For voters listening to the Republican leadership over the past year, the most startling surprise was the shift in their attitude toward Medicare. Where faithfulness to true conservatism was once measured by fierce hostility to the popular insurance program for the elderly, as articulated by Ronald Reagan at the birth of Medicare in 1965, today the Republicans claim to be its staunchest defenders.
When the nonsense messages about “death panels” and assisted suicide are swept aside, the most consistent Republican argument in the health care debate is that reform will somehow endanger Medicare. The Democrats, who created Medicare and have protected the program from Republican presidents and legislators for the past five decades, were suddenly determined to destroy it with budget cuts. Only the Republicans, who opposed Medicare from the beginning, could now be trusted to preserve the program from the dastardly president and his allies in the Congressional majority.
Republican leaders have articulated that message with remarkable unanimity from day one. During the initial debate over health care reform in the Senate Finance Committee, Mike Enzi of Wyoming warned that “[Democrats] are cutting hundreds of billions from the elderly,” a clear reference to Medicare. The House minority leader, John Boehner, stepped forward to frighten senior voters with the claim that if reform reduced projected spending on Medicare, the result would be “fewer choices and lower health care quality for our nation’s seniors.” The Senate minority leader, Mitch McConnell, accused Democrats of seeking to “raid Medicare.”
As usual, the Republican National Committee chairman, Michael Steele, went the furthest, buying television spots to raise alarms about “a government-run health care experiment that will cut over $500 billion from Medicare to be used to pay for their plan.” Without pausing to notice the irony—since Medicare is the nation’s premier “government-run health care experiment”—Mr. Steele posed as the savior who would protect Medicare by promoting a “seniors health care bill of rights.”
But last week, this charade ended when Representative Paul Ryan of Wisconsin, author of the House Republican budget proposal, revealed that nothing had really changed. Like every right-wing Republican, Mr. Ryan still wants to kill Medicare, leaving seniors at the mercy of the insurance industry. His budget plan proposes a “defined benefit” voucher system that would eventually abolish traditional Medicare in order to control future deficits. The Republican Study Committee, an influential conservative caucus of House Republicans, favors the same kind of proposal. In fact, converting Medicare into a subsidy for insurance companies has been a key objective of Republican legislators ever since Newt Gingrich served as House speaker, when he pushed a plan that he promised would let Medicare “wither on the vine.” (Lately, Mr. Gingrich has refashioned himself as a Medicare advocate, by insisting that costs must be controlled somehow without cutting the program’s budget—but then, he is probably dreaming of another presidential run.)
Unfortunately for Republicans like Mr. Ryan, there are at least two essential flaws in their plan to privatize Medicare. The first is that Medicare—that government-run experiment, now almost 45 years old—remains exceptionally popular across all income, ideological, geographical and age groups. It is especially popular when compared with private insurers, beating them on measures of customer satisfaction, security and trust by 20 percentage points or more.
The second flaw is that Medicare—that costly, budget-busting entitlement—continues to exceed private-sector providers in efficiency by well over 10 percent. Only with lavish subsidies have the so-called Medicare Advantage private plans been able to compete for customers. And many elderly consumers have returned to traditional Medicare because the private insurers dropped their coverage when they actually became ill.
What do the Republicans really intend for Medicare? Are they truly its staunchest defenders? Or do they plan to decimate its benefits and have it devolve into private vouchers as soon as they regain power? Perhaps there is one answer for the voting public—and another for the insurance companies.