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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Gingrich vs. Ryan and the Intra-conservative Medicare Reform Debate



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Ross Douthat has written a worthwhile post on the spat between Newt Gingrich and Paul Ryan. I recommend it. I am more inclined to agree with Ryan than with Gingrich. I don’t see transitioning Medicare to a premium support model as right-wing social engineering. That said, the Ryan plan is not the only way to put Medicare on a sustainable footing, and allowing premium support to grow at a somewhat higher rate might ease the transition to a system in which retirees rely more heavily on private savings. As Ross suggests, Gingrich’s criticism of Ryan didn’t deserve to be taken seriously, as Gingrich dodged the question of how we’d pay for a status quo approach.

But I do think that conservatives should be open to a debate about the details of the Ryan plan. A growing number of Republicans have distanced themselves from the particulars of Ryan’s approach, and this creates the danger that Medicare reform will vanish from the agenda. That would be a mistake. A better course would be for serious conservative critics to offer a more “moderate” alternative, e.g., a defined benefit approach that places Medicare FFS and Medicare Advantage plans on a truly level playing field. This wouldn’t achieve the same long-term savings, but it would preserve the value of the underlying benefit and it would encourage business model innovation. 

I would still favor a defined contribution approach, but an all-or-nothing debate makes nothing — that is, no reform of Medicare until we run into a wall — far more likely. 



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