Critical Condition

McCarthy, Olsen, and Grim Reality on Medicare

As one of the first conservatives to criticize Paul Ryan’s Medicare reform (here and here), I was pretty excited to read Andrew McCarthy’s spirited attack against the very existence of Medicare (latest here). According to McCarthy, it’s a wholesale scam, and he doesn’t mind telling everyone because he’s neither running for office nor responsible for getting anyone else elected.

Sure, I’ll admit I had the urge to jump up and down and pump my fists in the air. But then I read Henry Olsen’s warning about alienating blue-collar voters (upon which he expanded in the June 20 National Review print edition), and I decided that while McCarthy’s scorched-earth approach may be the right one for the conservative patriot to adopt when challenged by al-Quaeda or the Taliban, it might not be quite the thing for dealing with the median American voter, who desperately clings to the increasingly exposed false promise of Medicare.

I think we have a bigger problem than has yet been recognized. Olsen describes blue-collar voters swinging from one party to another on fear and hope for Medicare. But the entitlement struggle of the age of Obama is unique in its hyperpartisanship. As I have previously described, both Medicare and Social Security were passed with significant Republican support. Indeed, if you review all related legislation from 1935 through 1996, you’ll see bipartisanship. The 1996 welfare reform, of course, sticks in conservatives’ memory as Newt Gingrich’s high-water mark.

Only the 2003 Medicare Modernization Act approximates the bitterness of the 2009 law — and some of that came from Republicans appalled by the expensive Part D drug benefit! The MMA split 220–215 in the House, but only 16 Democrats voted for it and only 25 Republicans against.  And the legacy of the MMA is in tatters: The 2009 reform crushes Medicare Advantage, a key achievement of the MMA; and the so-called “free-market” elements of the Medicare Part D prescription plan are soon to fall prey to newly enacted rationing measures, such as the Independent Payment Advisory Board.

I don’t believe that voters trust politicians of either party to reform Medicare unilaterally. The Ryan Medicare reform, which the House eventually passed, relabeled vouchers as “premium support” in order to identify Democratic pedigree. But that did not earn it bipartisan support.

This poses a difficult challenge. If the next president does sign legislation repealing the 2009 reform, and proceeds to sign a solely Republican alternative reform, there is a significant chance that we’ll end up right where we were in 2008. No matter how good it is, such legislation will fail in the court of public opinion, and itself be threatened with repeal in 2017.

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