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Critical Condition

NRO’s health-care blog.

Obamacare and Entitlement Reform



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Okay, maybe the Republicans are serious about reforming entitlements — especially Medicare, the Big Kahuna. Usually, politicians’ claims to be almost willing to make preparations to eventually propose having an “adult conversation” about entitlements are not worth wasting time on. But this time may be different — and I credit the fight against Obamacare with moving the goalposts.

Historically, the politician who challenged the entitlement state enjoyed a short career. As William Voegeli of the Claremont Institute recently reminded us, conservatism has “clear, categorical arguments against permitting American government to take up any task it did not perform during Jefferson’s presidency.” However, “In 1936 and 1964, the Republicans’ presidential candidates, after repeatedly expressing their commitment to these principles, won 36.5% and 38.5% of the popular vote, respectively.” This undoubtedly explains why Republican politicians have been so weak on entitlements. (On the surface, Obamacare was different: It was pretty easy to get seniors on board the anti-Obamacare express by simply attacking the president for cutting half a trillion dollars from Medicare to finance Obamacare.)

Furthermore, except for the martyrdoms of Alf Landon in 1936 and Barry Goldwater in 1964, Republican “founding mythology” does not provide strong grounds for rolling back the entitlement state. Eighty-one of 102 Republican representatives and 16 of 25 senators voted in favor of the Social Security Act in 1935. As for Medicare and Medicaid, a narrow majority of Republicans in the House voted in favor of the 1965 Social Security amendments, as did almost half of those in the Senate. When Ronald Reagan had to deal with Medicare, he accepted an increase in payroll taxes and imposed centrally fixed prices for medical procedures (laying the ground for today’s ridiculous, never-ending sequence of “doc fixes”). Let’s not get started on the Medicare Part D drug benefit, a solely Republican expansion of Medicare passed in 2003.

But the fight against Obamacare may have delivered a shock to the system that goes beyond the battle cry of “repeal and replace.” The latest Pew Research Center survey of voters’ budget-cutting priorities shows that Americans are far less enamored of traditional Medicare than they were. Yes, 40 percent want to increase Medicare spending, versus only 12 percent who want to cut it. But this is a reduction of one quarter from the 53 percent who wanted to increase spending in 2009. With respect to health care in general, 41 percent want to increase spending, versus 24 percent who want it cut. However, this is a one third reduction from 2009, when 61 wanted the federal government to increase health spending.

Whether these shifts presage a trend I cannot say, but I have little doubt that the population has generalized the arguments against Obamacare to other government health programs, especially Medicare and Medicaid. This is supported by the fact that the shift of opinion on education spending was far smaller: 62 percent of respondents wanted to increase federal education spending, versus 67 percent in 2009.

So, it is not surprising that Republicans are taking more risk on entitlements. If Speaker Boehner and his colleagues propose (inter alia) voucherizing Medicare, getting the federal government out of the business of fixing doctors’ fees, and reducing (or eliminating) federal regulation of the practice of medicine, they might discover that they are pushing against an increasingly open door.



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