The steep challenge confronting Republicans as they try to restrain entitlement spending came into focus on Sunday’s Meet the Press. As Sen. Jim DeMint made clear in his guest appearance, merely cutting the growth of future entitlements is going to be a long-term challenge, requiring a long-term strategy.
DeMint was asked by host David Gregory about Republican pledges to cut spending. Would those pledges include reductions in entitlement spending? DeMint began his answer by praising Rep. Paul Ryan’s “Roadmap for America’s Future,” which outlines massive changes — and massive reductions — in entitlement spending over the coming decades. But then, having praised Ryan’s plan, DeMint backed away from any senior-scaring talk of immediate cuts. Here’s how DeMint put it:
Look at Paul Ryan’s roadmap to the future. We see a clear path to moving back to a balanced budget over time. Again, the plans are on the table. We don’t have to cut benefits for seniors, and we don’t need to cut Medicare like — like the Democrats did in this big Obamacare bill. We can restore sanity in Washington without cutting any benefits to seniors or veterans.
DeMint is not only saying, “We don’t need to cut Medicare,” he is even denouncing Democrats for having the temerity to cut the senior health program.
In fact, Ryan’s plan won’t involve any cuts, any time soon, for one big reason: His plan is not going to be enacted any time soon. In the outgoing 111th Congress, Ryan could gather only twelve co-sponsors for his plan. He will undoubtedly garner many more in the next Congress, but here’s a bet: He will still get nowhere near a majority of the Republican Conference. The plain fact is that most Republicans don’t want to vote for Ryan’s plan, which calls for partially privatizing Social Security and for voucherizing Medicare beginning in 2021.
Some might call these vote-shy Republicans gutless, but the plain fact is that with the Democrats still controlling the Senate, and Barack Obama sitting in the White House, there is zero chance of the Ryan plan’s being enacted in the next Congress. As an aside, we might note that a score or more of House Democrats probably lost their seats on November 2 because of another doomed legislative issue: They voted for the cap-and-trade bill, which never even came to a vote in the Senate. So those Democrats threw away their careers for nothing. Risky votes can be fine, but there’s no point in taking that kind of risk if there’s no upside. Bravado for the sake of bravado is poor strategy, and no kind of long-term plan.
In the meantime, cautious Republicans aren’t likely to be getting any pressure from DeMint on entitlement cuts. DeMint is no squish, of course, and he has never been shy about taking on fellow Republicans — on policy matters, or even in GOP primaries. But on the “third rail” issue of entitlements, he seems determined to pick his fights carefully.
Indeed, shrewd Republicans see the current mixed control of Washington as an opportunity for patiently pulling up the siege wagons, not for a lightning final assault. In this siege scenario, the next two years are better spent launching investigations — anyone remember Fannie and Freddie? — and setting up votes in which Democrats are forced to defend unpopular positions, as opposed to trying to govern the country from Capitol Hill. That was tried in the mid-Nineties, and it didn’t work.
But what about entitlement spending? What about future big deficits? Are we stuck simply adding to them, letting red ink flow, until Republicans take total control? And how do we know, even then, that Republicans can fix the problem?
There’s a good answer to all those questions, but it’s little discussed in Washington, because the answer involves science as much as politics. It involves changing the equation of America’s medical health, as a necessary prelude to changing the equation of America’s fiscal health.
Let’s observe that Social Security and Medicare are expensive in large part because for many people, by the time they reach their sixties, they need to retire — they are too sick and too exhausted to go on working. And so they vote defensively against any perceived threat to their retirement. That has been true in the past, and it will be true in the future.
Oftentimes people have contributed to their own ill health, to be sure, by smoking, overeating, and underexercising, but health hectoring doesn’t get anyone very far in American politics. After all, the American Way is to build a machine, or make a pill, that solves the problem. That’s how we got electric can openers and those annoyingly noisy leaf blowers. So why change now? Why abandon techno-fixes? Certainly Americans won’t change their kitchen habits, or their gardening ways, because low-tech greens tell them to. And the same holds true for the health-care equivalent of the greens, those lefty health wonks who want to introduce all of us to the joys of line-waiting and barefoot doctoring.
Back to seniors. If we want them to work longer, we had better figure out a way to enable them to thrive longer. And that means more medications to help them deal with heart disease and obesity. And of course Alzheimer’s, which seems to strike without regard to diet or lifestyle. That’s a tall order, to bend these disease curves, but if we succeed, then we can begin to think about raising the retirement age. And that solves the entitlement crisis, with or without Ryan’s roadmap.
So if we are planning a long siege against big spending, let’s pile up the best possible siege machinery. Let’s take seriously the reality that older people are likely to have medical problems, and that an aging population is inherently more expensive than a younger population. Some senators, including Democrat Joe Lieberman, Republican-turned-Democrat Arlen Specter, and Republican Thad Cochran, who co-sponsored Lieberman’s bill, have ventured various ideas for improving health by accelerating medical research, but these efforts haven’t gained much traction. Why? It would appear that the search for medical cures just doesn’t fit the partisan fighting needs of either Democrats or Republicans. The two parties are so used to combatting each other that they have seemingly forgotten how to cooperate, even on matters of interest to all Americans.
As a result of this Verdun-like impasse, the FDA is as reactionary as ever, the trial lawyers are more threatening than ever, and cures for diseases such Alzheimer’s seem as far away as ever. Indeed, capital is going on strike in the pharma sector; there are easier ways to make money than selling drugs into the teeth of John Edwards’s next class-action lawsuit.
A daring Republican, therefore, might take the lead on the search for cures in 2011, pushing for legal and regulatory reforms, confident that those changes alone would attract more capital into the medical sector. Yes, Democrats might clamber on board this forward-looking bandwagon, but Republicans could then claim the mantle of leadership, reminding voters that Democrats were silent on this issue when they were in charge. Obamacare, after all, was about health-care finance, not health itself — and so it did nothing to ease the graying upward pressure on entitlements. In any case, some long-term goals are more important than short-term partisan advantage. Good health is a good long-term goal, and so is winning the siege against entitlement overspending.
Indeed, every Republican should understand that you never win a siege, let alone a war, without the better army. Victory requires not just ideology, but also technology.
— James P. Pinkerton, a domestic-policy aide in the Ronald Reagan and George H. W. Bush administrations, is a Fox News contributor and the editor of the Serious Medicine Strategy blog.