Former House Speaker Newt Gingrich steered the break-out of his presidential campaign into a ditch a couple of weeks ago by suggesting that the Ryan Medicare reform was “right-wing social engineering.” He was wrong, but not for the reason cited by his critics. To be more precise, Representative Ryan’s plan is a surrender to left-wing social engineering on terms the right wing naïvely believes it can accept. Ryan is the darling of a Washington breed of conservative wonk convinced that we can make the welfare state work if we just incorporate a few free-market, family-friendly tweaks. It is a futile political strategy for two reasons.
First, the pathology to which all Medicare’s ills trace their origin is the involvement of government. If you don’t get government out of the mix, transient politics will eventually undo any reforms you put in place. Look at welfare reform, which took Republicans years to achieve but took the Obama Democrats a relative nanosecond to dismantle with their stimulus spending. In Medicare, the pattern is seen again and again. It was no less a stalwart opponent of socialized medicine than Pres. Ronald Reagan who signed off on an “administered pricing” scheme that allowed the government, rather than private health-care providers, to dictate the price of hospital services — in a well-meaning effort to address a Medicare payment system design that drove prices ever higher. Part of President Clinton’s pound of flesh for agreeing to balance the federal budget was the creation of Medicare Part C, extending the already over-extended program to managed care. The creation of Part D, the reckless prescription-drug benefit, was driven by the Bush GOP’s election-calendar craving to be seen as just as compassionate as Democrats have always been with other people’s money.
Reformers such as Representative Ryan always ignore this inevitable trajectory of entitlement politics. They rationalize that they can make a government-sanctioned bribery system run better, or at least preempt Democrats from making it run worse. Hoping to stave off Medicare, congressional moderates in 1960 passed a bill to provide means-tested medical assistance to the elderly. It only greased the wheels for not only Medicare but Medicaid. In Massachusetts, Romneycare was another well-meaning attempt to install a compulsory statewide health-insurance system that would be less autocratic and costly than the one the Left would have imposed. It is, predictably, a disaster that tends toward ever-more-suffocating government control.
The second and perhaps more obvious political flaw is manifested by the new commercial that depicts a Ryan lookalike pushing granny (in a wheelchair, of course) off a cliff. It does not matter how modestly conservative reformers would modify Medicare, “bend the cost-curve,” or whatever unthreatening descriptor is applied to their good-government proposals. It does not matter that Paul Ryan actually tries to save Medicare, which will soon implode if nothing is done. Conservatives will still be demagogued. They will still be accused of trying to destroy Medicare and kill old people.
Medicare deserves to be destroyed, and destroying it would be better for current and future generations, young and old. So why not make that case? Other than a committed socialist ideologue, no one in his right mind would vote to implement Medicare today — not if we were on a clean slate and knew what we know now about its ruinous operation. Ryan’s essential point is that health care is increasingly expensive because it is not permitted to function as a regular market commodity — one with sentient consumers shopping carefully, spurring competition, driving down prices, and encouraging innovation. That kind of market can never happen with the government as a central player. And we can provide some sensible measure of assistance to the truly needy without giving everyone an unsustainable “entitlement” that will destroy the economy.
Medicare is a scam. The people who designed and perpetuated it would be serving more jail time than Bernie Madoff if they pulled a fraud like it in the private sector. As it is for the victims Madoff swindled, so it is for we who’ve been swindled by Washington: The money is gone. We can make provisions for the needy elderly who are about to hit eligibility and have relied on Medicare in their assumptions. But the party is over — and the sooner we grasp that, the fewer victims there will be.
Preserving a scam in the vain hope of making it less offensive may be well-meaning, but it’s not right, and it’s not courageous.
—Andrew C. McCarthy, a senior fellow at the National Review Institute, is the author, most recently, of The Grand Jihad: How Islam and the Left Sabotage America.