House Republicans voted for the Medicare reform plan authored by Rep. Paul Ryan (R-Wis.). Ryan also put forward, in his Roadmap for America, complete plans for Social Security and Medicaid reform. Senate Republicans have voted for a variety of entitlement plans, including some of Ryan’s ideas. But in the Republican presidential race, those who have discussed overhauling entitlements have offered “plans” that are vague or downright silly.
Let’s start with Social Security. Herman Cain wants to import a new Social Security plan from Chile. This makes 9-9-9 seem attainable. The partial privatization of Social Security was rejected; a complete privatization is a non-starter.
Texas Gov. Rick Perry confirmed Mitt Romney’s accusations that he wants to send Social Security to the states. In his speech Tuesday, he said that one of his principles is “to return to pre-1983 law and allow state and local governments to newly opt out of Social Security and instead allow their employees to pay solely into state or locally run retirement programs. This has been done around the country, with better results. We ought to allow it again.” In other words, Romney was right, despite all of the Perry protestations to the contrary.
The logistics of such a plan, the potential burden imposed on state budgets and the sheer impracticability of the suggestion leads one to believe that this is no more serious than going to Chile for a retirement plan. Perry also wants to let younger Americans save privately and to have a lockbox on the trust fund. (Neither addresses fixing the current system.) The only serious proposal Perry offers is to “raise the retirement age for younger workers — on a gradual basis — to reflect the longer lifespan of today’s Americans.”
On Medicaid, Perry and Ryan agree on Medicaid block grants as the primary means of reform. However, in handing over to the states the medical care for the poor, some states will maintain a reasonable level of benefits and others will make it exceptionally difficult to qualify for Medicaid. Since Perry’s state falls into the latter category, it is fair to ask whether states should be obliged to meet any federal standards. (At some point he should explain why every state manages to cover a greater proportion of sick people than Texas does.)
It is on Medicare where the rubber meets the road. As I noted above, Ryan and the House Republicans took on the Mediscare attacks to offer a responsible plan. Does any Republican candidate think that he can duck the issue or that, by only vaguely approving of Ryan’s plan, they can escape scrutiny? If so, they probably think we can adopt a Chilean retirement system. Republicans are going to take the heat anyway, so why not pony up and get some credit for acting responsibly?
Cain has offered nothing. Perry said this in his speech:
We will also reform Medicare to save it for future generations of Americans. We will do this by working with Congress on several options, including giving patients greater flexibility in choosing the plan that best fits their unique needs through bundled premium support payments to the individual, or as a credit against purchase of health insurance.
Second, we should look at gradually raising the age of Medicare eligibility. Third, we should consider adjusting Medicare benefits to be paid on a sliding scale based on the income of the recipient. And lastly, we must tackle the $100 billion in annual waste and fraud to save this valuable program as Americans live longer.
In sum, Cain has offered a single impractical idea on entitlement reform. Perry has explained a viable Medicaid reform plan, but not whether he’d allow every state to do what Texas has done — leave 25 percent of the population uninsured. On Medicare, Cain is silent and Perry is intentionally vague, although he hints at proposals along the lines Ryan has suggested. (If he thinks Ryan’s plan is the right one why not say it?)
I have written previously that Romney could use more detail. But at least he’s excluded unserious or irresponsible ideas and stepped up to the plate on Medicaid and , to a degree, on Social Security. He should do the same on Medicare. It is on Medicare, where House Republicans have been the boldest, that he is the least forthcoming.
Now is the time for candidates to establish credibility and show leadership. Let’s hope they put fairy tales aside and start with a realistic assessment of what we need to do.