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Republicans and Medicare


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Republicans are quite right to point out that their defeat in the special election for New York’s 26th Congressional District was not entirely a referendum on Medicare. The Republican sex scandal that occasioned the election, the phony “Tea Party” candidate, the Republican candidate’s missteps: All of these contributed to the loss. The New York Republican party is particularly hapless, and has now played a role in two special-election defeats too many by letting insider self-dealing determine the candidates.

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But there is no denying that Medicare also played a role. The program is popular. People would prefer not to see it cut, and they are nervous about reform. And while Jane Corwin made some mistakes, the Republican party’s strategy cannot depend on all its candidates running flawless campaigns. It has to do what it can to foster a national political climate that helps not-so-great candidates win.

House Republicans almost all voted for Paul Ryan’s plan, which reforms Medicare for future senior citizens by giving each of them money toward the purchase of insurance. Because the amount of money spent would rise only with inflation, the program would be much easier for the federal government to afford than the unreformed version will be. The introduction of market forces into the program should also help restrain health-care costs generally. The reform is sensible, and voting for it was politically brave.

But the plan does fundamentally change Medicare, or, as the Democrats prefer to put it, “end Medicare as we know it” (sometimes they boil that down to two words). Congressional Republicans, having voted for this reform, cannot now undo their votes or play down the issue for political expediency. They will simply have to defend their votes. The best way to do so is to point out, as often as possible, that the alternative to their reform is not the status quo maintenance of the program Americans like. The alternative is a program “reformed” the Democratic way: with bureaucratic rationing and price controls. Under the Democratic plan, Medicare providers will be paid at lower rates than the ones that have already made Medicaid a crummy program for its beneficiaries. A board will decide which treatments to withhold to save money. Congressional Republicans can win an argument between the true alternatives.

They will, however, need help from their presidential candidates. Newt Gingrich’s recent attack on the Ryan budget, now retracted, was an example of what the Republicans need to avoid: a split between the presidential and congressional wings of the party, which would quickly lead to an every-candidate-for-himself rout. The Republican presidential candidates need not tie themselves to every detail of the Ryan plan, and should feel free and indeed encouraged to offer their own solutions to the entitlement mess. But they should defend the House budget from false attacks, support its broad outlines, and join in the attack on liberalism’s plans for Medicare.

Retreat is not really an option. But neither is standing still.



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