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One of the aspects of the current Medicare debate that just drives me crazy is how the Beltway pundits treat it as "bold, new, and courageous." I've written a lot on that particular frame in the past, but I ran across something tonight that reminds me of just how not-new it really is.
During the Medicare Advantage debate, Sherrod Brown said this, as recorded in the Congressional Record:
[Privatization] has really been the thrust. From President Bush to the gentleman from California (Mr. Thomas) to Speaker Gingrich a few years ago, to back in 1965, Republicans really wanted this system turned over to the insurance companies. Privatize Medicare and give it to the insurance industry. Go back to 1965, out of roughly 200 Republican Members of the House and Senate, only 23 voted for the creation of Medicare. Gerald Ford in 1965, a future President, voted against it. Congressman Dole, future Senator Dole, Republican Presidential candidate, voted against it. Senator Strom Thurmond voted against the creation of Medicare. Congressman Donald Rumsfeld in 1965, later Secretary of Defense and the architect of this plan, I put in quotation marks, of the rebuilding of Iraq, voted against the creation of Medicare.
Then in 1995, the first time Republicans had an opportunity to do something about Medicare, the Republicans under Speaker Gingrich tried to cut it by $270 billion in order to give a tax cut to the most privileged Americans, the same old story. Speaker Gingrich said in October 1995 that he hoped Medicare would wither on the vine.
Gosh, that sure sounds familiar. But wait, there's more, from Rep. Cardoza:
This motion instructs the Medicare conference committee to reject the controversial and risky privatization scheme of premium support and reallocate that money to increase the payment to physicians who care for Medicare beneficiaries.
Let me first discuss the issue of premium support and why I am concerned that this scheme could potentially dismantle the program of Medicare. I am concerned about subjecting a proven health care delivery system like Medicare to the uncertainty of the private market. I am especially hesitant about the system that relies on HMOs to provide this service to our seniors.
And this, from Rep. Pete DeFazio:
It is a funny thing here, we are being told that the Republicans want to inject competition into the insurance market. Well, if they really want to do that, why do they not support my bill to lift the antitrust exemption from the insurance industry?
Now we are going to throw our seniors onto the tender mercies of this collusive, anticompetitive industry. O, that is great. My seniors already had this experience. We had Medicare+Choice, HMOs. Oh, this is going to be great. You are going to get more benefits than under fee-for-service. Well, the companies were not able to collude and set the prices quite high enough to satisfy their profits, so they up and left with very little notice. My seniors were left in the cold.
Now there's much, much more in this particular section of the Congressional Record. I urge you to read it. But in a day where 24 hours seems too long for news cycles to last and memories to reach back, this is a really important piece of history in the long, protracted debate over Medicare for seniors and indeed, Medicare for all.
The Affordable Care Act basically repealed most of what Republicans did in 2003 with Medicare Advantage. It stripped away the bonus payments to insurers and established an outcomes-based system of reimbursements. Republicans are now trying to reverse that process yet again and ratchet it back up to their original dream: Full privatization of the Medicare program, lock, stock and barrel.
The part of the debate that's not happening in a meaningful way right now is really the answer to the "problem" of Medicare costs. Medicare costs are rising because it is, by definition, a program designed for adverse selection. It covers the disabled and elderly, a group that will generate the highest costs and the highest need for health care, but the young and healthy are covered under private insurance at far greater cost.
If the Beltway pundit class has a need for a 'bold, strong plan' then progressives should play the Medicare for All card much harder than they are right now. Countering with "don't repeal the Affordable Care Act" is not strong enough. This nonsense about Paul Ryan's 'innovative, bold plan' is just that -- nonsense. What makes sense is to counter it with sensible arguments for Medicare for all, and it should be countered with boldness and facts as to why that, and that alone, will save Medicare and lock it in as something untouchable by conservatives in the future.
Republicans are terrified of Medicare for all because they know they will never be able to undo what has been done. It will be too popular, too right. As long as they can keep Medicare in the realm of adverse selection and costly, they have a chance to kill it.