With the selection of Paul Ryan as the GOP Vice-Presidential nominee, Medicare reform will become a central theme of this campaign. Expect to hear two competing visions of the future of health care for seniors. And both tales will be wrought with exaggeration and the counter-attacks will only make it worse. So here’s a quick and easy guide to the rhetoric of Medicare reform.
Medicare (along with Social Security) is often called the “third rail of American politics,” a dramatic analogy that can convey both the need to sequester these programs as permanently safe or the creation of an unreasonable and unsafe barrier. The conservative movement has worked overtime to push the latter interpretation and, by extension, exalt those who would confront these programs as “serious” and “responsible” for taking on these programs. And the most “serious” and “responsible” person in the GOP mind is Paul Ryan.
After decades of declaring that Medicare must be destroyed, demolished, or repealed (note the video clip in the linked story of then-actor Ronald Reagan using all kind of extremist buzzwords to deride Medicare), the GOP has recognized that this is a poor political strategy. As the Baby Boomers came of age in the late 70s and throughout the 80s, a large number of that demographic openly embraced calls to slash health care spending on seniors to keep their own taxes low. Today, however, those Boomers are now retired or looking nervously at retirement, and calls to throw seniors out on the street are no longer popular.
For this reason, both parties are now focused on “saving” Medicare. So are both sides committed to saving Medicare. To draw from the infamous Bill Clinton line, that depends on what your definition of “saving” is.
Democrats will explain that the modern Republican argument (championed primarily by Paul Ryan) is merely lipstick on the pig of their decades-long war on Medicare. The most often charge is that Republicans seek to end Medicare “as we know it” within 10 years. The phrase “as we know it” is critical in the looming back-and-forth between the campaigns. The Democrats use the phrase “as we know it” in order to counter the fact that Republicans have decided to call even their most revolutionary cuts as “Medicare.” Basically, “how can you say we eliminate Medicare…see this plan is still titled Medicare!” So Democrats short circuit that superficial refrain by saying “as we know it.” Regardless of the modifier, the message is that Republicans are seeking to end Medicare and Republicans will work overtime to defeat that message.
But we’re not done with the importance of “as we know it.” Republicans will spend a lot of time proclaiming that Democrats are “lying” about the Republican Medicare reform plan by pointing to a number of fact checking organizations that have labeled certain Democratic attacks as lies. That’s true, except reading those articles in full reveals that they only identify as a “lie” statements without the phrase “as we know it.” (well…Politfact and others make only that claim — the absolute embarrassment of a “serious” entity that is Factcheck.org just bald-face lies about the Ryan plan). Republicans are attempting to bootstrap their superficial “we still call it Medicare” into the debate by acting as though the “this is a lie because it doesn’t include ‘as we know it'” comments actually apply to all attacks against the Republican plan. Very tricky.
Well, we’re getting ahead of ourselves. What exactly is the GOP vision for Medicare? In a nutshell, Paul Ryan argues that he wants to “save Medicare” by eliminating Medicare for everyone under the age of 55. With the savings provided by never having to pay for the care of future elderly people (including those retiring in a mere 10 years), he would continue current coverage for seniors on Medicare today — well, that’s not entirely true…he’s also cut back on the benefits of current Medicare recipients, but at least the system as a whole would continue to exist. For those of us under 55, the government would begin to provide a subsidy to the rest of us to help us buy private health care plans. This plays into standard conservative themes of “the importance of private choice” and “competition.” As a technical matter this would save the government money, but it would also explode the costs for American citizens because private health care policies are much more expensive per individual than Medicare is per individual. Medicare is “saved” by jacking up prices on all of us currently under 55 — and we’d still be paying some amount for the Medicare of those currently over 65.
The Obama plan is predicated on maintaining Medicare as it presently exists. Expect an invocation of tradition and history. Callbacks to the Johnson administration to imply that this is such an old policy that it forms a bedrock American promise. Speaking of “promise,” expect to hear more about Medicare as a “promise” to “our” seniors (for example, here’s one of many candidate websites invoking that language). This provides a call to individual honor and nobility and also invites Americans to come together to respect the seniors that we all share — like a national treasure. It’s a reversal of the GOP strategy of 30 years ago, which sowed the seeds of age division, pitting young professional Boomers against the elderly.
This isn’t to say that Obama is not planning changes to Medicare. Indeed, Mitt Romney and Paul Ryan have already slammed Obama for slashing some $700 billion from Medicare as part of the Affordable Care Act. This attack is distinguishable from the GOP proposals because it cuts Medicare services to those currently on Medicare. The cuts in question only cut Medicare reimbursements to health providers — not seniors. Moreover, the Romney-Ryan budget would…make the exact same cuts! Along with an additional $700 billion. The Obama campaign will be judged by their ability to overcome this attack without sounding defensive.
Thus, the election comes down who wins the messaging of health care. Will the Republicans prove that they save the current system while Democrats want to cripple benefits to today’s seniors to benefit future seniors? If they cannot sell this story, Obama is likely to cruise through Florida and doom Romney’s already flagging presidential hopes.