Even as Mitt Romney was introducing Wisconsin Rep. Paul Ryan as his running mate, his campaign was preparing a defense of the House Budget Chairman's draconian Medicare proposals. With good reason. After all, in April 2011 the nonpartisan
August 13, 2012


Even as Mitt Romney was introducing Wisconsin Rep. Paul Ryan as his running mate, his campaign was preparing a defense of the House Budget Chairman's draconian Medicare proposals. With good reason. After all, in April 2011 the nonpartisan Congressional Budget Office forecast that Ryan's scheme to convert today's guaranteed Medicare insurance program into an underfunded voucher system would dramatically shift the health care costs onto America's seniors. And in February 2010, Ryan acknowledged his privatization plan for millions of future elderly constituted rationing.

But it's not just Team Romney that should be concerned about being caught red-handed with the proverbial gun pointed at the wildly popular program. Last year, 235 House Republicans and 40 GOP Senators--98 percent of all Republicans in Congress--voted for Paul Ryan's budget and its blueprint to rationing Medicare.

To be sure, the Ryan budget blessed by Republicans on Capitol Hill means de facto rationing for the system that today serves 46 million American seniors. As the CBO documented last year, Ryan's plan to replace public insurance provided by the government with vouchers for the elderly to buy their own coverage in the private market means getting less care for more money. The CBO analysis concluded that "a typical beneficiary would spend more for health care under the proposal." Make that, as Director Douglas Elmendorf explained, a lot more.

Under the proposal, most elderly people who would be entitled to premium support payments would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, CBO estimated the beneficiary's spending on premiums and out-of-pocket expenditures as a share of a benchmark amount: what total health care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary's share would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.

While the math of the Ryan budget may not seem simple, its erosion of the Medicare program is nevertheless inevitable. Because the value of Ryan's vouchers fails to keep up with the out-of-control rise in premiums in the private health insurance market, America's elderly would be forced to pay more out of pocket or accept less coverage. The Washington Post's Ezra Klein described the inexorable Republican rationing of Medicare which would then ensue:

The proposal would shift risk from the federal government to seniors themselves. The money seniors would get to buy their own policies would grow more slowly than their health-care costs, and more slowly than their expected Medicare benefits, which means that they'd need to either cut back on how comprehensive their insurance is or how much health-care they purchase. Exacerbating the situation -- and this is important -- Medicare currently pays providers less and works more efficiently than private insurers, so seniors trying to purchase a plan equivalent to Medicare would pay more for it on the private market.

It's hard, given the constraints of our current debate, to call something "rationing" without being accused of slurring it. But this is rationing, and that's not a slur. This is the government capping its payments and moderating their growth in such a way that many seniors will not get the care they need.

In his February 2010 interview with Klein, Ryan acknowledged as much. Sadly for the Republican brain trust, he failed to follow the GOP script that only Democratic reforms lead to "health care denied, delayed and rationed."

"Rationing happens today! The question is who will do it? The government? Or you, your doctor and your family?"

(Of course, Ryan left out the real culprit--the private insurance market. But with 50 million uninsured, another 25 million underinsured, one in five American postponing needed care and medical costs driving over 60% of personal bankruptcies, Congressman Ryan is surely right that "rationing happens today.")

It was the Republicans' fear of being the branded "The Party That Killed Medicare" that led GOP leaders to run away from the Ryan Roadmap for America--at least until the 2010 midterms were safely won. In July 2010, then House Minority Leader John Boehner disowned Ryan's plan. "It's his," Boehner said, adding, "There are parts of it that are well done. Other parts I have some doubts about, in terms of how good the policy is." With only 13 co-sponsors that summer, Paul Ryan denied his was blueprint was the GOP's. As Ryan put in August 2010, "My plan is not the Republican Party's platform and was never intended to be."

That denial last until the GOP reclaimed the House majority in November 2010. By then, the ad campaign falsely accusing Democrats of $500 billion in cuts to Medicare benefits had successfully terrified seniors into overwhelmingly voting Republican. In April 2011, the House passed Ryan's plan. Senate Republicans gave it their blessing the next month.

Still, even some of the staunchest anti-government Republicans had misgivings about what they had just done. As Minnesota Rep. and future GOP presidential candidate Michele Bachmann put it:

Bachmann, one of many Republicans mulling a run for president in 2012, said she was concerned that Medicare cuts proposed in both budget plans -- which she carefully described not as bills, but as "aspirational documents" -- put an undue burden on America's seniors. "I put an asterisk on my support, I put a blog posting up that said just as much. That is my area of concern," she said on "Fox News Sunday." "I support this bill with that proviso."

"I'm concerned about shifting the cost burden to seniors," she added.

Or at least, being seen to be shifting the cost burden to seniors.

That concern is shared by her GOP colleagues, who as Greg Sargent reported in the Washington Post in March, have been trying to rework and relaunch Ryan's Medicare rationing scheme. In December, Paul Ryan offered version 2.0 of his "premium support" scheme, this time keeping the Medicare "public option" as one choice for future American seniors (those currently 55 or younger). In his public remarks and on his web site, Mitt Romney backed the outlines of that plan.

Because he joined Ryan in that proposal, Oregon Democratic Senator Ron Wyden will soon find himself the Republican Party's human shield on Medicare. Given the human toll the House Republican budget would take on millions of American seniors, Mitt Romney, Paul Ryan and their Congressional allies will look for protection anywhere they can get it.

(This piece also appears at Perrspectives.)

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