Politics & Policy

Romney: Right on Medicare

Needless to say, boldness hasn’t been a quality associated with Mitt Romney during this campaign.  That makes his endorsement of bold and specific proposals for entitlement reform in a speech at Americans for Prosperity last week all the more noteworthy.  

Most significant, Romney outlined a plan that would transform Medicare into a premium-support program — while holding current seniors and near-retirees harmless, and retaining an optional form of traditional Medicare (restructured as a premium-charging government insurance plan) to smooth the transition. It differs in details from the plan introduced by Rep. Paul Ryan and supported by the overwhelming majority of congressional Republicans, but the plans share their most critical features: reintroducing choice to seniors and competition to the health-insurance market while defusing the fiscal time bomb that is Medicare before it beggars the nation. In his speech, Romney also vowed to introduce forms of means testing to both Medicare and Social Security, while gently raising the eligibility age of the latter. All of this — as well as his promises to block-grant Medicaid to the states and institute real cuts in discretionary spending — deserves praise.

Romney’s buy-in on entitlement reform puts the center of gravity of the Republican field in more or less the right place on the most momentous issue of the day. Rick Perry and Newt Gingrich have embraced premium support in broad outline. Rick Santorum and Jon Huntsman have endorsed the Ryan plan explicitly. And though she has since been equivocal, Michele Bachmann voted for it. (Only Herman Cain remains difficult to pin down, though he did signal support for Medicaid block-granting in a recent debate with Newt Gingrich.)

Romney’s plan thus signals the victory within the GOP of Ryan’s vision for a smaller, smarter social safety net, and closes what could have been a dangerous gap on the issue between the executive and legislative wings of the party. Most important, it ensures that the general election will be a race between the liberal-progressive status quo, in which entitlements are both unaffordable and unassailable, and a candidate determined to save the country from the welfare state, and the welfare state from its own excesses.

The politics of entitlements remain toxic, and the political path forward is perilous. To minimize the Democrats’ ability to demagogue on the issue in the general election, the Republican nominee will need to emphasize that reform is not about “ending Medicare as we know it” but about improving the health-care system and, not least, avoiding bankruptcy. He will need to couple the reform message with a credible threat to repeal Obamacare, focusing on especially noxious aspects such as the “IPAB” rationing body. And he will need to contrast the status quo with a compelling alternative vision of the social compact, founded not on an unsustainable dependence but on freedom and growth, a vision he can sell to the middle class and independents.

It won’t be an easy battle to win. But to its credit, the presidential field has shown it is a battle that Republicans are at least willing to fight.


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