While the initial introduction of Rep. Paul Ryan as Mitt Romney’s running mate was a boffo success, one theme that didn’t get enough emphasis from the two principals was the bipartisan provenance of Ryan’s Medicare proposal that is already the target of such fierce Democratic assault. The Romney campaign ought to, first, explicitly adopt the specific plan Ryan crafted with Democratic U.S. Sen. Ron Wyden of Oregon as its official proposal, and, second, use Medicare Part D as a comparative selling point in marketing the plan to seniors.
First, from a political standpoint, even if most voters don’t know who Wyden is, the Romney campaign ought to make sure everybody knows he is a mainstream/liberal Democrat — and it should consistently call the campaign’s proposal the “Romney-Ryan-Wyden Plan.” While Democrats can still attack the proposal as a bad idea, there is no way they can get away with painting it as a mean-spirited, dangerous plan if a mainstream/liberal Democrat (ADA rating 95%, SEIU rating 91%) is its co-author.
Romney-Ryan-Wyden makes no changes to Medicare for anyone currently age 55 or over, and allows those younger than 55 to remain in the traditional Medicare system if they so desire. For others under 55, the federal government would provide what is known as “premium support,” meaning a specified grant for purchasing health insurance that would cover all monthly premiums for whatever private insurance plan in the region is the second-lowest bid offered, assuming it includes insurance for the entirety of a federally guaranteed minimum-coverage package. (Anything more expensive, purely voluntary, would be paid out of pocket.)
By the way, the campaign ought to find a new name for the boring, bureaucratese-sounding “premium support” — perhaps “Personal Health Grants,” or columnist Deroy Murdock’s plain but crystal-clear suggestion of “Insurance Assistance.” (Alternatively, Murdock said in a phone conversation, perhaps they could call them “Kemp Grants” in honor of Ryan’s late, beloved mentor — thus echoing the popular “Pell Grants” for student aid.)
One way or another, marketing is important.
Anyway, Wyden is only the last in a long line of Democrats who have endorsed versions of Personal Health Grants. Most famously, in 1997 and 1998 the Bill Clinton-created National Bipartisan Commission on the Future of Medicare designed a plan built around premium support. Not only did all eight commission Republicans endorse the plan, but so did two of the nine Democrats — then-Sens. Bob Kerrey of Nebraska and John Breaux of Louisiana. Several others, including Clinton economist Laura D’Andrea Tyson, either explicitly endorsed (in Tyson’s case) or all but endorsed premium support in concept but decided against the overall plan for other reasons — some of which were political, as Clinton himself had been expected to embrace the full report before he found himself suddenly needing liberal support to survive the Lewinsky scandal, and thus pulled the plug on his own expected embrace of the recommendations. (It is telling that Clinton did not list premium support as a reason for opposing the plan — because, presumably, he agreed with the concept.) In the end, Clinton several months later proposed a plan remarkably similar to (but awfully more bureaucratic than) the Ryan-Wyden plan.
Jump forward now to 2003. For good reason, conservatives were hardly happy with the Medicare Part D prescription drug bill, but one of its central features was, precisely, premium support for purchase of prescription drug coverage. If the idea was so radical, why did Democratic senators Max Baucus, John Breaux, Tom Carper, Kent Conrad, Tom Dorgan, Dianne Feinstein, Mary Landrieu, Blanche Lincoln, Zell Miller, Ben Nelson, and Ron Wyden vote for it?
While the program wasn’t “paid for” with either new revenues or other savings, and while it was not accompanied by the originally envisioned reforms for the Medicare system as a whole (rather than just for medicines), the premium support part of it has worked like a charm. (For that matter, so did the very similar health savings accounts included in the bill.) Just last week, the Department of Health and Human Services released its projections for the average premiums for 2013, which will stay almost the exact same for the third consecutive year at about $30 per month — an astonishing 50 percent under original estimates! And the cost to the taxpayer has come in at 43 percent below projections as well. Meanwhile, 88 percent of seniors are happy with their coverage, and 95 percent say it works well.
Paul Ryan should not have supported Part D, but — like fellow reformer Rick Santorum — he was so encouraged by the premium support aspect and the health savings accounts that he did indeed vote for it. The Romney campaign ought to make use of this fact in targeted advertising or mailings to seniors. After all, how could a guy like Ryan really be believably unconcerned about using Medicare to provide for seniors if he voted for the prescription drug program that they are so happy with?
Now jump forward to 2010. Ryan joined with another prominent and highly respected former Clinton economist, Alice Rivlin, to propose, yes, another plan whose central feature would be what should now be called Personal Health Grants or Kemp Grants. The liberal Washington Post editorial page in 2011 reiterated its own openness to Personal Health Grants (“hardly beyond the pale”) while describing Democratic attacks on the idea as “President Obama… reclaim[ing] the low ground,” and as “false, inflammatory” in a way that “threatens to set things back.” And the Romney campaign should make great hay of PolitiFact calling attacks on Ryan’s Medicare plans as the “Lie of the Year” in 2011.
In truth, honest liberals from academia, journalism, think tanks, and political offices alike have consistently supported versions of Personal Health Grants for a decade and a half. There is nothing radical about the idea. Similarly, Ryan’s suggestions for Medicaid are based directly on the successes of welfare reform in 1996 — signed and claimed credit for thereafter by Clinton. Ryan’s proposals for domestic discretionary spending also are perfectly in line with what was envisioned in Clinton’s second-term budgets (adjusted for inflation). Ryan’s ideas aren’t anywhere near the outer edges of mainstream thought; they aren’t penurious, but merely sober. They protect current seniors while reassuring younger Americans that Medicare really will be saved for them when they retire. And they also make seniors comfortable that their own grandchildren won’t be left wanting — an argument that almost certainly has more resonance than the political chattering classes are apt to credit.
The Romney-Ryan-Wyden plan should be seen by not a single soul as threatening; instead, if marketed well, it should be a net political plus. Personal Health Grants provided by some of the same people who gave prescription drug coverage to seniors should be an idea not from which the campaign should run, but on which it should proudly stand.