Last spring, when the House Republicans took the risky and courageous step of lining up behind a serious structural reform of Medicare proposed by Paul Ryan—a reform that would replace the program’s fee-for-service monopoly with a premium-support system to enable some real competition among private insurers—many people thought they had committed political suicide. The Democrats pounced, announcing plans to put that proposed reform at the center of their own 2012 election campaign in an effort to scare seniors away from Republicans. Even many Republicans were wary, and it was far from clear if the party’s presidential candidates would back the idea.
As the Republican primary race has progressed, however, it has become clear that the House Republicans’ decision has had its desired effect: The dire need to reform Medicare and the case for doing so through a premium-support reform have become conservative orthodoxy, and all of the Republican candidates have adopted some version of the idea as their own.
Now,
this article in Saturday’s
New York Times suggests that far more than that may be afoot, and that even some Democrats are acknowledging that some version of a premium-support reform will be necessary and could well work. Referring to the hearings held by the Supercommittee before it concluded in failure last week, the
Times’s Robert Pear notes:
Members of both parties told the panel that Medicare should offer a fixed amount of money to each beneficiary to buy coverage from competing private plans, whose costs and benefits would be tightly regulated by the government.
Republicans have long been enamored of that idea. In the last few weeks, two of the Republican candidates for president, Mitt Romney and Newt Gingrich, have endorsed variations of it.
The idea faces opposition from many Democrats, who say it would shift costs to beneficiaries and eliminate the guarantee of affordable health insurance for older Americans. But some Democrats say that — if carefully designed, with enough protections for beneficiaries — it might work.
The idea is sometimes known as premium support, because Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.
At the very least, this news should complicate the Democrats’ efforts to build their 2012 campaigns around a demagogic attack on the Ryan plan, since clearly “some Democrats” seem to have realized that it doesn’t involve pushing elderly people in wheelchairs off of cliffs and in fact might even save Medicare and the federal budget from doom. At most, this news might even mean that the idea could have a chance of getting somewhere if a president who supports it is elected next November.
The
Times article goes out of its way to minimize the news it brings. For one thing, it places it in the context of the Supercommittee, treating it as a recent development that some Democratic fiscal hawks like Alice Rivlin like the idea of premium support and don’t think Paul Ryan is the antichrist. But of course, this much is not news. The Bipartisan Policy Center’s debt reduction task force, which Rivlin co-chaired and which included other Democrats,
proposed a premium-support plan very similar to Ryan’s earlier this year. And for that matter, Rivlin and Ryan together proposed
another version of the idea to the Bowles-Simpson commission (of which they were both members). That information has been available to the
New York Times for some time. What’s news is that some Democratic politicians may be listening.
Second, rather than acknowledge that the fact that such reforms are needed is proof that no one seriously expects the supposed Medicare reforms in Obamacare (like the IPAB and its price controls) to work, the Times parrots the line tried out by various defenders of Obamacare in the past year, that Obamacare would actually move the under-65 market to something like a premium-support system, so its logic is the same as a premium-support reform of Medicare. This ignores the fact that Ryan’s Medicare reform would transform Medicare—which is currently a purely government-run single-payer fee-for-service insurer—into at least something of a competitive market among private insurers while Obamacare would transform our existing private market (in which competition is already severely constrained and distorted by a variety of federally imposed flaws and inefficiencies) into an even more heavily regulated and less competitive market, while leaving in place Medicare’s fee-for-service system, which is responsible for so much of the inefficiency in our entire health sector. In other words, Ryan would move the entire sector in the direction of more private competition than exists today while Obamacare would move the entire sector in the direction of less private competition than exists today. The fact that both might use something called premium-support, but in very different parts of the system and for very different purposes, can hardly mask this utterly fundamental difference.
Third, in an effort to justify the hysterical attacks on the Ryan proposal earlier this year, the article tries to make the versions of premium support that some Democrats now find acceptable seem vastly different from Ryan’s. It points out that Alice Rivlin is now backing a form of premium support that would include an insurance plan that resembles today’s Medicare as one of the options available for seniors to choose in the new system and that (unlike even the plan that Rivlin herself championed as part of the original Bipartisan Policy Center proposal) would set the growth rate of the benefit using competitive bidding among insurers. This idea (which I described a few months ago
here) is neither new nor all that different from Ryan’s. In fact, Ryan himself has said he would back both of these elements as completely in line with his vision for reform and,
according to Jeb Henserling, the Republican members of the supercommittee proposed this very idea to their Democratic colleagues and were rebuffed.
All that is surely annoying. But if such justifications are necessary to ease the Democrats’ consciences, so be it. The news that even a few of them are coming around to see that a premium-support reform of Medicare is necessary and wise is very welcome news indeed. It certainly doesn’t seem like President Obama is coming to that view. But if a president who does share that view takes over in 2013, it would be very helpful for him to have an even modestly bipartisan coalition to work with in Congress. The Times suggests there might be hope for such a coalition.
If true, this is, among other things, evidence of the extraordinary influence that the Ryan proposal has had on our politics in just a few short months. It is evidence, in other words, that in these times of trouble, political courage in the cause of serious reforms to get us beyond the liberal welfare state can pay off.
That Times article was incredibly vague about which Democrats are willing to support the idea (besides Rivlin). If a major name came forward, I would be impressed.
Reply to this commentLinkReport AbuseThere is no question that our current healthcare regime could benefit greatly from less government meddling and increased competition. The issue for me, though, is that increased competition requires an informed, engaged consumer. It's tough to find one of those among the seriously ill, and the family structure just ain't what it used to be.
Reply to this commentLinkReport AbuseShort version of Yuval Levin's post: Dems begin to find that socialism doesn't work and is finding ways to undo the socialism that they have implemented in the country as some new idea.
Reply to this commentLinkReport Abuse"...whose costs and benefits would be tightly regulated by the government." Even as a proposal backed by Republicans, why would this part, as quoted, be a good thing. Isn't the whole idea to get the federal government out of the healthcare business (contra Obamacare)?
Reply to this commentLinkReport AbuseIt's all about trying to find a way to give seniors less money because the current benefits are untenable.
Reply to this commentLinkReport AbuseOh yes.
Proposing purely partisan poison has worked out SO well for Republicans and for the country.
More of the same please!
Let's see how the 2012 elections turn out.
Reply to this commentLinkReport AbuseWhat have Obama and the Democrats been moderate on?
There was no bipartisan support for ObamaCare...they rammed that through.
Obama's by far the most partistan president we've had but you don't care because he's a Democrat. But what are the results? Zero or negative economic growth? High unemployment? Massive deficits and unsustainable debt in the name of "stimulus"?
Reply to this commentLinkReport AbuseThe fact that Democrats chose a plan that came out of the Heritage Foundation as a starting point instead of single payer is an example of the tendency of Democrats to compromise. The fact that Senate Democrats did not end the filibuster (like I thought they should) is an example of their tendency to compromise.
Democrats would have made major concessions to Republicans in exchange for their support on healthcare reform. As long as the goal of universal coverage was achieved. Republicans decided that they would rather try to make the Affordable Care Act Obama's Waterloo, because the most important thing was to make sure that Obama was a one-term President.
The goal of Republicans has been clear all along. Do everything in their power to make President Obama fail so that he is a one-term President. The country is what is called collateral damage.
Reply to this commentLinkReport AbuseNot ending the filibuster is a compromise? Please.
And if I'm not mistaken, Obamacare will not achieve universal coverage. If so, then you are asserting that the Dems were willing to make major concessions with the GOP as long as they agreed to something that the Dems themselves didn't agree to pretty much shows how distorted your views are.
Reply to this commentLinkReport AbuseConservatives and Republicans, as well as Americans in general, rejected government-run healthcare.
That had nothing to do with a desire to make Obama a one-term President, since the same group rejected the same idea when proposed by the Clinton administration.
An vast majority of Americans (80% according to surveys) do not trust government, and have no faith in government's ability to solve the problems that the nation faces.
Unless you are willing to concede that 80% of Americans are Republicans or Conservatives or both, the rejection of government as the solution to the health care issues in the US is grounded on far more than a need to make Obama a one-term President.
Only a minority of the American people (37%) expect that Obama will be re-elected, so being rejected by Americans has been Obama's greatest bipartisan achievement.
Reply to this commentLinkReport AbuseWow - do you even buy your own BS these days? 'Cause no one else does.
"The fact that Democrats chose a plan that came out of the Heritage Foundation as a starting point instead of single payer is an example of the tendency of Democrats to compromise. The fact that Senate Democrats did not end the filibuster (like I thought they should) is an example of their tendency to compromise."
Neither of these is an example of compromise. That you think "not ending the filibuster" is an example of compromise just shows how ignorant/deceitful you truly are.
"Democrats would have made major concessions to Republicans in exchange for their support on healthcare reform."
Again, total unsupported BS. Utter nonsense.
Reply to this commentLinkReport AbuseOf course the objective was to make Obama a one term president. I don't think Democrats are working hard to ensure our Republican presidents get re-elected.
Obamacare was never popular with Americans. The republicans rightly made him own it.ll
You asserted Republicans are partisan, but Obamacare was always about Obama getting government run healthcare, even if he had to do without bipartisan support.
I understand Obama supporters are not that bright (how can you be?) but geez, you think we are supposed to help re-elect this idiot too?
Look at all thep eople unemployed right now, the lack of economic growth and opportunity, and ask yourself why I should care if Obama loses the next eelectgion? The man was never qualified to be president and he doesn't even come acorss as giving a d---- about it.
Reply to this commentLinkReport AbuseYou've established your moonbat credentials long ago. You can stop trying now.
Reply to this commentLinkReport AbuseNice ad hominen attack.
You have established your inability to use logic long ago.
Reply to this commentLinkReport Abuse"Proposing purely partisan poison has worked out SO well for Republicans and for the country."
What, you mean like 2010? Um, yeah, that DID work out well for Republicans and the country. If that's what "more of the same" means, then yes, by all means!
Reply to this commentLinkReport AbuseExhibit 1: The article being referenced is in the New York Times, a wholly owned subsidiary of the Democrat Party.
Exhibit 2: The supposed "some Democrats" who supposedly are coming around on this idea are unnamed.
Conclusion: The Democrats and their media sockpuppets are getting ready to do yet another Lucy-pulls-the-football exercise against the Republicans. And the Republicans will undoubtedly fall for it, like they always do...
Reply to this commentLinkReport AbuseBut while Ryan’s boyish looks, youthful style, and sharp intellect have garnered him much praise from conservatives desperate to find the next Ronald Reagan, he has one major problem: His actual voting record.
Though he talks like Nobel Prize-winning economist Milton Friedman, some of Ryan’s most high-profile votes seem closer to Keynes than to Adam Smith. For example, in the span of about a year, Ryan committed fiscal conservative apostasy on three high-profile votes: The Troubled Asset Relief Program, or TARP (whereby the government purchased assets and equity from financial institutions), the auto-bailout (which essentially implied he agrees car companies – especially the ones with an auto plant in his district—are too big to fail), and for a confiscatory tax on CEO bonuses (which essentially says the government has the right to take away private property—if it doesn’t like you).
While Ryan’s overall voting record is very conservative, the problem with casting these high-profile votes is that they demonstrate he is willing to fundamentally reject conservatism when the heat is on.
Because it is impossible to believe the highly intelligent and well read Rep. Ryan was unfamiliar with conservative economic principles, one must conclude he either 1). Doesn’t really believe in free market economics, or 2). Was willing to cast bad votes for purely political purposes.
From my standpoint, ignorance can be forgiven and overcome; the other explanations, however, seem to be disqualifiers for higher office.
In fairness, Ryan was not alone. Other “conservative” members of Congress voted for at some of these bad bills, but the difference, of course, is that Ryan is the one many conservatives are viewing as a “rising star” conservative wunderkind. (Note: Nobody is arguing Paul Ryan should be “primaried” by a conservative in his Congressional district, but, by the same token, isn’t all this effusive praise a bit overwrought?)
Though Ryan has downplayed his bad votes, what is more interesting is that few conservatives seem to hold them against him. His many defenders (and trust me, I’ve encountered them) cavalierly dismiss his voting record as mere pragmatism, or an easily forgiven mistake, like, ‘Oops, I voted for $700 billion! My bad…’
When pressed, his apologists often admit they support him because of his style and intellect, despite his actual voting record. The irony, of course, is that conservatives were furious when Clinton and Obama apologists dismissed their flaws by saying, “but he’s so smart,” or “he’s cool…”
Still, a few critical voices have slowly emerged. Commenting on the fact that Ryan has been given multiple passes, prominent conservative blogger Michelle Malkin once asked: “How many strikes do ‘Republican rising stars’ get?” (Apparently, if your name is Paul Ryan, you get many).
Still, the talk of Ryan’s “rising star” status continues, and one can only imagine that, should he ever run for president, the bad votes would finally catch up with him. After all, it’s one thing to argue that your bad votes came before your political awakening (as Mitt Romney did), but Ryan would have a hard time making that argument. Ryan’s votes were volitional.
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Reply to this commentLinkReport Abuse"Le mieux est l'ennemi du bien." - Voltaire.
Ryan's lifetime ACU rating is just under 93%.
If you are a baseball player, and you get a hit 93% of the times that you're up to the bat, you are a freak of nature. If you are a quarterback with a 93% completion rate, the NFL is likely to rename the Lombardi trophy after you. If you are a Republican with a 93% rating from the American Conservative Union, you're not Conservative enough for Conservatives.
Held up to a standard where 93% of readers needed to fully agree with you in order for your response to be considered viable, would it hold up to that scrutiny?
Reply to this commentLinkReport AbuseYour baseball analogy is absurd, and those ratings will probably show McCain and other liberal Republicans fairly high. It doesn't mean anything.
Paul Ryan votes like a liberal when the heat is on on the big issues. You can make excuses for it all you want, but he wasn't facing some stud pitcher...he chose to do this. If zero true conservatives would have voted the way this man did on these issues, why do conservatives worship him so much? I don't get it?
Reply to this commentLinkReport Abuse"Le mieux est l'ennemi du bien." - Voltaire.
I'm not making excuses for Ryan, Who am I to make excuses for him, and why would he need me to do anything of the sort?
I'm illustrating the absurdity of the notion that only perfection suffices.
Ryan has a 100% rating from NRLC, 0% rating from the HRC, an 8% rating from NEA. He is anti-union, pro defense, pro business, pro family, but a liberal in your book.
I bet that you make the argument that Reagan was a liberal too.
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