The Right Prescription

Paul Ryan as the Great Destroyer

How a young congressional policy wonk was transformed into the Shiva of Medicare.

By 8.13.12

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The White House, "news" media and progressive blogosphere have many faults -- mendacity and collusion, to name the most obvious -- but they cannot be accused of being unpredictable. Thus, when Mitt Romney announced that Paul Ryan would be his running mate on the GOP presidential ticket, it was hardly necessary to consult one's Vedic astrologer to know that the Wisconsin congressman would again be denounced for his dark desire to deprive Granny of health care. And, sure enough, even as Ryan was introduced by Romney as his choice for VP in a series of Saturday appearances, he was being depicted as Ryan, Destroyer of Medicare.

The first and most irresponsible attacks came from bought-and-paid-for purveyors of White House talking points like the stooges at Media Matters, whose super PAC released a 290-page slander manual that claims Ryan would "essentially end Medicare." Likewise, Think Progress opened fire before lunch with a tweet declaring, "If you hate Medicare, you'll love Romney's pick for VP." Then, the "legitimate" outlets began to parrot the Obama campaign's message of the day. ABC News, for example, ran a piece early Saturday afternoon advising that "Critics have called Ryan's 2011 proposal the 'end of Medicare as we know it,' and that's true."

The obvious purpose of these tweets, posts and "news" stories is to scare seniors into voting against Romney and Ryan in November. Ironically, it is Obama's misbegotten health care law, the Patient Protection and Affordable Care Act (PPACA), that should terrify seniors. As Avik Roy points out, "According to the latest estimates from the Congressional Budget Office, ObamaCare will reduce Medicare spending by approximately $743 billion between 2013 and 2022, relative to prior law." Unlike Ryan's Medicare plan, which even ABC admits won't affect anyone over age 55, PPACA's cuts will hit current Medicare beneficiaries.

It should further terrify seniors that Obama has offered no serious plan for reforming Medicare, which is on a fiscal trajectory that actually will destroy the program if something isn't done soon. As Ryan himself told the President in February of 2010 during the charade billed by the White House as a bipartisan Health Care Summit, "Medicare right now has a $38 trillion dollar unfunded liability, that's $38 trillion in empty promises to my parent's generation, our generation, and our kid's generation." Yet the Obama administration has all but ignored the looming Medicare disaster, essentially pretending that the status quo is somehow sustainable.

In fact, when last April's report from the program's trustees predicted that the whole house of cards would begin to collapse in 2024, Obama's delusional Secretary of Health and Human Services said, "Medicare is in a much stronger position than it was a few years ago, thanks to the Affordable Care Act." This assertion by Commissar Sebelius is preposterous, of course. As former director of the Congressional Budget Office Douglas Holtz-Eakin wrote at the time, "Medicare's cash position makes Enron's business model look downright reputable. The reality is Medicare is bleeding cash, a fact disguised by creative accounting."

All of which suggests that ending Medicare "as we know it" is a pretty good idea. How then, would Paul Ryan go about cleaning it up? The first step, as he has often said, is to repeal Obamacare. Contrary to Sebelius's Orwellian claims, PPACA exacerbates Medicare's multiple ills. He would also utilize some of the market-based features of a program that has often been denounced by conservatives. As he put it in a June interview, "Our reforms draw upon the lessons of Medicare's prescription drug program (Medicare Part D), in which patients have the freedom to choose among competing Medicare-approved coverage options."

More specifically, as outlined in a pamphlet released when Ryan partnered with Democrat Ron Wyden to create the latest, bipartisan version of his plan, "Starting in 2022, a new Medicare program will begin offering seniors a choice among Medicare-approved private plans and the traditional Medicare plan.… Coverage will be guaranteed through a new 'premium support' system that encourages plans to provide high-quality care more efficiently." The plan will "encourage" efficiency by forcing traditional Medicare to compete with private plans for patients, and this competition will drive down costs just as it did with Part D.

The plan also "guarantees" that costs will be kept under control: "In the event that these efforts do not stem the rising tide of Medicare spending, beginning in 2023 there will be a cap on cost growth of 1 percent over Gross Domestic Product, plus inflation." The plan would also expand means-testing beyond that which already exists for Part B and Part D to the new premium support payments. The basic idea of Ryan-Wyden, then, is to allow the market to work as much as possible without disrupting the coverage of current beneficiaries or damaging the safety net. In other words, the notion that Ryan would destroy Medicare is absurd.

If the Romney campaign succeeds in defeating Obama, the plan will evolve further pursuant to the political conditions that prevail after January 2013. The new President will probably want a few changes, though he has already praised Ryan-Wyden. And Congress isn't simply going to rubber stamp what comes out of the White House, even if the Republicans retain their majority in the House and gain control of the Senate. So, if the new VP suddenly drops his clever disguise as a Wisconsin policy wonk and reveals himself as Ryan, Destroyer of Medicare, Romney will just send him to the funeral of some foreign head of state. 

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About the Author

David Catron is a health care revenue cycle expert who has spent more than twenty years working for and consulting with hospitals and medical practices. He has an MBA from the University of Georgia and blogs at Health Care BS.