If you’re a Republican, Representative Paul Ryan’s (R-WI) proposed budget puts you in a tight spot. Ryan’s plan is so enormously popular on the right that any criticism of it can practically get a presidential candidate disqualified. Just ask Newt Gingrich, who correctly called Ryan’s plan, which would eliminate Medicare and replace it with vouchers for seniors to buy health insurance, as “right-wing social engineering.” The condemnation from conservative pundits such as Rush Limbaugh was so furious that Gingrich had to call Ryan personally to apologize. Even though Gingrich retracted his comments, he has more recently reiterated, again correctly, that Ryan’s plan is unpopular among the American public.
Romney didn’t make Gingrich’s mistake. He has wholeheartedly embraced Ryan’s plan and he routinely attacks Gingrich for not having done so. That’s good politics in the Republican primary, but terrible politics in the general election. Republicans need to win heavily among older white swing voters to win in November, and seniors love their Medicare.
That meant the eventual Republican nominee would face quite a conundrum next year. But here comes Senator Ron Wyden (D-OR) to the rescue! On Thursday Wyden and Ryan introduced a new plan with no apparent rationale except to provide political cover for Republicans. The new version would allow seniors who choose to stay on Medicare to do so, but allow others to use vouchers—excuse me, “premium support”—to buy private plans. What’s the point? Seniors are already covered. Theoretically, it might save money through competition, although the competitive private insurance market for people under 65 is more expensive, not less so, than Medicare. Also countries with uncompetitive single-payer systems pay less for better results than our private market. And indeed, Wyden acknowledges that it might not save any money.
So, there’s no expanded coverage and potentially no cost savings, only conservative ideology. Igor Volsky of Think Progress writes, “They’re willing to set the nation on an untested path of private competition that breaks up the large market clout of Medicare (which is now experimenting with more efficient ways to pay providers) and pushes seniors into less efficient private plans. It moves the health care system closer to the Ryan ideal in which future Congresses would be able to reduce federal costs by eating away at the premium credit seniors receive.” In other words, once you set up a system where seniors get a defined contribution from the federal government instead of a defined benefit, Republicans in Congress can reduce the size of the benefit. That would save money, but at the cost of depriving seniors of medical care they need. Call it the ultimate death panel.
Even before future Congresses start cutting the premium support, you will run the risk that seniors on private plans will be inadequately covered. So Ryan-Wyden pledge to introduce complex regulations into the system to ensure minimum levels of coverage. But currently the precise details and mechanisms are unclear.
As Jonathan Cohn explains in The New Republic, an actual bipartisan compromise would be adopting the premium support model with a public option such as Medicare for the entire population, not only those over 65. Cohn writes: “Wyden is embracing premium support and, in the process, lending respectability to Ryan and the House Republicans. Ryan although distancing himself from his former proposal, still isn’t coming to terms with the Affordable Care Act. That’s been the story for a while now: Democrats are more willing to compromise than Republicans. Until that changes, Democrats make concessions at their own peril and with great risk for their constituents.”
But Romney must be thrilled. Now he doesn’t have to campaign on an unpopular plan to eliminate Medicare and President Obama cannot attack him for doing so. If you’re still wondering how Democrats manage to lose so many elections and policy fights in a country that largely agrees with them on the issues, here’s your answer.