Saving Rep. Ryan

Paul Ryan’s effort to breathe new life into Medicare is tragically demonstrating the cost of trying to be a serious adult in the lunatic political climate we have built.  Many inside the Party have said over the past decade or so that there’s no harm tolerating the loony wing.  There are no enemies to the right.  The extremists generate energy, suck the wind out of opponent’s plans, and help win elections.  What’s the harm?

If you want to see what ten years of balls-to-the-wall, unfettered, Republican nutjobbery has cost us, look no further than the way we are losing the critical debate over debt reduction and Medicare.

In response to Ryan’s plan Democrats are fielding some of the most irresponsible and fact-starved arguments we’ve seen from them in a generation.  We should own the high ground on this issue and be in a position to scatter them.  But…we spent the whole spring looking for a birth certificate.  We have wasted our credibility peddling craziness and weakened our capacity to stage a grown-up debate over real issues.  We brought this on ourselves.

Fat lot of good it does you to win an election if your tactics make the country ungovernable.

We have to find a way to rally.  This issue is what the Republican Party is supposed to be good at and Ryan is doing a hell of a job of representing us.  His unflinching courage offers us an opportunity to recapture what we do best.

Ryan’s plan to restore Medicare’s solvency can be boiled down to these points:

– Change nothing for anyone 55 and older.

– Those younger than 55 will, when they reach retirement age, receive vouchers allowing them to purchase a Medicare health insurance policy of their own from a private insurer.

– Starting in 2022, the age of Medicare eligibility will begin to increase by two-months per year until it reaches 67 in 2033.

– Standards for private Medicare plans would be set by the federal Office of Management and Budget and everyone of retirement age would be covered regardless of medical condition.

– The subsidies for premiums would be reduced for people at higher income levels.

– The amount of the health insurance subsidy would be based on the anticipated cost of insurance under Medicare, which is currently estimated to be about $8,000 a year.  Its growth would be tied to inflation (instead of being tied to usage).

– Recipients would also be eligible for an annual federal contribution into a medical savings account for their use for up to $7,800.  The growth of that amount would also be tied to inflation.

You can find these facts in the Congressional Budget Office’s report on Ryan’s plan on pages 7-9.

A few more facts:

– This is not a particularly radical plan.  This is very similar to the way the French and the Dutch deliver their sumptuous “socialized medicine” to their citizens.  They get their extremely high-quality medical care from private doctors and hospitals paid for with private health insurance which they purchase on a subsidized basis.  This is also very similar to the way federal employees, like your Congressmen, get their medical care.  In short, this plan adopts some of the most successful practices from European countries.  Help me understand how mimicking Holland can be a lunatic right-wing scheme.

– Nothing about this proposal would end Medicare.  Many Medicare recipients already get their coverage through private plans.  This proposal would only shift the current public-private balance of Medicare coverage much more solidly in the direction of the private sector and remove much of the federal government’s direct involvement in medicine.

– Ryan didn’t just pull this plan out of the depths of his brainy little head.  This model was developed by Democrats in the 90’s during the last great effort to rescue Medicare.  Ryan is trying to build a sensible, bi-partisan approach.  Clinton’s budget director, Alice Rivlin, helped Ryan put his plan together.  Although much is being made of her disagreement with Ryan, they only differ over a few details.  The substance of the plan, a shift to private vouchers, is the same as what the Democrats were working on more than a decade ago.

This plan is not the end of the world.  It would not kill people.  It would not deny anyone access to healthcare.  Those are lies, but there is a certain karmic justice at work here.

In considering Ryan’s plan we need to evaluate these tough questions in an honest debate:

1) Who would we prefer to trust with the bulk of the job (not all of it) of managing the growing cost of health care, the federal government or private insurers?

2) Can private insurance, with federal oversight and regulation, deliver an honest, capable, and competent service to seniors and the poor?

3) This is an important question and we have to be honest with ourselves – does it really make sense to place the burden of choosing an appropriate health plan on the shoulders of elderly, ill, and economically disadvantaged citizens, or are we just setting them up to be fleeced?  How can we best protect the most vulnerable?

4) Will the shift in financial incentives created by Ryan’s plan make a meaningful difference in the wider problem of health care inflation, or will other measures be needed to bring down costs?

The value of Rep. Ryan’s Medicare plan hinges on the answers to these questions, not hysterical raving about Republican hatred for the old and the poor.  Maybe the time has come to give Medicare recipients more choices.

We need credible voices who can explain what Rep. Ryan is actually trying to accomplish with Medicare reform.  But you can’t explain the hard facts behind Medicare through a megaphone while dressed in a Ben Franklin suit.  It just doesn’t work.  This is a fine moment for the Party’s most sober voices to emerge from wherever they’ve been hiding and join the fight.

Can we toss out the rest of the junk and work on these questions?  Do we as a culture, not just as a Party, still have the capacity to work on hard problems like this?  It’s time to prove it.


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