GOP plan to change Medicare is rooted in bipartisan history

Two powerful members of Congress, a Democrat and a Republican, were leading a federal commission to find a secure financial path for Medicare. Instead of relying entirely on public insurance for older Americans, they argued, the government should help seniors buy private health plans.

The idea was polarizing, and, by a single vote, the commission ended a year of debate by failing to recommend the change to the White House or Congress.

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The Bipartisan Commission on the Future of Medicare finished its work in 1999. But a dozen years later, the core ideas — championed then by a centrist Louisiana Democrat, Sen. John Breaux, and a brainy and acerbic chairman of the House Ways and Means Committee, Republican Bill Thomas of California — live on in the proposal to change Medicare that the House has embraced in recent weeks.

The proposed change is known as “premium support,” because the government would pay part of the insurance premiums charged by private insurers that compete for older Americans’ business.

The idea’s lineage reflects a more complicated reality than either political party acknowledges today. Although Democrats are now vilifying it as a dangerous creation of the GOP, it has had Republican and Democratic proponents alike for more than three decades.

But even some of the leading health policy and economic thinkers who have advocated premium support are distancing themselves from the specific plan drafted by House Budget Committee Chairman Paul Ryan (R-Wis.).

Among these critics is Alice M. Rivlin, a Brookings Institution scholar who wrote a rough outline of such an approach with Ryan as members of a recent presidential commission on the federal deficit. “I think it’s still a valuable concept,” Rivlin said. “I wouldn’t support the version that he has.”
Such hesitancy is echoed by public skepticism: Only one-third of Americans favor changing Medicare in the way Ryan suggests, according to a WashingtonPost-ABC News poll. The House has adopted the change as part of a budget proposal written by Ryan, but the Democratic-controlled Senate is reluctant. President Obama has condemned the idea, saying it would create a“fundamentally different society than the one that we have now.”

Still, Ryan and conservative allies are not alone in believing that market forces may be the best way to slow spending in the massive entitlement program — a lifeline to care for 47 million elderly and disabled people — that imperils the nation’s fiscal stability. “Medicare as we know it is going to end by itself if we don’t make some changes,” said Breaux, the Democratic senator-turned-lobbyist who still favors the ideas considered by his commission.

There is a broad consensus that Medicare in its current form will be overwhelmed by the financial pressures of the aging baby-boom generation, longer life spans and sophisticated medical treatments. Various estimates say the fund that pays Medicare hospital bills will run short in a decade or two; the program’s trustees are to release new predictions in a few weeks.