In mid 2011, Paul Ryan got the House of Representatives to pass a budget that radically changed Medicare. It would have gone from a defined benefit program to a defined contribution program, and the contribution would have increased so slowly that the CBO estimated that by 2030, seniors would have had to cover about 68% of premium costs themselves. The Democrats pounced, and the backlash was so severe that the Republicans lost a couple of elections that should have been easy wins for them.
By the end of the year, Ryan had moved somewhat. The Ryan-Wyden plan, while still a major shift from the current single-payer system of Medicare today, is a much less radical program. Sure, there are still issues with it that concern many, but it eliminates many of the “ending Medicare as we know it” concerns of the House budget.
In the coming weeks, we should have a strong and vigorous debate as to how to reform the health care system. But let’s keep it rational. I have no doubt that Democrats would rather run again the first Ryan plan. That one was hard to defend. But it’s the second Ryan plan that closely aligns with Mitt Romney’s, and unless things go crazy, that is the plan they will be running on.
It may make for good politics to demonize Ryan for his first plan. I expect politicians will do that. But here, and in places where policy is taken seriously, I hope we can focus on the plans that are actually being considered. As I’ve said before:
I’ve often been snarky towards those who think that a single payer system is American as apple pie if you’re 65, but communism if you’re 64 (I’m looking at you, Congress). But if [Ryan-Wyden] picks up steam, it will flip things for many people. It will be hard to argue that the ACA is a viable, progressive solution for universal coverage if you’re 64, but free-market-heartlessness if you’re 65. And many who wholeheartedly supported the ACA will find themselves in that position moving forward. After all, [Ryan-Wyden] even has a public option.
Moreover, with Ryan’s support, many who want to repeal the ACA may soon be in a similar spot. How do you support [Ryan-Wyden] as a sensible solution for universal healthcare if you’re 65, but believe that it’s tyranny and the end-of-freedom if you’re 64? After all, the ACA doesn’t even have that public option.
There’s a real case to be made for compromise here, if politicians could act like adults. They may not for the next few months, but that doesn’t mean we can’t set an example for them here.
[Cross-posted at The Incidental Economist]