In the brief period since Paul Ryan was chosen to be Mitt Romney’s running mate, health policy experts have been spending a lot of time explaining what Ryan’s budget plan means for Medicare. There’s no doubt that the contrasts between Ryan’s ideas and Obama’s on Medicare are significant. But as Ezra Klein pointed out Monday, the two approaches to reforming the most popular government program in history are not diametrically opposed.
Both Ryan’s most recent plan and Obama’s most recent budget strive to contain the growth of Medicare expenses to the same rate—GDP +0.5%. The difference is in how those costs are contained. This is incredibly important—Klein frames the debate as being over an effort to save money by improving quality (via the Affordable Care Act on the Democratic side) versus trusting the free market to reduce prices (on the Republican side). Neither of these approaches have been proven to lower costs, as noted by Klein.
It’s safe to say there are problems with both paths. The ACA relies on some guess work: hoping that pilot programs might reveal a way to make Medicare cost less; Ryan’s Medicare plans have left many key details out, but critics say it’s clear that seniors will be on the hook for much more out of pocket spending. Sadly, despite these substantive points, we shouldn’t expect the 2012 presidential campaign to feature a robust debate over how to fix Medicare.
While Republicans have been hailing the Ryan VP pick as a bold choice—House Speaker John Boehner says it means Romney is “playing offense”—it already seems clear that the GOP ticket does not intend to staunchly stand behind the idea that Medicare needs to be largely privatized in order to function in the future. Here’s what Romney said on 60 Minutes over the weekend:
What Paul Ryan and I have talked about is saving Medicare, is providing people greater choice in Medicare, making sure it’s there for current seniors. No changes, by the way, for current seniors, or those nearing retirement. But looking for young people down the road and saying, “We’re going to give you a bigger choice.” In America, the nature of this country has been giving people more freedom, more choices. That’s how we make Medicare work down the road.
That’s not exactly tough talk. The GOP ticket instead will talk about the upside of “choice” and hammer Obama on the Medicare cuts in the Affordable Care Act, hoping voters will assume both presidential candidates want to make cuts to the program and that it’s a wash. The Republican candidates will do this despite the fact that Ryan has said he believes Obama’s ACA Medicare cuts should stay, even if the parts of health reform that expand coverage to low and middle-income Americans get thrown out.
Ryan, along with most House Republicans, have symbolically voted to repeal the ACA more than 30 times since it passed in 2010, but Ryan’s 2013 budget references “current-law Medicare savings” and “potential savings in current law.” Current law is code for the ACA and Ryan assumes in his plan that the Medicare reductions within it aren’t going anywhere.
The Obama campaign meanwhile intends to hit the Republican ticket hard on Ryan’s proposed Medicare cuts. This will happen even though the health plan on Romney’s web site—and the latest Ryan proposal—are both much more moderate than previous Ryan plans and preserve existing Medicare for seniors 55 and older while keeping traditional Medicare as a choice for everyone else going forward.
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When it comes to “Mediscare” campaign tactics, these sorts of nuances are not welcome. Expect Romney-Ryan and Obama-Biden to compete to see who can demagogue health care the best. The effectiveness of either campaign’s message remains to be seen. Voters have traditionally trusted Democrats more than Republicans when it comes to Medicare and Social Security. But the health care reform war of 2009, which focused a lot of attention on the ACA’s Medicare cuts, left a stain on Obama that might be hard to remove.