What’s Left of the Ryan Plan?

Jennifer Steinhauer in the Times reports that some Republicans are running away from the Ryan Plan (you know, the one that changes Medicare from a health insurance plan to an underfunded subsidy), while others are trying to figure out if they should support in order to gain Tea Party votes. As policy, of course, it never had a chance to pass the Senate or of being signed by President Obama (and every Republican staffer Politico could find agrees), so it was pure political theater from the start. As Paul Krugman points out, the goal may have been to win over the pundits — a group that is vastly more concerned with the deficit than ordinary voters — but even that failed. (They got Jacob Weisberg, but he backpedaled furiously, and they got David Brooks, which was mainly amusing because then we got to watch Krugman trying to observe intra-Times decorum by not going after Brooks by name). Now Republicans are wondering if the loss of a Congressional seat in a conservative New York district was Ryan’s fault.

But while I'd like to think that the nation is recovering its senses, at least on what Republicans mean for Medicare, I'm not optimistic. Brad DeLong put it well:

“the political lesson of the past two years is now that you win elections by denouncing the other party's plans to control Medicare spending in the long run — whether those plans are smart like the Affordable Care Act or profoundly stupid like the replacement of Medicare by RyanCare for the aged — sitting back, and waiting for the voters to reward you.”

Remember that at the same time they were plotting the destruction of Medicare as we know it,* the Republicans were also attacking the Obama administration for planning to reduce Medicare spending (from its projected levels, not its actual levels). Remember when Mitch McConnell's office released press releases, on consecutive days, saying, “Cutting Medicare Is Not What Americans Want” and “Expanding Medicare 'A Plan for Financial Ruin'”? Politically, the only mistake they made — if they made one at all — was putting out those press releases on consecutive days from the same office. I'm certain that a majority of Americans would agree with both of those positions, standing on their own.

Most likely, the Republicans will reposition the Ryan Plan as an attempt to “save Medicare” (wait, they're already doing that). They will try to eliminate the provisions in the Affordable Care Act that attempt to reduce Medicare costs by making Medicare spending more efficient, like the Independent Payment Authorization Board, demonizing them as government intrusion into medical treatment decisions. The answer, they will say, is a “Medicare” system free of government involvement. And if they can create enough gridlock to make sure the Affordable Care Act fails, then five or ten years from now, when the debt projections are even worse, they will take another shot at privatizing Medicare. Remember, this wasn't the first one: Newt Gingrich took a shot back in 1995. As long as the Republicans can use voters' fears of “big government” to block real reforms to Medicare, time is on their side. At some point, even if they have to wait twenty years, the fiscal imbalance will be so big that they will be able to eliminate Medicare.

The Obama administration knows this game. They knew what they were doing when they put cost-control measures into the Affordable Care Act, and I’m sure Obama will veto anything that prevents those measures from working. But it’s still an uphill battle.

* No, I don’t think this is an overstatement. The Ryan Plan would change Medicare from a guaranteed level of health insurance coverage to a voucher that may or may not buy you health insurance at all.