demands that schools improve their performance every year. In 2004, Maury students passed the state reading test at the lowest rate in Alexandria: 38 percent of third-graders and 59 percent of fifth-graders passed.No Child Left Behind demands that schools improve their performance [on statewide tests] every year. Mathews paints a detailed portrait of Maurys struggle to improve on Virginias state tests. But that basic demand is so absurd that it simply jumps off the page whenever NCLB is described. Schools must improve their performance every year? By normal standards, this demand is especially daft in the case of a school like Maury—a school with very few students. Last spring, just 43 kids were involved in Maurys high-stakes testing—19 in third grade and 24 in fifth, the only two grade levels tested in Virginia at the time. By normal standards, NCLBs demand for improvement is especially daft in a school with so few kids.
Why is that basic demand so absurd? Because, especially in a small school like Maury, one group of third-graders may not be as capable as the group from the previous year. When youre only dealing with 43 kids, chance variation can render significant effects from one year to the next. And how about this? How about if last years third-grade teacher was especially strong—and she has now been replaced by a first-year teacher? Under that circumstance, does it make really sense to demand improved scores? Meanwhile, school-wide student demographics can change, in ways which may tip the scale against the demand for higher scores. For example, Mathews describes what happened at Maury in 2004, after the school was tagged as needing improvement:
MATHEWS (continuing from above): In 2004, Maury students passed the state reading test at the lowest rate in Alexandria...Uh-oh! If a school loses its (presumably) more capable students, does it still make sense to demand improvement on the next years test scores? In fact, Maury did improve its test scores (or seem to improve them) after this middle-class exodus. (As Mathews describes, an energetic new principal went out and recruited a bunch of new kids.) But did it make sense to demand such improvement? Anywhere else, would anyone think that such a demand made real sense?
That triggered a provision of [NCLB] that allows parents to transfer their children to a better-performing school. Maury's enrollment dropped from 166 to 131. Middle-class parents were the first to leave, pushing the school's percentage of low-income children above 80 percent.
Of course, fractured logic has long been a part of the burgeoning standards movement. At least since 1990, the logic of the Soviet agricultural plan has helped define the scene. For example, in his 1990 State of the Union Address, President Bush the Elder announced six widely-ballyhooed education goals—goals to be met by the year 2000. In an editorial, the Post gave a summary:
WASHINGTON POST (2/2/90): By the year 2000, says Mr. Bush, "every child must start school ready to learn," and "U.S. students must be the first in the world in math and science achievement." The high school graduation rate must be 90 percent, students' progress must be assessed at grades 4, 8 and 12 in "critical subjects"...and "every American adult must be a skilled, literate worker and citizen." And schools must be drug-free.U.S. students must be first in the world, Bush demanded. These goals all sounded very good—in the manner of Soviet-era pledges about vast future bushels of wheat. But uh-oh! As things turned out, U.S. students were not first in the world in math and science in the year 2000, nor had there ever been any reason to think that they actually would be. But so what? Demands and goals and pledges come cheap. Indeed, the soul of the Soviet bureaucrat lives in a basic goal of NCLB—proficiency for all students in reading and mathematics by the year 2014. That laughable promise wont be kept, either. But Margate Spellings keeps insisting that the goal will not be dropped.
So yes—one is always struck by the fractured logic at the heart of No Child Left Behind. As a rational matter, it doesnt make sense to demand that every school make improvement each year, and no one can seriously believe that all our kids will be proficient by 2014. But hold on! Football coaches tell their teams to give 110 percent, and that demand doesnt quite make sense, either. But the demand may have motivational effects which make up for its failure to parse.
NCLB demands that schools like Maury accomplish things which dont make sense. But do schools like Maury, struggling to comply, end up gaining from such demands? Mathews describes a massive effort as the hard-working staff at Maury tried to get off that needs improvement list. Tomorrow, well look at some parts of that effort which may have made sense—and well note a few others that didnt.
Well watch as Maury tries to move up. But will we really see Maury succeed? You might think so from reading the Mathews report (see below). But did Maury really succeed?
TOMORROW: See Maury try harder
SEE MAURY SUCCEED: Has low-income Maury become successful? That was the message Post editors gleaned from the Mathews report. Heres part of a Sunday editorial about No Child Left Behind:
WASHINGTON POST EDITORIAL (2/5/06): By helping to fine-tune and implement [NCLB] instead of constantly running it down, Democratic politicians, child welfare advocates and teachers unions could help fix broken school systems as well. A profile of once-disastrous, now-successful Maury Elementary School in Alexandria by The Post's Jay Mathews last week showed what can be achieved if teachers and administrators use the law well. It's an odd idea, getting the Democrats to embrace a Republican project. But if they are brave enough to do it, thousands of inner-city children will be better off.According to the high-minded editors, Maury was a disaster—but now its successful. Well revisit—and evaluate—the Posts pleasing statements at the end of our series this week.