Republican Mitt Romney’s selection of Rep. Paul Ryan as his running mate has elevated Medicare to the highest level of national political debate this election year, say public policy experts and political observers.

Ryan, a young, highly personable congressman from Wisconsin, has put forth—with incremental changes—a roadmap for remaking Medicare over the course of a decade and longer. It’s a politically risky approach for the GOP ticket; Medicare is an emotional issue for many Americans. But the Romney–Ryan ticket says it is pursuing a bold idea that will strengthen the economy as well as entitlement programs in the long run. 

“We are going to go on offense on Medicare,” declared Ed Gillespie, a senior adviser to the Romney campaign.

Clearly, the stakes are raised.

“This will put Medicare higher on the list of topics that are going to be discussed,” observed Joe Antos, the Wilson H. Taylor Scholar at the conservative American Enterprise Institute and a former official at the Congressional Budget Office (CBO) and the U.S. Department of Health and Human Services. “Medicare is going to be very important.” Though voters will also be focusing on day-to-day issues such as the price of gasoline, the uncertain future of Medicare “has been in front of us for decades” and will garner much greater scrutiny during the campaign, Antos told The Medicare NewsGroup (MNG).

“The time for big thinking has arrived,” said Paul Ginsberg, Ph.D., president of the nonpartisan Center for Studying Health System Change and a former official at the CBO. “The country needs to focus more on how to address its entitlement spending.”

Some public policy experts say that even before Romney picked Ryan, Medicare, Medicaid and Social Security were rising on the list of topics that Americans want addressed by leaders. “Quite likely, Medicare would have been an issue in the campaign anyway,” said Paul N. Van de Water, Ph.D., a Senior Fellow at the Center on Budget and Policy Priorities and a former official at the Social Security Administration. Romney’s selection of Ryan “is certainly likely to make it even more so.”

The reform plan Ryan authored with Sen. Ron Wyden (D-Ore.) and his fiscal year 2013 budget proposal aim to reform the Medicare program so that seniors can choose to receive premium support from the government to purchase private insurance or to remain enrolled in traditional Medicare. Ryan’s plan would increase the Medicare eligibility age from 65 to 67 by 2034. It would cap the growth of Medicare after 2023 so that it does not exceed the growth of the U.S. economy plus 0.5 percent. It would not change Medicare benefits for those age 55 and older.

The Ryan blueprint is consistent with the congressman’s stated intent to dismantle the social safety net in the United States and to put more emphasis on individual empowerment. Though Romney and Ryan have differed on details, they share a desire to remake Medicare while curbing the nation’s long-term debt.

Reaction to the Ryan plan and his vision for the federal government has been strong, and largely predictable. However, some key Medicare stakeholders say they will not comment publicly on Ryan or his Medicare plan because they need to work with whoever wins the November 2012 election.

After Ryan was announced as Romney’s running mate, America’s Health Insurance Plans said in a statement to MNG: “We look forward to working with members of Congress in both parties to improve the quality and safety of patient care and to help put these critically important programs on sustainable and responsible paths.”

AARP stated that that it “believes that the future of Medicare and Social Security are critical issues in this election season.… We’re happy to see an elevated level of public discussion around Medicare and Social Security.”

However, in April 2011, the organization reacted more strongly to the version of Ryan’s plan then on the table, with AARP Executive Vice President Nancy A. LeaMond declaring: “Rather than tackling skyrocketing health care costs, [it] would simply shift these costs onto the backs of people in Medicare. It would undermine Medicare’s promise of secure health coverage—a guarantee that future seniors have contributed to through a lifetime of hard work.”

Families USA, the American Hospital Association and the Pharmaceutical Research and Manufacturers of America had no comment on Ryan’s selection or his vision for Medicare.

Romney’s choice of Ryan set off a stronger war of words among political stalwarts. Republicans describe their approach as one necessary to “save” Medicare. Democrats claim that the plan would “end Medicare as we know it.” Both sides cite statistics and reports to bolster their argument. But taken out of context and because of the complexity and the significance of the issue, rhetoric and slogans could drown out attempts to interpret the facts and proposals in a constructive manner, policy analysts fear.

“These issues are not simple ones,” said Van de Water. “Different people can view the same proposals in a different light depending upon their values.”

“Ideas are going to be portrayed by opponents as much more extreme than they are,” said Ginsberg.

News organizations have a responsibility to explain the Democratic and Republican stances on Medicare fairly and in detail, according to policy experts. But will voters pay attention to the details as they are inundated with sound bites and attack ads that oversimplify complex issues?

Created in 1965, Medicare served more than 48 million Americans in 2011. Though most experts accept the contention that it faces the prospect of running out of money, there is not universal agreement that it is broken. “Medicare has become a lightning rod simply because it is eating up more federal resources every year,” says a paper by University of Illinois Professor Richard L. Kaplan.

However, with health care costs continuing to escalate faster than wages, most experts acknowledge that changes are necessary.

The Obama administration has sought revisions to Medicare provider payments, such as cutting payments for hospitals and forcing pharmaceutical firms to accept lower rates. And it proposed more than $700 billion in Medicare funding reductions in the Affordable Care Act, the controversial 2010 health care reform law largely upheld by the U.S. Supreme Court in June 2012. Designed to increase insurance coverage to millions of Americans, the cuts won’t impact Medicare beneficiaries, Democrats said. That didn’t stop Republicans from beating up on Democrats, particularly in the November 2010 midterm elections, for proposing Medicare funding reductions.

Democrats cite a CBO analysis of the Ryan Medicare plan finding that, “most elderly people would pay more for their health care.” The additional costs, averaging as much as $6,400 for a typical beneficiary in 2022, would require seniors to “reduce their use of health care services, spend less on other goods and services, or save more in advance of retirement,” the report stated.

Already critical of Romney’s support for tax cuts for the wealthy, Democrats jumped on the Ryan selection. His plan “puts millionaires first and Medicare and the middle class last,” said New York Rep. Steve Israel, chairman of the Democratic Congressional Campaign Committee. Democrats point out that Ryan’s plan would increase the federal debt during the next decade and would reduce it only after that time.

Polls show significant voter distrust of changing Medicare. The issue could be particularly problematic for Republicans in states and congressional districts with large numbers of seniors, including Florida. Some analysts say the burden will be on the Romney–Ryan team to make the case that market-driven health care changes will produce savings for the system and will not cut into seniors’ expected benefits.

Republicans counter that Obama has no effective plan to save Medicare. Restraining payments to providers just isn’t enough, they say. So it’s time to “go big.”

Antos agrees. “The government top-down approach has not worked,” he stated. “We need to change the fundamental incentives that drive spending throughout the health care system.” In fact, Antos argues that the Ryan plan waits too long to cut benefits. “We need to phase in some of the changes.”

The issue of giving seniors premium support—also known as “vouchers” —is particularly sensitive politically. The Ryan proposal would give Medicare recipients an annual federal payment that they could use to purchase health coverage. Ginsberg says the term “voucher” is misleading, because under the Ryan plan it would not be a blank check; it would provide funds to be spent only for health care. That’s somewhat similar conceptually to the health care exchange system that the Obama administration inserted into the Affordable Care Act, effective in 2014, he says.

Ginsberg said that “after the election, the two parties are going to have to come together” to address Medicare. Fixes will become much more expensive “if you wait 10 to 20 years.”

“There are going to be major changes in Medicare and in the Affordable Care Act no matter who’s president,” agreed Antos. “Next year is going to be a very difficult year.”

MedicareNewsGroup.com (MNG) original articles and Medicare Matters news summaries can be reprinted or republished with credit to the Medicare NewsGroup. To use our content, simply copy and paste text from the MNG website. Use of our content is done in compliance with our Terms and Conditions but does not extend to material from other sources that are subject to their copyright.   

RELATED LINKS

MNG MEDICARE FAQs

What Does U.S. Rep. Paul Ryan's (R-Wis.) Propose for Medicare Reform in the House Budget Committee's Fiscal Year 2012 Budget, "The Path to Prosperity?"

How Would U.S. Rep. Paul Ryan’s (R-Wis.) Reform Proposals Impact Medicare Beneficiaries?

What Is House Budget Committee Chairman Paul Ryan’s (R-Wis.) Plan for Medicare Reform? 

What Is the Premium Support Option, and How Is it Different From Current Medicare? 

What Is President Barack Obama's Position on Medicare Reform? 

What Are Republican Presidential Candidate Mitt Romney’s Views on Medicare Reform?

MNG NEWSMAKER

Paul Ryan

MNG BEYOND THE SOUND BITE

Fact/Fiction: Mitt Romney and Paul Ryan Would End Medicare as We Know It

Fact/Fiction: Premium Support Has Bipartisan Roots