Political Animal


November 29, 2012 12:02 PM Tough Spot For the Saviors of Medicare

By Ed Kilgore

The most amusing thing about the fiscal talks as reflected in the VandeHei/Allen Politico “inside account” was immediately identified by Ezra Klein:

The austerity crisis talks have hit a peculiar impasse. The problem isn’t, as most analysts expected, taxes, where Republicans seem increasingly resigned to new revenue. It’s Medicare. And the particular Medicare problem isn’t that Democrats are refusing the GOP’s proposed Medicare cuts. It’s that Republicans are refusing to name their Medicare cuts….
But it’s partly policy, too. The fact is that short of converting the program to a premium support system — a non-starter after they lost the 2012 election — Republicans simply don’t know what they want to do on Medicare….
If you dig deep into the Republican think tank world, you can find a few proposals that focus on the near-term. The most serious plan I found came tucking inside the American Enterprise Institute’s contribution to the Peterson Institute’s 2011 Fiscal Summit: In addition to moving toward premium support, they propose simplifying and enlarging the deductible, instituting a 20 percent co-insurance rate, introducing a “premium surcharge” for seniors who use supplemental insurance, and giving physicians more discretion in setting their prices. But there’s little unanimity around these proposals, and no leading Republican politician has endorsed them, perhaps because doing so would be tantamount to suicide.
That’s left Republicans in a peculiar negotiating position: They know they want “Medicare reform” — indeed, they frequently identify Medicare reform as the key to their support for a deal — but aside from premium support, they don’t quite know what they mean by it, and they’re afraid to find out.

All of this is to say that like many other elements of “entitlement reform,” anything that passes for “Medicare reform” either involves health care cost containment measures like those in Obamacare, or is (as Greg Sargent reminds us) wildly unpopular.

Add in to that the fact that Republican politicians have been proclaiming themselves the saviors of Medicare since at least 2009, right up to the recent point where champion premium-support advocate Paul Ryan was constantly posing with his mother and other seniors and promising to claw back every dime in Obama “cuts” to the program, and you can see why they don’t want to be first out of the gate with a “reform” proposal.

Truth is the Ryan Budget was and remains the sum and substance of GOP domestic policy preferences. That ain’t happening, a circumstance that flushes years of Republican prevarications and evasions and euphemisms and back-loaded, under-handed assaults on the New Deal/Great Society safety net. So now they are relying on Democrats to propose “entitlement reforms” they can then reluctantly accept as a price for also accepting revenue increases. I can’t imagine why they for a moment think Obama or congressional Democrats owe them the courtesy of doing their dirty work for them. But that’s where they are until such time as they are forced to acknowledge their whole “we’re saving Medicare” rap was as deep and authentic as Sarah Palin’s “death panel” posts at Facebook.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • Stetson Kennedy on November 29, 2012 12:14 PM:

    There are winning Medicare cuts both politically and policy-wise. They're the cuts ObamaCare started - to the provider side. Dems should propose trimming more fat from that side of the equation, and let RepubliCONS go crazy and cry for cuts for beneficiaries as well. You know they will.

    Game. Set. Match.

  • c u n d gulag on November 29, 2012 12:15 PM:

    No NEW ideas?
    Whatever happened to Republicans being "The Party of Ideas?"

    Hiring morons to work under Wingnut Welfare has caused a brain-drain at their "Think Tanks!"

    Maybe if all of the old and young geezers stopped popping their "Quicker-Pecker-Uppers" to chase interns for awhile, the blood could rush back up into whatever they have for brains, and they'd think of something slightly less repugnant than "Vouchers?"

  • T2 on November 29, 2012 12:24 PM:

    judging from the election results, I don't think the American voter believed Paul Ryan when he told them that he was out to save Medicare from mean old Obama. Those Americans who can read understand that Ryan's plan to voucherize Medicare is the real danger to the program.
    Maybe it's just me, but it seems like Ryan's overall budget plan, unanimously approved by the GOP, is the major stumbling block the GOP has. Until they get the nerve to dump that, they're behind the eight ball.

  • Tired Liberal on November 29, 2012 12:53 PM:

    The reform being pushed hardest now is increasing eligibility age to 67, something that would be a big step backwards for the entire healthcare system. This would remove the youngest (lowest cost) users from Medicare (the most efficient provider of healthcare other than VA) and make the average cost per enrollee higher. It would push those people into the standard insurance system (the least efficient provider) where they would be the most expensive members of that group, so the premiums of everyone would go up. It is truly a lose lose situation except for the Simpson-Bowles fans. It would increase the total amount of money being spent on healthcare, but Alan Simpson and Erskine Bowles can claim that they cut Medicare costs by a relatively small amount.

  • howard on November 29, 2012 12:57 PM:

    all of which is to say, there is still no reason to cut a deal at this point. send congress home, let the "cliff" happen, and give the gop a tax cut to vote for in january and, amazingly enough, all their concerns about "entitlement reform" will melt away....

  • Josef K on November 29, 2012 1:00 PM:

    The most serious plan I found came tucking inside the American Enterprise Institute’s contribution

    Can those words be used in that particular sequence with even a trace of seriousness?

    And what the hell was the point the AEI's 'contribution' anyway? I grant its been nigh unto 18 years since I looked closely at the policy-logic behind Medicare's structure (and even then it was more a graduate-level case study on unintended consequences), but what AEI was proposing didn't seem to make a lick of sense.

  • Lance on November 29, 2012 1:09 PM:

    You can cut medicare by having fewer people on the probram, which cuts into the profits of health care providers,

    Or you can cut medicare by paying health care providers less, which cuts into their profits.

    Seems an easy choice.

  • KK on November 29, 2012 1:20 PM:

    How about we expand the risk pool to include 50 year olds? Seems adding that relatively healthy group would lower the average cost per insured. Charge participating 50's the market price. Get even better pricing power on Pharma and Provider care. Anyone ever see a study of its impact?
    As it is, why not kick up the tax another 1% on income over 500k?

  • Roddy McCorley on November 29, 2012 2:02 PM:

    Republicans simply don’t know what they want to do on Medicare…

    Oh yes they do. They want to eliminate it.