National Review / Digital
The Week

(Roman Genn)


Mediscare, Again

Democrats believed that Romney’s selection of Ryan would make it possible for them to hammer the Republicans for “ending Medicare as we know it.” Their attack on Romney’s plan is false through and through, and it is proving less politically effective than they had hoped.

Obama strategist David Axelrod was one of many Democrats to say that Ryan’s plan “would raise costs on seniors by thousands of dollars.” The actual worst-case scenario for how much more it could make beneficiaries pay: $0. The Axelrod attack is based on a hostile interpretation of an earlier version of Ryan’s proposal. Ryan has changed the proposal over the last year, however, and Romney has endorsed the new version. The Democratic criticism, applied to the new plan, is indisputably false.

The Romney-Ryan proposal — which has the support of liberal Democratic senator Ron Wyden of Oregon — would let senior citizens choose a coverage plan provided either by the federal government or by a private company. The government would defray the cost of purchasing the plan selected. The providers would submit bids showing the premiums they would charge to cover the benefits Medicare has traditionally offered. The second-lowest bid would set the amount the government would provide for each beneficiary.

Seniors who picked the second-cheapest provider would have their entire premium paid by the government, and seniors who picked the cheapest would get a check for the difference. Seniors who picked a more expensive plan would have to pay the difference out of pocket.

We have reason to be confident that this arrangement would restrain the growth of costs. A study has just shown that applying the second-cheapest-bidder approach to even the much less robust form of competition in Medicare Advantage would have resulted in a 9 percent reduction in Medicare costs in one year alone. The savings from years of real competition could be enormous.

If, however, competition does not restrain costs, the growth of government spending per beneficiary will be capped at a level a bit above the growth rate of the economy plus inflation. That is the exact level that the Obama administration envisions as well. The administration, however, hopes to reach the target by setting low prices for medical providers and otherwise micromanaging medical markets. There have been many past efforts along these lines, and they have always failed.

Under a worst-case scenario, then, the Romney-Ryan plan costs senior citizens no more than current law. It offers the hope of doing considerably better: of reining in the costs of Medicare, the principal cause of long-term debt disaster, without sacrificing patient choice, the quality of health care, or medical innovation.

The Democrats’ political problem is that their own precious health-care law cuts Medicare by hundreds of billions of dollars — and in the next few years, not starting a decade from now. It imposes these cuts in the worst possible way, by squeezing providers without reforming the system. Our preference would be to find other ways to make these near-term savings, as Ryan’s budgets envision. Romney has, however, pledged to undo the cuts. That may make more sense than implementing the cuts the way Obama favors, and is especially worth doing if it makes it easier for Romney to gain support for the free-market reforms he favors. His stance makes the Democratic defense of Obama false.

The truth of the matter, then, is this: Obama is cutting Medicare in a particularly ham-handed way, and his plans will lead to bureaucratic rationing of care for future seniors. Romney would stay these cuts and avert that threat. Instead he would implement a promising strategy to stave off national bankruptcy while improving senior citizens’ health care. If Obama and his aides persist in claiming that the Romney-Ryan plan will increase costs for senior citizens or shift risks to them, Republicans and fair-minded observers should not hesitate to call these charges what they are: lies.

September 10, 2012    |     Volume LXIV, NO. 17

Republican Convention Special
Books, Arts & Manners
  • Sean Trende reviews An American Son: A Memoir, by Marco Rubio, and The Rise of Marco Rubio, by Manuel Roig-Franzia.
  • Ross Douthat reviews The Queen of Versailles.
  • Richard Brookhiser evaluates the transatlantic exchange.
The Long View  .  .  .  .  .  .  .  .  
Athwart  .  .  .  .  .  .  .  .  
Poetry  .  .  .  .  .  .  .  .  
Happy Warrior  .  .  .  .  .  .  .  .