“This is a defining moment, and we will go district by district to hold Republicans accountable for ending Medicare.”
— Rep. Steve Israel, chairman of the Democratic Congressional Campaign Committee
Last Friday was indeed a defining moment. When House Republicans voted in favor of Rep. Paul Ryan’s fiscal blueprint for 2012 to shrink spending and restructure Medicare and Medicaid over the coming years, they were making a large and risky bet.
They were gambling that Americans are now more motivated by fears of the growing national debt than by fears of entitlement cuts.
They may have bet wrong, of course, as Democrats denouncing them for heartlessness clearly believe. Maybe trillion-dollar deficits and Standard & Poor’s newly negative outlook on U.S. Treasury debt are still not enough to convince Americans to reject business as usual.
Maybe Ryan’s plan to convert Medicare (for those who turn 65 in 2022 and beyond) to a system in which the government provides a subsidy for health insurance but ties it “to overall consumer prices,” in the words of the Congressional Budget Office, is not what Americans had in mind last fall when they turned on Democrats at the polls.
Maybe most Americans believe the fable that “the rich” alone can be tapped to fill the budget gap.
But if Israel is wrong, and House Republicans suffer little political backlash as a result of their daring vote, it will signal a new maturity within the electorate. It may even mean that voters understand that Medicare won’t be sustainable until it is less generous, too.
None of this is to say that the House Medicare plan is superior to every other meaningful reform idea. For one thing, the GOP plan isn’t going anywhere. Every single House Democrat voted against it and every Senate Democrat probably would, too. Only a truly bipartisan anti-deficit proposal — one that involves both spending reductions and more tax revenue — has any chance of passing both chambers and being signed into law.
In the Senate, 41 determined senators can block just about any major legislation.
Whatever their party, voters serious about tackling the debt ought to be rooting for the Senate’s “Gang of Six” — three Democrats and three Republicans — to strike a deal that can be debated this summer. If those senators don’t succeed, all bets are off on a comprehensive deficit package until 2013 at the earliest.
But maybe you’re one of those who still think Medicare and Medicaid can be spared revamping. If so, you might want to read a recent blog post by CBO director Douglas Elmendorf. He lists five types of strategies for reining in health-care expenditures, and not one of them, as it happens, sounds painless.
Those strategies include raising the eligibility age for Medicare (“to 67 for example, to line it up with the full retirement age for Social Security”); turning Medicaid payments into block grants (as the Ryan plan does); increasing the “premiums or cost-sharing amounts paid by beneficiaries”; reducing the tax deductibility of premiums; and even taking treatment costs into account rather than having the federal government pay “the costs of nearly any medical treatment or procedure that a doctor recommends.”
Every one of those approaches is vulnerable to grandstanding opposition by the sentinels of the status quo. And yet, Elmendorf contends, “the daunting long-term budget outlook means that some combination of these or other approaches will ultimately be needed in order put the nation on a sustainable fiscal course.”
So yes, let this be a defining political moment, just as the demagogue from New York says. Americans are either committed to deficit reduction or they’re not. And after all, if a single House vote is enough to scare a majority of voters back into the embrace of the big spenders, then the fiscal outlook may be even bleaker than we’d supposed.
E-mail Vincent Carroll at vcarroll@denverpost.com.
