House GOP Medicare Elimination Plan Puts Conservatives in a Pickle


It’s subscription-only, but Roll Call has a nice little piece by Steven T Dennis about how House GOP budget chief Paul Ryan’s plan to balance the budget by eliminating Social Security and Medicare is putting some of his colleagues on the hot seat:

For the past year, Senate Republican leaders have largely avoided putting forward alternative visions to the major bills Democrats have offered, preferring to cherry-pick politically charged amendments instead. House Republicans have taken a somewhat different tack, offering alternative bills. But in some cases, such as in their health care package, offering piecemeal ideas that eschewed politically tough choices.

The Republican game plan appears to have worked to some degree, with the Democrats’ big climate change and health initiatives stalled and a huge GOP upset victory in the Massachusetts Senate special election. But some conservatives have wanted more substance on issues such as Medicare cuts. Republican leaders bashed the Democratic health care plans for cutting more than $400 billion out of Medicare, but GOP budget hawks view controlling Medicare costs as essential to balancing the budget.

A Republican who asked to have his name withheld said the party’s leadership and rank and file aren’t ready to follow Ryan’s lead. “There’s a lot of worry that we beat the Democrats up on health care for cutting Medicare and now we’re going to turn around and do it,” the Republican said.

To be clear about the difference, though, the Democrats had a targeted proposal to try to eliminate specific inefficiencies. They want to take out some bonus subsidies to private insurance firms that Republicans larded onto Medicare in the 1990s. And they have a plan for a beefed-up Medicare payments commission that, in theory, should allow reimbursement rates to be made in a more technically sound manner. Some people claim these measures will have an adverse impact on patients, but that’s really a quite debatable claim.

The House GOP budget, by contrast, just goes after Medicare with a chain saw. Right now, the rapidly rising cost of health care implies rapidly increasing Medicare costs. Ryan doesn’t have a plan to control those exploding costs. Instead, his plan is to refuse to pay the bill. This saves a ton of money. If instead of paying for old people’s health care you just . . . don’t pay for their health care, then you reduce expenditures a great moment. But the reason nobody’s come up with this genius proposal before is that we’ve had a decades-long commitment to finding a way to ensure a dignified retirement, including adequate medical care.