Paul Ryan’s Plan to Destroy Medicare

Paul Ryan’s Plan to Destroy Medicare

Paul Ryan’s Plan to Destroy Medicare

The threatened government shutdown was averted, but Democrats agreed to $38 billion in budget cuts. Here’s what we’ll see in the next negotiations.


As an opening salvo from Republicans in the 2012 budget debate, the plan offered by Wisconsin’s Paul Ryan—supposedly a model of “seriousness” and “courage” next to overzealous Tea Partiers and Democrats silly enough to want to keep the government minimally functional—is remarkable mostly for its cynicism.

Consider Ryan’s approach to Medicare. One of the most fundamental tensions in our politics is that senior citizens are, simultaneously, the demographic group that most benefits from the welfare state and the one most sympathetic to the right-wing push to abolish it. The only age group in which McCain beat Obama was voters 60 and older. Part of the reason Democrats fared poorly in 2010 is that voters 60 and older made up 34 percent of the electorate, up from 23 percent in 2008. Senior citizens were also the group most opposed to Obama’s Affordable Care Act, with 58 percent now in favor of repeal.

This produces all kinds of bizarre, contradictory results, like the iconic Tea Party protester who warned the government to keep its hands off his Medicare. Welfare state for me, not for thee.

The Republican Party understands this tortured impulse well and has been adept at exploiting it, its supposed ideological commitments be damned. In 2003 it passed Medicare Part D, a massive entitlement expansion with billions in giveaways to big Pharma and zero new revenue to pay for it. Ryan not only voted for it; he was the deciding vote in the House. During the 2010 midterms, Republican candidates hammered “Obamacare” for “cutting $500 billion from Medicare.” And everyone should remember that the origin of the “death panel” hysteria was a provision that would have subsidized doctors’ end-of-life care conversations with Medicare patients, a practice that’s proven effective in reducing the hardship and cost of care. Republicans gleefully demgogued it to death.

Ryan has taken this cynical hypocrisy to its logical conclusion. He wants to replace Medicare with an exchange and subsidies system that would, in broad contours, resemble the Affordable Care Act. But the savings he projects would come less from competition than from simple cutbacks to care and benefits. If he succeeds, it’s the end of Medicare and the end of the Great Society. But—and here’s the amazing wrinkle—none of this applies if you’re over 55. Those folks will continue to enjoy the benefits of the very popular single-payer version of Medicare as currently constituted. In other words, if you’re a senior citizen, Paul Ryan will indeed keep the government’s hands off your Medicare. If you’re younger than 55, you’re screwed.

Particularly galling is that intergenerational stewardship is the banner under which the slash-and-burn agenda is being pursued. We must do this so our children and grandchildren will not inherit a massive debt. So instead of debt, apparently, we are going to leave them lousy healthcare and no jobs while making sure current seniors, whose votes we need, enjoy the benefits of social democracy.

Ryan, in other words, isn’t at all serious about controlling costs or securing the future for young people. But he is deadly serious about bribing narrow constituencies to cement his party’s power, redistributing wealth upward and dismantling the elements of government on which our collective security depends. On the eve of what, at this writing, appears to be a likely government shutdown forced by GOP recklessness and intransigence, it’s worth remembering what, exactly, upstanding men like Ryan actually stand for.

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