Tough Spot For the Saviors of Medicare

The most amusing thing about the fiscal talks as reflected in the VandeHei/Allen Politico “inside account” was immediately identified by Ezra Klein:

The austerity crisis talks have hit a peculiar impasse. The problem isn’t, as most analysts expected, taxes, where Republicans seem increasingly resigned to new revenue. It’s Medicare. And the particular Medicare problem isn’t that Democrats are refusing the GOP’s proposed Medicare cuts. It’s that Republicans are refusing to name their Medicare cuts….

But it’s partly policy, too. The fact is that short of converting the program to a premium support system — a non-starter after they lost the 2012 election — Republicans simply don’t know what they want to do on Medicare….

If you dig deep into the Republican think tank world, you can find a few proposals that focus on the near-term. The most serious plan I found came tucking inside the American Enterprise Institute’s contribution to the Peterson Institute’s 2011 Fiscal Summit: In addition to moving toward premium support, they propose simplifying and enlarging the deductible, instituting a 20 percent co-insurance rate, introducing a “premium surcharge” for seniors who use supplemental insurance, and giving physicians more discretion in setting their prices. But there’s little unanimity around these proposals, and no leading Republican politician has endorsed them, perhaps because doing so would be tantamount to suicide.

That’s left Republicans in a peculiar negotiating position: They know they want “Medicare reform” — indeed, they frequently identify Medicare reform as the key to their support for a deal — but aside from premium support, they don’t quite know what they mean by it, and they’re afraid to find out.

All of this is to say that like many other elements of “entitlement reform,” anything that passes for “Medicare reform” either involves health care cost containment measures like those in Obamacare, or is (as Greg Sargent reminds us) wildly unpopular.

Add in to that the fact that Republican politicians have been proclaiming themselves the saviors of Medicare since at least 2009, right up to the recent point where champion premium-support advocate Paul Ryan was constantly posing with his mother and other seniors and promising to claw back every dime in Obama “cuts” to the program, and you can see why they don’t want to be first out of the gate with a “reform” proposal.

Truth is the Ryan Budget was and remains the sum and substance of GOP domestic policy preferences. That ain’t happening, a circumstance that flushes years of Republican prevarications and evasions and euphemisms and back-loaded, under-handed assaults on the New Deal/Great Society safety net. So now they are relying on Democrats to propose “entitlement reforms” they can then reluctantly accept as a price for also accepting revenue increases. I can’t imagine why they for a moment think Obama or congressional Democrats owe them the courtesy of doing their dirty work for them. But that’s where they are until such time as they are forced to acknowledge their whole “we’re saving Medicare” rap was as deep and authentic as Sarah Palin’s “death panel” posts at Facebook.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.