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It’s been a common refrain of politicians in Washington for as long as the capitol has been unpopular: “It’s good to get outside the Beltway, good to go get back to the real America.” But in recent days that cliché might feel a bit stale for Republican House members, who voted last month for Representative Paul Ryan’s budget proposal. Inside the Beltway, Ryan is called “courageous,” a “visionary,” a “serious man,” for having the bravery to put forth a budget that pays for tax cuts for the wealthy by ending Medicare as we know it. Back home in his district, he’s becoming known as the leader of the most serious assault on seniors since President Bush’s attempt to privatize Social Security.

In April, Ryan was greeted, not with the outsized praise of New York Times columnist David Brooks at his town hall in Milton, Wisconsin, but instead, with sustained boos. On Friday, according to Politico, he asked police to remove a man from his town hall because the man refused to stop yelling about the impact the Ryan budget would have on Medicare.

He’s not alone. In New Hampshire, the first six questions posed to Representative Charlie Bass (R-NH) were about his vote in favor of Ryan’s budget. “I’m not surprised it’s controversial,” said Bass of his vote. But for a man who won his seat during the 2010 Republican wave by a little more than 3,000 votes, it’s an open question as to whether his career can afford such controversy.

In addition to Ryan and Bass, at least six other GOPers have faced pointed questions and outright protest at town halls, reminiscent of the tea party anger seen at Democratic town halls in 2009. Rep. Daniel Webster (R-FL) arrived at his town hall greeted with signs that said “Hands Off Medicare.” The meeting became so contentious that police officers intervened to quiet the crowd. The New York Times described one such town hall as approaching “near chaos.” The Orlando Sentinel described another as reaching the level of “bedlam.”

Already, some members are backing away from their votes. By the end of Charlie Bass’s town hall, he already seemed to be wavering. “If there are certain facets of the budget that are manifestly unpopular, I think that should be taken into consideration.… this is the beginning of a long conversation.” How manifestly unpopular is Ryan’s plan for Medicare? A recent Washington Post/ABC News poll showed that more than 80 percent of all Americans disapprove of cuts to the program. A whopping 70 percent of Republicans opposed them, as well, making it one of the most unpopular positions supported by a national party in modern memory.

Even Speaker Boehner himself ducked away from the budget. He told ABC News, “It’s Paul’s idea. Now other people have other ideas. I’m not wedded to one single idea.” Last week, Washington Post reporter Greg Sargent, writing about yet another town hall uproar, asked if we could “call this a national phenomenon yet?”

In the words of President Obama, yes, yes we can.

Democrats and progressive allies are already getting started, working to mobilize voters to attend future town hall meetings. A campaign called “Don’t Make Us Work ‘Til We Die” organized two days of action in thirty five cities across the country in April. MoveOn.org is encouraging its members to attend town halls, as well. The Congressional Progressive Caucus is planning a whistle stop “people’s agenda” tour in seventeen cities—as a follow up to their “People’s Budget.” Other groups are planning large mobilizations in August, to coincide with the month-long summer recess.

SEIU, for example, plans to organize massive nationwide protests around “national flash points,” including during August recess. “We felt like we were called in this moment to roll the dice and to think about how to use our members resources for the greatest hope for changing members lives,” SEIU President Mary Kay Henry says. “I hope what people will see is more of what we all witnessed in Madison…more people in the streets making demands about what kind of America we want to see.”

As The Nation’s John Nichols reports, the goal of this campaign, called “Fight for A Fair Economy,” is to begin shifting the character of the national debate, from one defined by right-wing talking points and ginned up by tea party “populism” to one that reflects the aspirations of the poor and middle class.

And with the recent announcement that Harry Reid will hold a vote for the Ryan budget in the Senate, it’s clear that the issue of ending Medicare won’t just be the House’s albatross.

Democrats see a lot of short-term political opportunity here. Seniors have been the least receptive of any demographic group to President Obama and Democrats in Congress. Even a modest swing in their vote could upend the political landscape. Steve Israel, chairman of the DCCC, has said he believes the Ryan budget, which all but four Republicans voted for, will cost the Republicans control of the House come 2012. And it may remake the dynamic in the Senate, where conventional wisdom has suggested that Democrats are especially vulnerable to losing control of the chamber.

There’s no question that the issue allows progressives to draw clear distinctions between Republicans and themselves, and with such overwhelming opposition to the Ryan plan, it’s likely that the GOP will be on the defensive for months, if not years, to come.

But there is also a broader, and perhaps more important opportunity for progressives: the opportunity to reset the terms of the debate and make an aggressive case for what the president called “the basic social compact in America.” The 2009 town hall protests were characterized by misinformation. The now infamous protest sign that read “Take your government hands off my Medicare” was emblematic of a decades-long campaign to denigrate government, leaving the American people with a deeply false impression of its role in their lives.

Indeed, a 2010 study by Cornell political scientist Suzanne Mettler found that when Medicare beneficiaries were asked if they had ever benefited from a government social program, 40 percent said no. Forty-four percent of Social Security beneficiaries said the same thing, as did more than a quarter of food stamp users and 43 percent of unemployment insurance receivers.

But unlike the 2009 protests, the 2011 protests represent a genuine opportunity to cast government not as something to be “drowned in the bathtub,” as Grover Norquist once described it, but instead, as a crucial lifeline, not just for the working class, but for every American. With Medicare as a shining example, this new national conversation has the potential to redefine government not as a guttural negative, but as a vital partner in American life.

Republicans have been caught flat-footed in this debate. What has been most astonishing thus far hasn’t been the national reaction to the budget, but Republicans’ surprise at it. They are apparently so disconnected from the lived experiences of most Americans that they genuinely believed ending Medicare would have broad appeal. Now they’re learning the hard way, and yearning for a swift return back to the warm embrace of Washington.

By Dean Baker for the Guardian –

The film Casablanca features one of greatest moments in movie history. With Humphrey Bogart standing with a smoking pistol over the body of the dead Gestapo major, Claude Rains, in the role of the French colonel, tells his troops: “the major has been shot, round up the usual suspects.”

Unfortunately, the Washington policy gang is busy following Claude Rains’ instructions. The nation is drowning in endless accounts of how the huge deficit will sink the economy and the country. These accounts invariably feature stories of a Congress addicted to spending and a nation that wants government benefits that it doesn’t want to pay for.

This story has nothing to do with reality, as all budget analysts know. The explosion of the budget deficit in the last three years is a response to the plunge in private sector demand following the collapse of the housing bubble. If the budget deficit were smaller, we would simply have less demand and fewer jobs.

Paul Ryan did his best to lay out the long-term story as clearly as possible with his plan to privatize Medicare. The analysis by the non-partisan Congressional Budget Office (CBO) shows that Ryan’s plan would hugely increase the cost of healthcare to seniors. Under the Ryan plan, a Medicare-equivalent policy is projected to cost almost half of a median 65-year-old retiree’s income by 2030. It would soon exceed the income of most retirees, as healthcare costs outpace income growth.

However most of the additional burden projected for retirees is not the result of cost-shifting from the government. The vast majority of the additional burden that the CBO projected for retirees comes from the higher cost of private insurance compared with the government-run Medicare system. The additional cost as a result of adopting Ryan’s privatized system is more than $30tn over Medicare’s 75-year planning horizon.

To put this in perspective, CBO’s projected increase in the cost of buying Medicare-equivalent insurance policies through the private sector is roughly six times the size of the projected social security shortfall. The projected shortfall in social security has sent thousands of politicians screaming about devastating burden on our children. How, then, should we describe something that is six times as large as this “devastating burden”, a sum that is just under $100,000 for every man, woman and child in the country?

The CBO analysis should have led every budget reporter in the country to point out the enormous cost savings that Medicare provides relative to private insurers. They should have been pointing out that the country will face an enormous burden from exploding healthcare costs if it does not fix its healthcare system. And that the Medicare system is an important part of the solution.

However, it seems that no budget reporters – not a single reporter at the New York Times, Washington Post, Wall Street Journal or any other major news outlet – picked up on this central point in the analysis from the CBO. Instead, they talked about the plan as a question of whether people preferred a government guarantee or would rather have individuals rely on themselves and the market to obtain healthcare in their old age. The $30tn price tag – in the form of added waste – was altogether missing in the reporting.

Perhaps, this should not be surprising. After all, reporters at major news outlets are better known for what they miss than what they catch. The vast majority of them bought President Bush’s nonsense about Saddam Hussein’s weapons of mass destruction in the period leading up to the Iraq war. While the Bush administration’s accounts were presented with due solemnity, the voices of skeptics were rarely heard.

Similarly, there was almost no reporting on the $8tn housing bubble, the collapse of which has given us the worst economic downturn since the Great Depression. Instead, we were given the assurance from Alan Greenspan, Ben Bernanke and the rest that everything was OK. And instead, the news outlets told us to worry about the budget deficit – back when it was just 1.0% of GDP.

Incredible as it may seem, the national press corps is almost completely ignoring a report from the government’s main source of budget projections. Rather than telling people that the Ryan plan to privatize Medicare means transferring tens of trillions of dollars from taxpayers and Medicare beneficiaries to private insurers and the healthcare industry, they spread drivel about the issue being a matter of whether people like the government or the market.

This fits the “usual suspects” story. The ostensible choices are between those who prefer the government and those who prefer the market. But the real smoking gun is in the hands of those who want to redistribute tens of trillions of dollars to the insurance and healthcare industry. Preferences for the government or the market have nothing to do with it.

House Republicans plan this week to propose more than $4 trillion in federal spending reductions over the next decade by reshaping popular programs like Medicare, the Budget Committee chairman said Sunday in opening a new front in the intensifying budget wars.

Appearing on “Fox News Sunday,” the chairman, Representative Paul D. Ryan of Wisconsin, also said Republicans would call for strict caps on all government spending that would require cuts to take effect whenever Congress exceeded those limits.

“We are going to put out a plan that gets our debt on a downward trajectory and gets us to a point of giving our next generation a debt-free nation,” Mr. Ryan said, even as he predicted that the politically charged initiatives he intended to lay out in the 2012 budget beginning Tuesday would give Democrats a “political weapon to go against us.”

“But they will have to lie and demagogue to make that a political weapon,” he said.

Republicans and Democrats remained divided over how to reach an agreement that would avert a government shutdown, which could come as early as Saturday, when a budget bill now financing the government is set to expire.

Senator Charles E. Schumer of New York, the chamber’s No. 3 Democrat, said progress was being made, but neither he nor other top lawmakers could guarantee that government agencies would be able to stay open after Friday.

Mr. Schumer said Democrats were urging Republicans to consider reducing some of the automatic annual spending in Agriculture, Treasury and Justice Department programs to reach a target of about $33 billion in cuts rather than insisting that it all come out of what is known in budget parlance as discretionary accounts.

A Democrat involved in the negotiations, who spoke on the condition of anonymity, said alternative spending cuts from the White House and Senate Democrats would range up to $8 billion. But to the Democrats’ dismay, not only were Republicans resisting those cuts, they were also proposing more spending than the Pentagon wants for military and homeland security programs.

“If you just cut from domestic discretionary, you’ll have to cut things like helping students go to college; you’ll have to cut scientific research, including cancer research,” Mr. Schumer said on the ABC News program “This Week.” “These things have created millions of jobs through the years.”

Continue reading…

By NEIL KING JR. and SCOTT GREENBERG for the WSJ –

WASHINGTON— Less than a quarter of Americans support making significant cuts to Social Security or Medicare to tackle the country’s mounting deficit, according to a new Wall Street Journal/NBC News poll, illustrating the challenge facing lawmakers who want voter buy-in to alter entitlement programs.

A new WSJ/NBC poll shows Americans do not approve of the government slashing Social Security and Medicaid to reduce the nation’s deficit. They also have a bleak economic outlook for 2011, but feel President Obama is handling the economy well.

In the poll, Americans across all age groups and ideologies said by large margins that it was “unacceptable” to make significant cuts in entitlement programs in order to reduce the federal deficit. Even tea party supporters, by a nearly 2-to-1 margin, declared significant cuts to Social Security “unacceptable.”

At the same time, a majority supported two specific measures that lawmakers might employ to shore up the shaky finances of the main entitlement programs.

More than 60% of poll respondents supported reducing Social Security and Medicare payments to wealthier Americans. And more than half favored bumping the retirement age to 69 by 2075. The age to receive full benefits is 66 now and is scheduled to rise to 67 in 2027.

Depending on how they are structured, those two changes could eliminate as much as 60% of Social Security’s underfunding, according to experts. Support for the two ideas in the poll is “impressive,” said Chuck Blahous, one of the program’s public trustees and a former Bush administration official. “I wonder if [public] receptivity is increasing.”

The poll comes as Republican lawmakers, many elected on promises to slash federal spending, have focused mostly so far on cuts to non-defense, discretionary programs. But many political leaders say meaningful deficit reduction cannot be accomplished without making changes to entitlement programs.

A small group of senators in both parties has begun discussions that include changes to entitlement programs, as well as to the tax code. House Republicans say they will address entitlements in their next budget. And several likely 2012 GOP candidates have vowed to to shore up the finances of Social Security and Medicare as part of their campaigns.

But Republican Bill McInturff and Democrat Peter Hart, the pollsters who conducted the survey, said the poll raises warning signs for anyone proposing cuts to the three main entitlement programs, including Medicaid, that provide health and retirement benefits to seniors and the poor. The programs, which already make up 41% of federal spending, are expected to balloon in coming years.

Mr. McInturff called the poll “a huge flashing yellow sign for Republicans on how much preparation will be needed if they propose to change Social Security and Medicare.”

Asked directly if they thought cuts to Medicare were necessary to “significantly reduce” the deficit, 18% of respondents said yes, while 54% said no; the rest were not sure or had no opinion. On Social Security, 22% said cuts would be needed, while 49% said they weren’t.

The results cannot be compared easily to prior polling, but they suggest durability to the support for entitlement programs. In 1995, when Congress was considering cuts to Medicare, 36% said in a Journal/NBC poll that they supported a plan to cut Medicare spending and devote the money to deficit reduction. Some 52% called for maintaining Medicare at its existing level.

Overall, the new poll found deepening pessimism about the future of the economy and the country’s direction. Only 29% thought the economy would get better over the next year, a dip of 11 points since last month and the lowest since August. “This is a country that refuses to feel better,” said Mr. McInturff.

Mr. Obama’s own job approval dipped to 48%, from 53% last month, but was still higher than at any time since last May. Some 46% disapproved of his job performance. Mr. Hart, the Democratic pollster, said that until the unemployment rate dips significantly, “it is always going to be a struggle for the president to get majority support.”

As a snapshot of public opinion, the poll highlights some of the perils ahead for Republicans as their core voters and tea party supporters demand big reductions in federal spending to tame the deficit.

More than seven in 10 tea party backers feared GOP lawmakers would not go far enough in cutting spending. But at the same time, more than half of all Americans feared Republicans would go too far.

Among those most fearing spending cuts were younger voters, independents, seniors and suburban women—groups that include many swing voters in national elections, who potentially could turn against the GOP.

“It may be hard to understand why someone would try to jump off a cliff” to solve the debt crisis, Mr. McInturff said of his fellow Republicans, “unless you understand that they are being chased by a tiger, and that tiger is the tea party.”

Rep. Kevin McCarthy of California, the Republican House whip, said his party needs “to have a conversation with people” before moving forward on jarring changes to federal entitlement programs.Don Dunlap, an 82-year-old writer and Republican in Sunnyvale, Calif., is one of many voters who need some convincing. “We’re spending ourselves to oblivion—we haven’t seen a comparable level of spending since the Roosevelt era,” he said. “But Social Security is not the right place to trim the budget.”

“You don’t go out and lay out the solution without talking about the problem,” he told reporters at a Bloomberg News breakfast Wednesday.

Assessing the president’s position ahead of the 2012 election, the survey found Mr. Obama leading potential GOP challenger Tim Pawlenty, the former governor of Minnesota, 50% to 31%.

Mr. Obama led by a narrower 49% to 40% margin in a hypothetical match-up against Mitt Romney, the former Massachusetts governor and a Republican candidate in 2008. When tested against an unnamed Republican running for president, Mr. Obama led 45% to 40%. Mr. McInturff said the finding contained warning signs for the president: Voters who remained uncommitted might be tough for the president to win, he said, as those voters disapproved of Mr. Obama’s job performance and believed the country was on the wrong track by large margins.

Four years after starting his effort to win national office, Mr. Romney is known by 80% of the public, with 25% saying they feel positively toward him and an equal 25% saying they have negative feelings toward him.

Amid the union protests in Wisconsin, the poll found that 62% of Americans oppose efforts to strip unionized government workers of their rights to collectively bargain, even as they want public employees to contribute more money to their retirement and health-care benefits.

The results suggest that public opinion may be tipping against Wisconsin Republican governor Scott Walker in his prolonged faceoff with the unions.

By Suzy Khimm for Mother Jones –

Republicans have a new target, and its name is Medicaid. A few weeks ago, at the sidelines of the budget debate, Republicans quietly began to float proposals to roll back this health care program for the nation’s most vulnerable. In Washington this week, those under-the-radar whispers grew to a roar as GOP governors called on Congress to let them have their own way with the program.

As it stands now, states receive a percentage of their Medicaid money from the feds—based on the size of their beneficiary pool, among other factors. In exchange, they must follow guidelines governing minimum benefits they must offer and who must be eligible. Under health care reform, more than 12 million Americans will join the Medicaid rolls, and states will no longer be able to skimp on benefits.

Republicans have responded by reviving an old idea. They are pushing for an alternate system of block grants wherein states would receive a fixed amount of federal money and be free to administer care as they see fit—which could include significantly scaling back their programs should they so chose.

Rep. Cathy McMorris Rodgers (R-Wash.), the fourth highest-ranking Republican in the House, is at the forefront of the push in Washington. She’s currently examining a proposal that would let states opt out of existing Medicare and into some such alternate setup. “The key is flexibility,” she told Mother Jones, employing the GOP’s latest buzzword. “Perhaps those who want to stay with the current system could do so,” the congresswoman adds. “Those states that want a different option could do so, with the flexibility. We need to work on it.”

The GOP has been pushing for Medicaid block grants ever since the Clinton era, but has been unable to overcome protestations from Democrats decrying their efforts as attacks on the poor. This notion of “opt-out/opt-in” may have a better chance of attracting support from conservative Democrats, and also Republicans concerned about cutting entitlements in states with politically significant numbers of Medicaid beneficiaries.

Continue reading…

Hiding out at a secret location in Illinois, Wisconsin state Sen. Kathleen Vinehout ends every media interview with the same warning: Republican Gov. Scott Walker’s attack on public employee unions is overshadowing another part of his budget plan that could shred the state’s health care safety net.

The governor’s proposal, part of “budget repair” bill would allow the Walker administration to make potentially drastic changes in health programs with little legislative oversight, a move officials say will make it easier to tackle a looming, two-year $3.6 billion deficit. But the result, Vinehout predicts, is that “large numbers of people will lose BadgerCare,” a component of Wisconsin’s Medicaid program.

Taking the lead in revamping health programs for the poor would be Dennis Smith, Wisconsin’s new health secretary. A mild-mannered bureaucrat and head of the federal Medicaid program under President George W. Bush, he’s known within policy circles for staunchly conservative views and stinging critiques of President Barack Obama’s health care law.

Under Walker’s plan, Smith could reshape critical aspects of Wisconsin Medicaid and potentially strip tens of thousands of people from the rolls. He’d also be directed to ask the federal government for permission to go further.

In the process, Smith could chart a course for other Republican-led states seeking to reduce deficits by paring Medicaid. And he could emerge as a national leader in the right’s resistance to the new health law, an increasingly important issue in the lead-up to the 2012 elections.

Still, Smith faces some hurdles. The health law makes an additional 16 million people eligible for Medicaid, a joint state-federal program, beginning in 2014 and bans states from dumping most people who are now covered.

Nonetheless, an analysis by the independent state Legislative Fiscal Bureau says Wisconsin could drop about 70,000 higher-earning adults from Medicaid without getting permission from Washington.

Smith is already edging into the national spotlight – in part thanks to House Budget Committee Chairman Paul Ryan of Wisconsin. A day after Smith was confirmed as health secretary, he was called before the panel to testify on how the health law will hurt the state’s residents.

“Expanding Medicaid under the current framework doesn’t make sense,” he told Kaiser Health News in late 2009 as the law was being debated. “You’ve got to give states flexibility.” (Smith couldn’t be reached for comment for this story.)

Just over a million people in Wisconsin are enrolled in Medicaid, at a cost of more than $6.5 billion in 2009, the latest year available. That year, the federal government picked up almost 70 percent of the cost, but the share will decline when stimulus funds dry up this summer. Walker says Medicaid costs are at the root of half of the projected deficit.

Currently, most major Medicaid changes must be cleared by the full Wisconsin legislature. But, under Walker’s bill, Smith’s health department could make those changes through an emergency rule-making process without legislative approval. The Joint Committee on Finance would have 14 days to veto the changes. But critics say the new rules mean Smith and Walker wouldn’t have to present detailed plans to the public.

What Smith comes up with “may be brilliant,” says David Reimer, a former state budget official who is now director of Community Advocates Public Policy Institute in Milwaukee. “It may be awful. But we don’t know.”

Smith, an Illinois native, was head of the federal Center for Medicaid and State Operations from 2001 to 2008. He also worked on Capitol Hill and ran Virginia’s Medicaid program. Before becoming Wisconsin’s health secretary, he was a senior fellow at the conservative Heritage Foundation and also worked for Utah-based Leavitt Partners, a consulting firm set up by Michael O. Leavitt, former secretary of the Department of Health and Human Services.

Leavitt says Smith left the consulting firm because “he wanted to use his experience in a laboratory where his vision could be demonstrated. There’s no question that if he’s able to put it together and make it work, others will follow him.”

Still, while it’s clear that Walker and Smith want to tackle Medicaid, the question is: What’s their plan? The budget bill outlines some likely changes, but also gives Smith leeway to make broader ones that aren’t yet clear.

In the past, Smith has consistently argued that Medicaid should focus only on the poorest people (Wisconsin covers individual adults earning nearly $22,000), and should rely on private managed-care programs to restrain costs. He also has promoted charging recipients higher co-pays to try to dissuade them from seeking unnecessary treatments.

Critics, such as Judith Solomon, an analyst with the liberal Center on Budget and Policy Priorities, say Smith has long advocated policies that could hurt the poor and undermine the intent of Medicaid. Opponents also cite a 2009 paper published by Heritage that seemed to advise states to drop out of Medicaid altogether.

But Robert Moffit, a senior fellow at Heritage who brought Smith to the think tank in 2008, says while “there’s no question Smith is a real conservative,” he’s thoughtful and open to new ideas.

As head of the federal Medicaid program, Smith issued a record number of waivers that allowed states to experiment — including increasing the use of managed care and allowing states to find new ways to pay doctors and hospitals.

“How many newly insured individuals gained health insurance under the Bush administration because of our waivers?” Smith said in the 2009 interview. “Instead of getting credit for that, we got criticism” from liberals who wanted Washington to control the programs more tightly, he said.

The Obama administration is likely to resist the kind of changes Smith will likely want to make in Wisconsin. Though federal Medicaid officials would not specifically comment on Wisconsin, they indicated that the types of policies suggested in Walker’s bill — such as barring people who are likely eligible for Medicaid from receiving services before being formally enrolled — could pose problems.

But Leavitt, Smith’s old boss, says economic problems have become so severe that something has to give. “Health care policy has always been driven by human compassion,” he says. “We can’t lose it, but we are now dealing with a new factor.”

ALBANY — In an unexpected vote, a committee appointed by Gov. Andrew M. Cuomo to cut billions in health care spending approved on Thursday an annual spending cap and across-the-board reductions for all Medicaid providers.

The vote, on 79 cost-cutting measures, was part of a sweeping overhaul of how the state finances the program for the poor and disabled. It came only five hours after some of the measures had been made public, and only minutes after state officials had finished explaining how some of the proposals would work.

But hospital and union leaders on the committee said they believed they had reached their goal and did not need any further study, and Mr. Cuomo said he would add the recommendations to his budget, which is before the Legislature.

“People said, ‘Well, this will never happen, it will never be done, it’s too difficult, they’re too contentious a group,’ ” Mr. Cuomo said. “Lo and behold, they did it.”

Mr. Cuomo had asked the committee to give him recommendations by March 1 on how to reduce Medicaid spending without simply cutting payments to health care providers.

The package the panel approved, which totaled $2.3 billion in savings, includes dozens of ideas culled from the health care industry and from public hearings in a two-month sprint overseen by Jason A. Helgerson, the state’s Medicaid director. But those ideas added up to only $1.1 billion, so the committee concluded that more traditional cuts, including cuts to some reimbursement rates, would be unavoidable.

It remains to be seen how receptive the Legislature will be to the measures, which would give the Health Department significant power to make some future rate cuts without legislative approval.

Mr. Cuomo’s budget director, Robert L. Megna, said that the committee needed to find less in savings than budgeters had originally thought, because a revised budget analysis was projecting that the Medicaid caseload would grow less than expected.

The proposals include measures to move more people to managed care; impose spending controls on home health care and personal care; and limit noneconomic damages in medical malpractice cases.

Other savings would come from the spending cap, which would require a rate cut that totals $345 million, and as much as $640 million in future cuts if providers cannot find their own ways to reduce spending in the meantime.

“You don’t challenge the kind of budget deficit that we had without dealing with pain,” said George Gresham, the president of 1199 S.E.I.U. United Healthcare Workers East. “This,” he added, “resulted in pain, but it was shared pain.”

The vote marked a huge political victory for Mr. Cuomo, whose predecessors had been bludgeoned during budget season by television advertisements financed by many of the same officials who smiled broadly alongside the governor inside the Capitol’s ornate Red Room on Thursday.

“This is a historic day by any stretch of the imagination,” said Kenneth E. Raske, the president of the Greater New York Hospital Association.

Still, Health Department officials acknowledged that many details still needed to be worked out. One committee member, Assemblyman Richard N. Gottfried of Manhattan, a Democrat and the chairman of the Assembly’s Health Committee, doubted that a key provision in the proposal to create the spending cap would even be constitutional.

The committee had been scheduled to meet again Friday to review the proposals, and then hold a formal vote on Tuesday, a month before the Legislature’s deadline to pass a budget. But over lunch on Thursday, the members decided they did not need more time.

“It didn’t serve any purpose to belabor the issue and just continue just for the sake of continuing,” said a co-chairman of the committee, Michael Dowling, the president and chief executive of the North Shore-LIJ Health System.

In the end, 20 committee members voted to approve the cuts, while 4 others abstained — including Mr. Gottfried, who called the abrupt vote “highly inappropriate” — and 3 were absent.

One of those who did not show up at the meeting was Jeffrey A. Sachs, a close friend of Mr. Cuomo’s, who has come under fire from government watchdogs for refusing to fully disclose the clients of his consulting business, which include major New York hospitals likely to be affected by the recommendations approved on Thursday.

A spokesman for Mr. Sachs declined to explain his absence.

Mr. Cuomo, asked by a reporter about the potential conflicts involving friends from whom he seeks policy advice, noted that members of the Medicaid team were not subject to disclosure laws.

“I take friends’ advice, plus or minus, with a grain of salt,” he said yesterday. “If they’re a friend, I know where they’re coming from, I know who they are, I know their bias, I know their perspective.”

Lost amid the budget battles in Congress and the anti-union legislation being considered in several states has been the White House’s deliberate decision to take the topic of Social Security reform off the deficit debate menu.

The latest move in that direction came on Tuesday, when Jason Furman, deputy director of the President Barack Obama’s National Economic Council, insisted that talk of Social Security reform “is not one you care about” if “you are worried about our long-run fiscal future.”

“The reason you care about it is because you want to strengthen Social Security,” Furman added in a speech at the progressive nonprofit group NDN. “It is such a critical part of our social insurance, the bedrock of retirement security for senior citizens, one of the leading anti-poverty programs for children, critical support for people with disabilities. And for all those reasons and the fact that its solvency … is another 26 years, till 2037, the real motivation is strengthening the program.”

Those remarks are a strong reflection of growing defensiveness on the White House’s part in response to calls to reform the longstanding entitlement program. During this year’s State of the Union address, Obama said he would “speak out against” plans to “target” Social Security should they materialize in Congress. Top adviser David Plouffe likewise said the president would neither slash nor reduce benefits while in office.

Furman’s comments are more assertive in their framing. Rather than merely ruling out drastic changes to the entitlement program, he is arguing that Social Security has no place in a debate over the deficit — a position directly at odds with the conclusions reached by the chair’s of president’s own deficit commission.

Earlier on Tuesday, another Obama administration official made a similar case. In an op-ed in USA Today, Office of Management and Budget Director Jacob Lew wrote that “Social Security does not cause our deficits” and that the program’s “benefits are entirely self-financing.”

“Strengthening Social Security is an important, but parallel, issue that needs to be addressed as quickly as possible,” Lew wrote. “But let’s not confuse it as either the cause of or a solution to our short-term fiscal problems.”

By Theodore R. Marmor and Jerry L. Mashaw for Philly.com –

The continuing discourse about the federal budget deficit and Social Security has proven to be thoroughly misleading and confusing. As a result, most Americans are understandably uncertain about the financial stability of Social Security and its connection to the budget deficit. We offer some examples of how not to regard this connection, all drawn from the public debate of the past year.

Social Security retirement benefits, we regularly hear, must be cut to solve the nation’s long-term budget deficit. This is triply wrongheaded.

First, the retirement program has a $2.6 trillion surplus; it’s an island of green in a sea of red ink. Second, virtually all of the nation’s long-term deficit can be blamed on interest on the national debt and rising health-care costs. Third, the idea that pensions must be cut relies on two assumptions: that the Social Security program is in trouble, and that its revenues cannot be increased – neither of which withstands examination.

Critics regularly claim that Social Security faces a looming fiscal crisis. There may be a crisis someday, but it is not “looming.” If, as the program’s trustees say, Social Security can pay 100 percent of promised benefits for the next 20 to 30 years, what is the immediate problem? There is none.

Social Security is not free of issues, and there are ways to responsibly increase confidence in the program. But making significant cuts in benefits now on the basis of 75-year projections would be a very strange approach. Would any serious person have made significant policy decisions in 1936 on the basis of predictions about the state of the economy and pensions in 2011?

Some opponents of Social Security claim the crisis is already here. One version of their story is that the $2.6 trillion surplus in the program’s trust fund is a “hoax.” Because the trust fund holds U.S. Treasury bonds, these critics mock it as relying on mere pieces of paper, or “IOUs.”

Bonds, of course, are pieces of paper that promise future payments to the bondholder. But U.S. Treasury bonds are known in the world of finance as virtually riskless investments; there is no more secure financial instrument. Its reliance on Treasury bonds does not make the Social Security trust fund a “hoax.”

Similarly, the public is warned that Social Security is a “Ponzi scheme.” The critics mean that, trust fund aside, benefit payments to today’s retirees are financed by today’s workers, and the benefits of the next generation will be financed by the following generation, and so on.

If a private individual – Bernie Madoff, for example – sets up a plan in which future payments depend on attracting new investors, it’s an unsustainable Ponzi scheme. At some point, all such schemers will fail to attract enough new investors to pay their existing clientele. The scheme goes bust.

But Bernie Madoffs do not have taxing power. This Ponzi analogy defines any government program or contract that relies on future taxes as a fraud. That makes no sense.

The analogy might apply if it were politically impossible to increase Social Security’s long-term financial stability by raising revenues in the future. And one can imagine a world in which the federal government stops making good on some of its promises because of the public’s aversion to taxes. But it’s very hard to imagine that in the case of Social Security. Whatever they think about taxes in general, polls show that Americans of every age, income group, and political party would overwhelmingly prefer raising the taxes that support Social Security to reducing its benefits.

In short, linking Social Security financing to the broader federal budget deficit is misguided. And arguing that its finances are fictitious or unsustainable is nothing more than a scare tactic designed to tarnish America’s single most popular public program.

Theodore R. Marmor is a professor emeritus at the Yale School of Management. Jerry Mashaw is a professor at Yale Law School.