Ruth Marcus
Ruth Marcus
Opinion Writer

Feeling ill over the Medicare debates

The Republican National Committee chairman says President Obama has “blood on [his] hands” for cutting Medicare. Mitt Romney blasts the president for having “robbed” the program of $700 billion.

Vice President Biden accuses Romney and running mate Paul Ryan of “gutting” Medicare. And, inevitably, President Obama warned that Romney-Ryan would “end Medicare as we know it.”

Ruth Marcus

An editorial writer specializing in politics, the budget and other domestic issues, she also writes a weekly column and contributes to the PostPartisan blog.

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Aren’t you glad we’re having a sober policy discussion about how to rein in entitlement spending?

Such hyperbole was inevitable. The laws of political gravity drag every debate from the lofty realm of ideas to the grungy plain of invective. The more complex and weighty the issue, the more it is at risk of being distilled — distorted — into a 30-second caricature.

Let’s pause for a bit of fact-checking.

The cheeky response to the critique of Obama’s Medicare cuts is that Ryan assumes those very cuts in his budget — the one passed by the House and endorsed as “marvelous” by Romney. So there are robbers galore and blood to spread around.

The slightly less cheeky response is to say: Aren’t these the people who have been screaming about Medicare bankrupting the country? Shouldn’t they be praising cuts, not denouncing them?

The on-the-merits response is that the cuts — more accurately, reductions in the rate of growth — involve lower reimbursements to hospitals and nursing homes, reduced payments to insurers, higher premiums for better-off beneficiaries, and savings from reforms such as lower hospital readmissions.

In other words, Grandma might lose her free eyeglasses, but her basic benefits remain untouched.

The fairer question is whether the savings should have been used to reduce the debt rather than underwrite low-income subsidies in Obamacare. But since Romney-Ryan would do nothing — nada! — to slow the growth of Medicare for a decade, they are not the ones to ask it.

Not that Democrats are more honest. The attack on Romney-Ryan for “ending Medicare as we know it” studiously ignores the unpleasant reality that Medicare as we know it cannot continue. Meanwhile, an Obama campaign video of Floridians bemoaning the GOP team’s Medicare plan (“It’s my No. 1 priority now that I’m going on 65,” one woman says) somehow omits the salient fact that current beneficiaries and those near retirement would be unaffected.

The Romney-Ryan approach would transform Medicare by giving seniors a voucher to shop around for coverage on insurance exchanges. Insurers would have to take all applicants and not charge more to sicker seniors. Those with lower incomes would receive extra help to pay for premiums.

Sound familiar? Yes, like Obamacare — except Romney-Ryan has the public option that liberals were clamoring for back when. Seniors could decide to use their voucher to keep traditional fee-for-service coverage.

The addition of the traditional Medicare option was one key change Ryan made when he teamed up last year with Democratic Sen. Ron Wyden (Ore.).

The second was to let vouchers grow more quickly over time. Under Ryan’s original plan, the benefit would have increased only with the rate of inflation. Health-care costs rise far faster, which is, of course, precisely the problem.

So the value of the voucher would be quickly eroded, and seniors would have to dig into their pockets to afford coverage. The Congressional Budget Office projected that a typical 65-year-old would have to pay an additional $6,500 a year.

The Wyden-Ryan proposal would allow the voucher to grow at a more generous rate — inflation plus economic growth plus 1 percent. (Romney dodges the issue.) That is the target set under Obamacare for the new cost-control oversight board.

There are legitimate and important questions about this approach, beginning with the fundamental theory: that competition among insurance companies and more price-consciousness among beneficiaries will reduce costs. Will this work?

Will traditional Medicare remain a viable option, or will private insurers lure the healthiest seniors, driving sicker beneficiaries into Medicare and producing a death spiral of rising premiums?

Fair questions, but here’s another fair one, to Democrats and the president: What’s your plan? They haven’t offered one.

The current debate, with overblown, dueling accusations, helps explain why: Details on a topic this emotional can be hazardous to your political health.

So as much as I welcome a vapid campaign’s nascent shift to substance, I worry about the aftereffects. The Ryan pick could move an essential discussion forward. But I worry, as I think responsible politicians in both parties should, that it could serve instead to reaffirm the danger of the third rail.

ruthmarcus@washpost.com

 
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