The best defense is a good offense, which is why the most powerful counter to Democratic attacks on Paul Ryan’s Medicare plans is to hit back at IPAB (the Independent Payment Advisory Board), the rationing board at the heart of Obamacare. IPAB is both a constitutional affront and a way of pushing poor granny off a cliff far more certainly than Paul Ryan’s plan ever would or could.
We had a dress-rehearsal for this battle back in mid-2011 when a backlash developed among Democrats and Republicans alike to IPAB, while the Democrats went after the Ryan plan (in its original form) in the special election for NY-26. I pushed hard for the GOP to go after IPAB at the time. Nothing of the sort happened, yet the Democrats gave up on attacking Ryan as well. Why?
I think both parties sensed their vulnerabilities. Republicans worried that attacks on their reforms would hurt with seniors (even though Ryan’s plan doesn’t cut spending for current seniors). Democrats worried that attacks on the rationing panel of Obamacare would likewise stick, since Obama’s unpopular health-care reform had already been undercut by fears of rationing. With so much at stake and the danger so great, both parties pulled back from a full-on debate.
To the extent that we plunge into that contest now, the solution for the Republicans remains the same. Hit IPAB and hit it hard. The criticism is richly deserved and politically far more effective than constant whining about the unfairness of the attacks on Ryan’s plan.
Do we still need to make a clear and strong defense of the Ryan plan? Absolutely. This is particularly so because the plan itself has been modified in important ways. The advantage of explaining these excellent changes is that the truth should be sufficient to convince fair-minded Americans that the modified Ryan plan, far from being a danger to present or future seniors, is a desperately needed benefit. Ryan supporters are rightly proud of his revised plan’s clever solution to a very tough policy problem and hope to tout that answer to the world. That is as it should be.
The danger, however, is that constant explanation of the plan’s new features could inadvertently trap the GOP in a defensive posture. Going into a “Mediscare” debate without prominently hammering IPAB as well is like fighting with one hand tied behind our backs. The moment for Republicans to go after IPAB in earnest has come.
I was just on a radio show in the battleground state of Ohio about my new book. The host was talking Ryan and said that for his audience, the choice seemed to be between keeping Medicare as is, and Ryan’s plan. The public still has no idea how deeply Obamacare is going to change things, through the rationing board in particular. That is why going on offense against Obama’s IPAB matters so much. I hit IPAB on that show, and it worked.
For a quick take on the politics of this battle, see “On Medicare, Go on Offense.” For substance, see “The Acronym That Ate Health Care.”