The new Wyden-Ryan Medicare framework is the most fascinating policy and political maneuver of the year. Let me try to explain why.
First, until this moment, Rep. Paul Ryan’s original Medicare plan had been slated to be the centerpiece of the Democrats’ 2012 campaign, featuring all the predictable cries that the GOP is tossing Grandma off a cliff. By making sufficient adjustments to his plan to be able to draw the cooperation of a Democrat like Sen. Ron Wyden (Ore.), Ryan has plausibly inoculated his party against a full-frontal Mediscare campaign. Or at least he gives Republicans a credible rebuttal to neutralize it. After all, Wyden got into politics as the founder of the Oregon chapter of the Gray Panthers. The man’s been a champion for seniors for 35 years. If he’s standing with Ryan on Medicare, how evil can Ryan (and the GOP) be?
A senior fellow at the Center for American Progress and the host of the new podcast “This...Is Interesting,” Miller writes a weekly column for The Post.
For Wyden’s part, he’s bravely chosen to incur the wrath of his fellow Democrats for having blunted their demagogic spear. But he’s right to, because, as I’ve argued previously, it’s quite possible that done right, premium support can be part of the answer to Medicare’s long-term woes. Wyden has always been one of the few senators focused on big, creative, bipartisan solutions; Wyden-Bennett, for instance, which would have moved us sanely beyond our archaic employer-based health system, was always the best of the health-reform plans offered (and one that cost poor Robert Bennett his job in the Senate).
In this new plan, Wyden gets Ryan to sign onto a key component of that earlier reform. Though it has nothing to do with Medicare, Wyden-Ryan would allow firms with fewer than 100 employees the option of giving their workers (on a tax-advantaged basis) the cash the firms would have spent on their health coverage to buy, voucher-style, other policies. Since most small firms offer just one health plan, this is a huge victory for choice. It means that as many as a third of American workers could use the new health-care exchanges — a fantastic expansion of access to the exchanges that was perversely killed by both big business and big labor in the Affordable Care Act endgame.
But there’s more. With this new plan, Ryan has signed onto the idea of subsidizing people to buy coverage from well-regulated health exchanges that must take all comers and charge them similar premiums regardless of health status (provisions that did not exist in Ryan’s previous premium-support plan). If that framework sounds familiar, it should — it basically describes the dreaded Obamacare! And here’s the kicker: Wyden-Ryan has a public option to boot, because fee-for-service Medicare would remain an option for seniors. If you’re with me, Ryan is now on record for the Affordable Care Act model, more generously funded than was his previous plan, with a public option. But just for seniors. Oh, and for workers at small firms representing a third of America’s total employment. Paul Ryan is so close to universal coverage he can almost taste it!